纤维支气管镜介入治疗耐多药肺结核

目的探讨纤维支气管镜介入对耐多药肺结核的治疗价值。方法经纤维支气管介入并注入抗结核药物治疗耐多药肺结核32例与对照组32例进行对照研究。结果痰菌阴转率71.88%,病灶吸收率90.65%,空洞闭合率46.88%均显著高于单纯化疗组59.37%、75%、28.12%。结论纤维支气管镜介入注药治疗耐多药肺结核,疗效明显且无明显毒副反应及并发症。     

耐多药空洞肺结核的介入治疗

目的 探讨耐多药空洞肺结核介入治疗的意义。方法 采用36例临床培养的耐药菌株作耐药结核菌抑制试验、临床对照观察的方法。180例耐多药空洞肺结核住院患者随机分成两组，均用3DLOZA／18DLOZ化疗方案治疗，治疗组86例配合抗结核药物凝胶介入治疗并完成疗程。结果 提高抗结核药物浓度，可有效控制耐药结核菌生长，而所需浓度远远低于药物凝胶的含药浓度。临床观察治疗组比对照组痰菌阴转率高(88．4％)，痰菌阴转速度也快，空洞闭合率高(43．0％)，空洞闭合速度快，疗效较好。单发空洞、干酪空洞的疗效比多发空洞、纤维空洞的疗效较好。未发现与介入药物凝胶有关的不良反应。结论 经纤支镜引导灌注抗结核药物凝胶，是治疗耐多药空洞肺结核的有效方法，其有净化空洞，促使痰菌转阴，空洞闭合的作用。并且有安全无创，无明显不良反应，并发症少的优点，值得临床推广使用。     

经纤维支气管镜导管介入治疗耐多药肺结核

目的 耐多药肺结核多为病程长、病情重、多次复治、久治不愈的空洞型肺结核，由于严重的干酪样坏死、广泛的纤维增生、多发的纤维厚壁空洞，药物不易渗入病灶，更难透过空洞壁，全身用药难以奏效。为提高耐多药肺结核的治愈率，治疗了导管介入灌注治疗技术的研究。方法 在全身抗结核化疗的强化期2个月内，进行导管介入治疗，每周一次，在纤维支气管镜（简称纤支镜）直视下，经纤支镜活检孔插入导丝导管，在导丝引导下，导管插入段支气管开口5－8cm以远的空洞病灶内，再从导管灌注高浓度的抗结核新药氧氟沙星等。共治疗耐多药肺结核206例，其中包括并发呼吸衰竭或持续高热的重症肺结核70例，同时设对照组进行常规治疗。结果 导管介入治疗组的痰菌阴转率90％，病灶显效率91％，空洞闭合率31％，显著高于对照组的59％、57％及12％，治愈率显著高于国内外常规治疗的治愈率（50％－70％）。意义 该项研究提出了在纤支镜直视下，导丝引导、导管插入空洞病灶的介入治疗技术，既使药物灌注准确到位，又避免了药液的反流和溢漏，提高了病灶局部的抗结核药物浓度。导管介入同时疏通了气道，促进了引流，有利于结核性炎症的好转和空洞的闭合。为耐多药及难治性肺结核提供了一项定位准、起效快、疗效好的介入治疗新技术，经多家省级肺科医院推广应用，治愈率达93％。     

抗痨凝胶介入治疗耐多药肺结核空洞的临床研究

目的探讨抗痨凝胶空洞介入治疗耐多药肺结核的临床疗效。方法利用介入放射学技术，以纤维支气管镜为介导，经气道-空洞引流支气管，将抗痨凝胶定期注入空洞，以放射学等指标观察疗效。结果治疗组比对照组空洞闭合率、痰菌阴转率均增高。未发现与抗痨凝胶有关的毒副作用。结论抗痨凝胶空洞介入是治疗耐多药肺结核的有效方法，未见明显毒副作用。     

纤维支气管镜介入治疗耐多药空洞型肺结核

目的探讨纤维支气管镜（纤支镜）介入治疗耐多药空洞型肺结核的疗效。方法125例耐多药空洞型肺结核患者被随机分成2组,治疗组经纤支镜空洞内灌注含抗结核药物凝胶配合全身化疗,对照组仅采用全身化疗。结果治疗组在痰结核菌阴转率、空洞闭合率和支气管黏膜恢复方面与对照组比较,差异有统计学意义（P〈0．05）。结论经纤支镜给药配合全身化疗治疗耐多药空洞型肺结核,疗效显著,优于单纯全身化疗。     

耐多药空洞肺结核的介入治疗

目的　探讨耐多药空洞肺结核介入治疗的意义。方法 采用 36例临床培养的耐药菌株作耐药结核菌抑制试验、临床对照观察的方法。 1 80例耐多药空洞肺结核住院患者随机分成两组,均用 3DLOZA/1 8DLOZ化疗方案治疗,治疗组 86例配合抗结核药物凝胶介入治疗并完成疗程。结果 提高抗结核药物浓度,可有效控制耐药结核菌生长,而所需浓度远远低于药物凝胶的含药浓度。临床观察治疗组比对照组痰菌阴转率高 (88.4%),痰菌阴转速度也快,空洞闭合率高 (43.0%),空洞闭合速度快,疗效较好。单发空洞、干酪空洞的疗效比多发空洞、纤维空洞的疗效较好。未发现与介入药物凝胶有关的不良反应。结论 经纤支镜引导灌注抗结核药物凝胶,是治疗耐多药空洞肺结核的有效方法,其有净化空洞,促使痰菌转阴,空洞闭合的作用。并且有安全无创,无明显不良反应,并发症少的优点,值得临床推广使用。     

