西安市111例耐多药肺结核患者的药物敏感试验结果

目的 分析西安市目前耐多药结核病（MDR-TB）患者的耐药状况,为合理选用耐多药抗结核方案提供依据。方法 收集西安市2016年1月—2016年12月经痰检分离并鉴定为MDR的结核分枝杆菌药物敏感试验资料,并对其一线及二线抗结核药物进行药敏检测,使用卡方检验对初始耐多药与获得性耐多药组间进行比较。结果 111株MDR的结核分枝杆菌对链霉素和乙胺丁醇的耐药率分别为85.6%和45.0%,二线抗结核药物耐药率由高至低分别为左氧氟沙星（42.3%）、莫西沙星（34.2%）、对氨基水杨酸钠（9.9%）、阿米卡星（8.1%）、丙硫异烟胺（7.2%）、卷曲霉素（4.5%）。链霉素、乙胺丁醇、阿米卡星、卷曲霉素、丙硫异烟胺和对氨基水杨酸钠在初始耐药和获得性耐药两组患者中的耐药率无显著性差异。左氧氟沙星和莫西沙星在获得性耐多药患者中的耐药比例均显著高于初始耐多药组（P<0.05）。结论 西安市MDR-TB临床分离株对链霉素和乙胺丁醇的耐药现象较为严重,对阿米卡星和卷曲霉素敏感性好,而对氟喹诺酮类药物耐药情况严重,在耐多药结核病治疗中应考虑到初始耐药和获得性耐药的不同,制定合理的化疗方案,并强化针对耐多药结核病的控制策略（DOTS-plus策略）,特别是要合理使用氟喹诺酮类药物。     

74例结核分枝杆菌耐药情况分析

目的了解遵义地区结核分枝杆菌耐药情况,并探讨其耐药特点,为耐药结核病的监测提供参考。方法采用比例法对我院门诊及住院的肺结核患者痰标本中分离到的74株结核分枝杆菌进行异烟肼、利福平、链霉素和乙胺丁醇4种一线抗结核药物的敏感性试验。结果 74例肺结核患者结核分枝杆菌对一线抗结核药的总耐药率为54.1%,耐多药率为12.2%。结论本地区结核分枝杆菌耐药情况严重,应进一步加强耐药结核的监测。     

安徽地区结核分枝杆菌对一线抗结核药物耐药情况分析

目的了解结核分枝杆菌分离株对一线抗结核药物的耐药情况。方法统计2007年至2011年间4 248株结核分枝杆分离株药物耐受性结果。结果 4 248株结核分枝杆菌中耐药1 919株,耐药率45.17%;耐多药结核(MDR-TB)1 044株,MDR-TB发生率24.58%。从2007年到2011年耐药率、MDR率逐年降低,但耐药株数、MDR-TB株数逐年增加。1 919株耐药株中有1 362株来源于复治患者,557株来源于初治患者。复治患者耐药率及MDR率分别32.06%、19.97%,均高于初治患者的13.10%、4.61%。结论结核分枝杆菌耐药情况在复治患者中更严重。需要加强初治患者的结核控制,以减少由于结核病反复治疗及不规范使用抗结核药物产生的耐药株。     

苏北农村结核分枝杆菌临床分离株耐药特征分析

目的分析苏北农村结核分枝杆菌临床分离株的耐药现状和特点,为结核病防制提供依据。方法应用间接比例法药敏试验测定苏北两县2001年结核病人的初始分离株对异胭肼(INH)、利福平(RIF)、乙胺丁醇(EMB)和链霉素(STR)的敏感性。结果152株临床分离株的总耐药率为32.9%,初始耐药率和获得性耐药率分别为28.6%和48.5%;耐多药率为17.1%,初始和获得性耐多药率分别为16.0%和21.2%。同时耐INH和STR是最常见的耐两药或多药类型,其次是耐INH和RIF。四种抗结核药物的耐药率依次为INH(26.3%)、STR(24.3%)、RIF(18.4%)、EMB(10.5%)。RIF耐药株中,92.9%的同时耐INH。结论当地农村结核病耐药水平较高,耐药性的发生趋向于对多种药物同时耐药,RIF耐药可作为耐多药的标志。     

初治培阳肺结核患者起始耐药情况分析

目的了解肺结核患者结核分枝杆菌起始耐药情况,制定科学的防治对策。方法采用世界卫生组织制定的结核分枝杆菌耐药监测方案进行结核分枝杆菌耐药监测。使用绝对浓度法对山东省胸科医院住院的1184例培阳肺结核患者的耐药性进行测定。结果 1184例培阳肺结核患者中,全敏感834例(70.44%),耐药350例(29.56%)。其中起始耐药157例(44.86%),复治耐药193例(55.14%)。在起始耐药病例中,单耐药结核病(MonoDR-TB)53例(33.8%),其中耐链霉素的病例最多(38例,24.2%);多耐药结核病(PDR-TB)72例(45.9%);耐多药结核病(MDR-TB)20例(12.7%);广泛耐药结核病(XDR-TB)12例(7.6%);无全耐药结核病(TDR-TB)患者。结论山东省胸科医院住院肺结核患者结核分枝杆菌起始耐药现状十分严重。实现抗结核防治方案的统一管理、全程督导化疗势在必行。     

Xpert MTB/RIF检测利福平耐药结核分枝杆菌的表型药敏结果分析

目的：分析Xpert MTB/RIF（Xpert）检测利福平耐药肺结核患者的表型药敏结果,为耐药结核病的治疗方案制定提供依据。方法：选取2015年1月至2020年12月期间在温州市中心医院感染科就诊,且痰液或肺泡灌洗液Xpert检测显示利福平耐药的结核患者,回顾分析患者结核分枝杆菌表型药敏结果。结果：570例Xpert检测利福平耐药患者获得一线抗结核药物药敏试验结果,总耐药顺位为利福平（90.18%）＞异烟肼（88.60%）＞链霉素（56.32%）＞乙胺丁醇（29.47%）;复治患者异烟肼、利福平、乙胺丁醇的耐药率（分别为94.50%、94.50%、35.78%）均高于初治患者（分别为84.94%、87.50%、25.57%）,差异有统计学意义（均P ＜0.05）;24 株菌株对一线抗结核药物均敏感,耐1种、2种、3种及4种药物分别有46株、156株、226株、118株;耐多药结核菌株476株,初治278株,复治198株,复治患者耐多药结核病比例更高（90.83% vs.78.98%,χ2=13.723,P ＜0.001）。302例Xpert检测利福平耐药患者获得二线抗结核药物药敏试验结果,总耐药顺位为氧氟沙星（35.76%）=阿米卡星（35.76%）＞卡那霉素（13.25%）=卷曲霉素（13.25%）;初治患者氧氟沙星耐药率低于复治患者（26.46% vs. 51.33%,χ2=19.044,P ＜0.05）;128株菌株对二线抗结核药物全敏感,耐1种、2种、3种及4种药物分别有111株、23株、21株、19株;泛耐药结核菌株50株,初治、复治各25株,复治患者泛耐药结核病比例更高（22.12% vs. 13.23%,χ2=4.051,P =0.044）。结论：异烟肼、氧氟沙星及阿米卡星耐药在Xpert利福平耐药肺结核患者中常见;复治患者耐药情况比初治患者更为严峻,应尽早获得一二线抗结核药物药敏结果,以指导临床用药。     

结核分枝杆菌痰培养阳性肺结核患者对一线抗结核药耐多药情况分析

目的:分析初治和复治结核分枝杆菌痰培养阳性的肺结核患者对4种一线抗结核药的耐多药(MDR)情况,了解抗结核药耐药现状和形势。方法:选取结核分枝杆菌痰培养阳性患者395例,按中国防痨协会《结核病诊断细菌学检验规程》的要求进行菌种鉴别试验。采用WHO推荐比例法对阳性分离菌株进行药物敏感性检测,计算每种一线药的耐药率及4种一线药的MDR情况。计算初、复治患者的MDR率。结果:4种一线抗结核药物耐药率顺位依次为链霉素(93/395,23.5%),异烟肼(88/395,22.3%),利福平(58/395,14.7%),乙胺丁醇(23/395,5.8%)。初治和复治组患者耐药均以耐链霉素和异烟肼为主,且耐药顺位一致,复治组患者利福平耐药率(17.4%)高于初治组(6.9%)(χ²=6.714,P=0.010)。至少同时对异烟肼和利福平耐药者33例,总MDR率为8.4%,复治患者MDR率(10.2%)高于初治患者MDR率(2.9%)(χ²=5.263,P=0.022)。初、复治组患者MDR形式均以同时耐异烟肼、利福平和链霉素为主,分别为2例(2.0%)和13例(4.4%)。结论:结核分枝菌痰培养阳性肺结核患者耐药频度顺位依次为链霉素、异烟肼、利福平和乙胺丁醇。复治组患者利福平耐药率、MDR率均高于初治组。初、复治组耐多药形式均以同时耐异烟肼、利福平和链霉素为主。     

长治地区结核分枝杆菌的耐多药性研究

目的分析长治地区结核分枝杆菌耐药性的特点,了解其耐多药菌的流行情况。方法采用分离培养,菌种鉴定。并对鉴定的结核分枝杆菌利用绝对浓度法进行耐药性测定。结果在长治地区500例结核病人的临床标本中,分离出结核分枝杆菌168株,阳性分离率为33.6%。168株结核分枝杆菌对14种抗痨药物的耐药性分别为：无耐药32株,为19.0%;耐1种药32株,为19.0%;耐2种药48株,为28.6%;耐3种药16株,为9.5%;耐4、5种药各4株,为2.4%;耐6、7、10种药各2株,为1.2%;耐8、9种药各4株,为2.4%;耐11种药18株,为10.7%。耐两种以上药104株,为59.9%;在168株中,农村分离菌株101株（60.1%）,城镇67株（39.9%）;在耐多药104菌株中,农村的为34株,为32.7%,城镇70株,为67.3%。结论长治地区耐多药性结核分枝杆菌所占比例较大,对结核病的流行产生严重的影响。农村的结核病发病率高于城镇,城镇的耐多药菌株高于农村。     

大理州87例结核杆菌耐药监测结果分析

目的分析大理州结核杆菌培养药敏结果,了解肺结核病耐药情况及相关影响因素,为进一步完善耐药结核病控制策略提供决策依据。方法由县疾控中心对涂阳肺结核患者作痰标本采样、培养及流行病学调查调,由省疾控中心统一做药敏试验。结果获完整资料87人份,有耐药标本32人份,总耐药率为36.78%。其中:初治涂阳65份,耐药18份,初始耐药率27.69%,复治涂阳22份,耐药14份,获得性耐药率63.64%。结论大理州肺结核初始耐药率位于全国13.0%～42.1%的中位水平,获得性耐药率达全国27.5%～67.5%的高位水平。切实加强肺结核耐药监测、强化耐药病例治疗对国家防制结核病规划具有重要意义。     

结核分枝杆菌耐药性分析

目的:回顾性分析结核分枝杆菌耐药状况。方法:分析分离培养出并使用噻吩-2羧基肼(TCH)和对硝基苯甲酸(PNB)进行分型确认的127株结核分枝杆菌药物敏感试验结果,包括异烟肼(H)、利福平(R)、链霉素(S)、乙胺丁醇(E)、吡嗪酰胺(Z)、力克肺疾(D)、氧氟沙星(O)、丙硫乙烟胺(TH)、卷曲霉素(C)、对氨基水杨酸钠(P)、丁胺卡那(AK)。11种药物采用绝对浓度法进行药物敏感性检测。结果:127株结核分枝杆菌中,R耐药率最高,高浓度药物耐药达74%、C耐药率最低,高浓度药物耐药率为3.9%;HR联合耐药率为67.7%,HRS联合耐药率为52%,CThZ联合耐药率为9.4%,同时对7种药物耐药的耐药率为39.4%,同时对11种药物的耐药率为11%。结论:结核分枝杆菌耐药情况已很严重,需要更严格的执行结核病预防和治疗。     

Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries

CONTEXT: No large-scale study has investigated the impact of multidrug-resistant tuberculosis (TB) on the outcome of standard short-course chemotherapy under routine countrywide TB control program conditions in the World Health Organization's (WHO) directly observed treatment short-course strategy for TB control. OBJECTIVE: To assess the results of treatment with first-line drugs for patients enrolled in the WHO and the International Union Against Tuberculosis and Lung Disease's global project on drug-resistance surveillance. DESIGN AND SETTING: Retrospective cohort study of patients with TB in the Dominican Republic, Hong Kong Special Administrative Region (People's Republic of China), Italy, Ivanovo Oblast (Russian Federation), the Republic of Korea, and Peru. PATIENTS: New and retreatment TB cases who received short-course chemotherapy with isoniazid, rifampicin, pyrazinamide, and either ethambutol or streptomycin between 1994 and 1996. MAIN OUTCOME MEASURE: Treatment response according to WHO treatment outcome categories (cured; died; completed, defaulted, or failed treatment; or transferred). RESULTS: Of the 6402 culture-positive TB cases evaluated, 5526 (86%) were new cases and 876 (14%) were retreatment cases. A total of 1148 (20.8%) new cases and 390 (44.5%) retreatment cases were drug resistant, including 184 and 169 cases of multidrug-resistant TB, respectively. Of the new cases 4585 (83%) were treated successfully, 138 (2%) died, and 151 (3%) experienced short-course chemotherapy failure. Overall, treatment failure (relative risk [RR], 15.4; 95% confidence interval [CI], 10.6-22.4; P<.001) and mortality (RR, 3.73; 95% CI, 2.13-6.53; P<.001) were higher among new multidrug-resistant TB cases than among new susceptible cases. Even in settings using 100% direct observation, cases with multidrug resistance had a significantly higher failure rate than those who were susceptible (9/94 [10%] vs 8/1410 [0.7%]; RR, 16.9; 95% CI, 6.6-42.7; P<.001). Treatment failure was also higher among patients with any rifampicin resistance (n=115) other than multidrug resistance (RR, 5.48; 95% CI, 3.04-9.87; P<.001), any isoniazid resistance (n=457) other than multidrug resistance (RR, 3. 06; 95% CI, 1.85-5.05; P<.001), and among patients with TB resistant to rifampicin only (n=76) (RR, 5.47; 95% CI, 2.68-11.2; P<.001). Of the retreatment cases, 497 (57%) were treated successfully, 51 (6%) died, and 124 (14%) failed short-course chemotherapy treatment. Failure rates among retreatment cases were higher in those with multidrug-resistant TB, with any isoniazid resistance other than multidrug resistance, and in cases with TB resistant to isoniazid only. CONCLUSIONS: These data suggest that standard short-course chemotherapy, based on first-line drugs, is an inadequate treatment for some patients with drug-resistant TB. Although the directly observed treatment short-course strategy is the basis of good TB control, the strategy should be modified in some settings to identify drug-resistant cases sooner, and to make use of second-line drugs in appropriate treatment regimens. JAMA. 2000;283:2537-2545     

西安市2015-2018年青少年结核病患者耐药特征

目的 了解西安市青少年结核病原发性耐药和获得性耐药情况,为制定青少年群体结核病防治模式及策略提供依据。方法 收集2015—2018年在西安市胸科医院及雁塔区、长安区结核门诊进行治疗的556名34岁以下耐药结核病患者资料,分析异烟肼（H）、利福平（R）、链霉素（S）、乙胺丁醇（E）4种一线抗结核药物耐药率及青少年耐药流行病学特点。结果 农民和家政服务、家务、待业人员依然是耐药结核病高发群体,学生患病比例由5.41%上升到11.06%,干部职员的患病比例由10.81%上升到12.98%。结核病耐药患者中,青少年所占比例由2016年的63.68%降为2018年的46.01%,差异具有统计学意义（P=0.000）。青少年耐药群体中原发性结核病耐药患者比例逐渐升高,由54.05%上升到68.27%,差异具有统计学意义（P=0.019）。原发性耐药和获得性耐药中耐药比例占前3位的分别为HRS、HERS和HR,原发性和获得性耐药耐HRS比例为49.86%和49.74%,耐HERS比例分别为36.01%和37.44%,耐HR比例为9.14%和7.18%。结论 西安市2015—2018年青少年结核病耐药比例持续下降,但原发性耐药比例不断上升,达到获得性耐药2倍水平。青少年耐药类别以HRS为主,占耐药类别一半比例。     

Prevalence and Risk Factors of Primary Drug-Resistant Tuberculosis in China

ObjectiveTo investigatetheprevalence of primary drug-resistant tuberculosis (TB) and associated risk factors in China.We also explored factors contributing tothe transmission of multidrug-resistant tuberculosis (MDR-TB). MethodsA total of 2794 representative,Mycobacterium tuberculosis isolates from treatment-naive patients were subjected to drug susceptibility testing, and risk factors for drug-resistant TBwere analyzed. We also analyzed MDR-TB strain sublineages, drug-resistance-conferring mutations, and risk factors associated with clustered primary MDR strains. ResultsAmong 2794Mycobacterium tuberculosis isolates from treatment-naive patients, the prevalence of any resistance to first-line drugs was 33.2%andthe prevalence of MDR-TB was 5.7%. We did not find any risk factors significantly associated with resistance to first-line drugs.The93 primary MDR-TB isolates were classified into six sublineages, of which, 75 (80.6%) isolates were the RD105-deleted Beijing lineage.The largest sublineage included 65 (69.9%) isolates with concurrent deletions of RD105, RD207, and RD181.Twenty-nine (31.2%) primary MDR strains grouped in clusters;MDR isolates in clusters were more likely to have S531LrpoBmutation. ConclusionThis study indicates that primary drug-resistantTBand MDR-TBstrains are prevalent in China,and multiplemeasures should be taken toaddress drug-resistant TB.     

Rifampin

Rifampin is a potent antituberculous drug. In the treatment of drug-resistant tuberculosis it is highly effective provided it is given in combination with other drugs to which the patient's organisms are sensitive. Rifampin and ethambutol is a particularly powerful combination and will achieve almost 100% sputum conversion. It seems likely that rifampin will replace streptomycin, and ethambutol will replace PAS in first-treatment cases. Optimum first-line treatment will thus consist of rifampin, INH and ethambutol, with the probability of almost 100% success and the possibility also that the total duration of treatment may be considerably reduced. Rifampin is well tolerated but it may give rise to liver dysfunction and thrombocytopenia in a small proportion of patients. Patients treated with rifampin must be kept under close supervision because of the risk of side effects and, more important, because irregular treatment may lead to the development of rifampin-resistant organisms.     

2011~2013年连云港市结核病耐药监测结果分析

目的 分析江苏省连云港市结核病耐药现况,为制定有针对性的结核病防制策略提供参考。 方法 对连云港市2011~2013年确诊的1976例涂阳结核病患者进行痰菌培养,对分离出的1521株结核分枝杆菌进行4种一线抗结核药物耐药检测。 结果 连云港市结核病总耐药率17.23%,其中初始耐药率12.67%,复治耐药率为40.4%。初治组和复治组均以异烟肼(INH)耐药率最高,分别为8.81%和34.8%。耐多药率为4.34%,其中初治患者耐多药率2.20%,复治患者耐多药率15.20%。不同年龄和性别的患者耐多药率差异具有统计学意义。 结论 连云港市复治结核病患者的耐药率较高,应规范结核病治疗方案,加强督导管理,预防和控制耐药结核病的发生和流行。     

非结核分枝杆菌肺病的回顾性分析

目的：分析湖南省长沙市中心医院近3年来非结核分枝杆菌(nontuberculous mycobacteria,NTM)肺病 患者的临床特征及耐药情况。方法：回顾性分析2014年2月至2017年5月于湖南省长沙市中心医院确诊的153例 NTM肺病患者临床资料,根据药敏试验浓度分为低浓度组和高浓度组,检测两组的药物敏感性及耐药状况。 结果：153例患者中男79例(51.63%),女74例(48.37%),年龄为(60.27±19.46)岁;NTM 肺病常见于支气管扩张患者, 病程较长(平均7.8年), 临床症状无特异性,极易误诊为肺结核(92.81%)。菌种以鸟/胞内分枝杆菌(56.21%)和龟/脓肿 分枝杆菌(20.92%)多见;对一线、二线抗结核药的耐药率高,多数耐 8 种药物以上,其中低浓度组38.56%的患者全部耐药,高浓度组25.49%的患者全部耐药。结论：NTM肺病极易误诊,且耐药率高,NTM的菌种鉴定和药物敏感性检测对临床的诊断和治疗有重要的指导作用。     

荧光PCR熔解曲线法对痰样本结核分枝杆菌耐药性检测价值及耐药特征分析

目的：评估荧光PCR熔解曲线法（熔解曲线法）检测肺结核患者涂阳痰样本结核分枝杆菌（MTB）对一线抗结核药物耐药性价值及耐药特征分析。方法：收集涂阳且培养阳性肺结核患者痰样本和相应MTB菌株各142例,采用熔解曲线法检测痰样本MTB对抗结核药物链霉素（SM）、异烟肼（INH）、利福平（RFP）、乙胺丁醇（EMB）耐药情况,同时采用液体药敏法对相应MTB菌株耐药性检测,对两种检测结果行方法学比较。结果：以液体药敏法为标准,熔解曲线法检测痰样本MTB对4种抗结核药物耐药性结果差异无统计学意义（P>0.05）,熔解曲线法检测SM、INH、RFP、EMB耐药性的敏感度分别为：78.57% (11/14),70.00% (14/20),100.00% (12/12),71.43% (5/7);特异度分别为：92.97%(119/128),96.72%(118/122),97.69%(127/130),100%(135/135);两者符合率分别为：91.55%(130/142),92.96%(132/142),97.89%(139/142),98.59%(140/142);Kappa值分别为：0.601,0.696,0.877,0.826。结论：与传统液体药敏检测相比,熔解曲线法检测痰样本MTB对抗结核药物SM、INH、RFP、EMB的耐药性效能一致,特异度和符合率均较高。该法对结核患者涂阳痰样本MTB耐药性检测有较好临床参考价值。     

Status of drug resistance in tuberculosis after the introduction of rifampicin in India

The current threat in tuberculosis treatment lies on the fact of emergence of strains resistant to two most antituberculous drugs, isoniazid and rifampicin. Drug resistance to TB may be classified as primary and acquired. Causes of drug resistance are inefficient administration of effective treatment, poor case handling, use of sub-standard drugs, ignorance of healthcare workers, etc. Multidrug resistant TB (MDR-TB) prevalence (median) in new case is highest (14.1%) in Estonia. Studies undertaken in different regions in India by Tuberculosis Research Centre (TRC) during 1997-2000 revealed acquired MDR-TB resistance levels of 25-100%. The key to successful prevention of the emergence of drug resistance remains adequate case finding, prompt and correct diagnosis and effective treatment of infective patients.     

Tuberculosis surveillance in immigrants to Manitoba.

Despite a decrease in the incidence of tuberculosis in Canada over the last decade, the proportion of cases in people not born in Canada has increased. To determine the prevalence of active tuberculosis at the first surveillance clinic visit and the incidence of the disease over a 2-year to 6-year follow-up period, we reviewed the records of all 523 immigrants admitted to Manitoba between 1981 and 1985 who were placed under surveillance. Of the 523, 429 (82%) were seen at least once in the clinic. Among the 429, active tuberculosis was diagnosed at the first visit in 12 (3%) and during the follow-up period in 7 (2%). The relative risk of tuberculosis was 4.5 times higher for immigrants under surveillance than for those not under surveillance. Of the 483 immigrants who were to be seen in Winnipeg 232 (48%) were noncompliant: 94 were not seen at any time, and 138 did not attend for the full follow-up period. Active disease was not reported to have developed in any of the noncompliant subjects. Noncompliers were significantly older than compliers (p less than 0.005), and variations in compliance were noted according to region of origin. Further attempts to improve compliance with surveillance without resorting to punitive measures are indicated.     

耐药肺结核的成因与治疗

目的 总结分析耐药肺结核的成因和治疗方法。方法 对1998年1月～2002年1月期间收治的资料完整的耐药肺结核病例62例进行回顾性分析。结果 62例耐药肺结核患者均为继发性肺结核，其中单纯对异烟肼耐药10例，单纯对利副平耐药3例，同时对利副平、链霉素耐药2例，同时对异烟肼、利副平耐药15例，同时对异烟肼、链霉素、乙胺丁醇耐药3例，同时对异烟肼、利副平、链霉素、乙胺丁醇耐药10例，同时对异烟肼、利副平、乙胺丁醇耐药4例，同时对异烟肼、利副平、链霉素耐药15例。62例耐药肺结核患者中未完成规定疗程自行停药22例，间断不规则用药20例，化疗方案不合理6例，因肝功异常停药10例，因药物过敏停药2例，因严重胃肠反应被迫停药2例。根据药敏试验应用力克肺疾、利福贲丁、丙硫异烟胺、吡嗪酰胺、氧氟沙星等组成治疗方案对上述耐药肺结核进行了治疗，治愈40例，治愈率为64％。结论 耐药肺结核的成因有医生、患者、药物3方面的因素。耐药肺结核的治疗需要合理的治疗方案和良好的患者依从性。