经纤维支气管镜导管介入治疗耐多药肺结核

目的 探讨纤维支气管导管介入对耐多药肺结核的治疗价值。方法 经纤维支气管镜导和介入空洞病灶内注入氧氟沙星及丁胺卡那霉素加化疗治疗耐多药肺结核４８例，与单纯化疗４０例进行对照研究。结果 经纤维支气管镜导管介入治疗组疗程结束时痰菌阴转率９２％，病灶显效率９６％，空洞闭合率２７％，均显著高于单纯化疗组的６３％、５８％及１０％（Ｐ〈０．０１－０．０５）。结论 经纤维支气管镜导管介入空洞病灶内主药加化疗治疗     

经纤维支气管镜药物灌注治疗耐多药空洞型肺结核疗效分析

目的探讨纤维支气管镜导管介入对耐多药肺结核的治疗价值。方法经纤维支气管镜导管介入空洞并注入抗痨药物治疗空洞性肺结核102例,与单纯化疗组106例进行对照研究。结果痰菌阴转率89％,病灶吸收率92％,空洞闭合率50％,均显著高于单纯化疗组的54％、69％、23％（P〈0．01～0．05）。结论经纤维支气管镜介入注药治疗耐多药肺结核,疗效优于单纯化疗组且无明显毒副作用。     

经纤维支气管镜导管介入治疗耐多药肺结核的临床研究

目的探讨纤维支气管镜导管介入治疗配合全身化疗对耐多药肺结核（MDR—PTB）的治疗效果。方法将110例耐多药肺结核患者随机分为治疗组（60例）和对照组（50例）,2组均采用3DVThAE／15DVThE全身抗结核治疗,治疗组强化期每二周经纤支镜注药1次,共6次,然后比较两组的临床疗效。结果治疗6个月时,在痰菌阴转率、病灶显效率（显著吸收＋吸收）、空洞闭合率方面两组比较差异有统计学意义（P〈0．01）。结论经纤维支气管镜给药配合全身化疗治疗耐多药肺结核,疗效显著优于单纯全身化疗,其有促使痰菌阴转、空洞闭合的作用,并且安全无创、无明显不良反应、并发症少的优点,值得推广使用。     

经纤维支气管镜局部灌注给药辅助治疗耐多药肺结核60例

目的 探讨纤维支气管镜局部灌注给药辅助治疗耐多药肺结核（MDR．TB）的效果。方法将120例MDR-TB患者随机分为观察组和对照组各60例,两组均采用3DVThAE／15DVThE方案行全身抗结核治疗,在此基础上观察组强化期每2周经纤支镜注药1次,共6次。观察两组临床疗效。结果治疗3—6个月后,观察组痰菌阴转率、病灶显效率（显著吸收＋吸收）、空洞闭合率均显著高于对照组（P〈0．01、0．05）。结论经纤维支气管镜给药配合全身化疗治疗耐多药肺结核,疗效显著优于单纯全身化疗。     

Nationwide study of drug resistance among acid-fast bacilli positive pulmonary tuberculosis cases in Lebanon.

OBJECTIVE: To assess the prevalence of drug resistance among smear-positive sputum specimens from pulmonary tuberculosis (TB) cases in Lebanon. DESIGN: Between July 2002 and April 2004, 224 newly diagnosed TB cases and 21 previously treated TB cases were collected nationwide. Mycobacterium tuberculosis isolates were tested against isoniazid (INH), rifampicin (RMP), streptomycin (SM) and ethambutol (EMB) using the BACTEC-TB system. RESULTS: M. tuberculosis and non-tuberculous mycobacteria (NTM) isolates were recovered from 190 and 15 new cases, respectively, and from 16 and 1 previously treated cases, respectively. Overall drug resistance among new TB vs. previously treated TB cases was 19.5% and 75%, and for single drugs it was INH (12% vs. 63%), RMP (3% vs. 56%), SM (12% vs. 44%) and EMB (3% vs. 44%). The overall rate of multidrug resistance (MDR) was 5.8% (1% vs. 62.5%). The male:female ratio was 1.3:1; most were young adults. CONCLUSION: Relatively moderate single drug resistance and very low MDR rates were found among new TB cases, while among previously treated TB cases very high resistance and MDR resistance rates were detected. Such findings underline the need for ongoing stringent control measures to curb the spread of M. tuberculosis and its deleterious effects.     

HIV/TB双重感染与HIV阴性结核病结核分枝杆菌耐多药现状分析

目的探讨艾滋病病毒（HIV）/结核病（TB）双重感染的结核分枝杆菌耐多药现状,为HIV/TB双重感染的耐多药结核病的防治,制定合理的预防措施及个体化的治疗方案提供科学依据。方法 2004年1月至2008年12月,在南宁市第四人民医院住院的痰结核分枝杆菌培养阳性的结核病患者,按HIV抗体检测结果分为HIV抗体阳性结核病组（HIV/TB双重感染组）和HIV抗体阴性结核病组,对两组检出的结核分枝杆菌进行菌种鉴定及耐药检测（INH、RFP、EMB、SM）,并比较两组结核分枝杆菌的总耐药和多耐药发生率,初始及获得性耐药、耐多药的发生率。结果 HIV/TB双重感染组的149株结核分枝杆菌,发生耐药的61株,总耐药率40.94%,总耐多药率为18.79%;初始耐药率为40.30%,耐多药率为18.66%;获得性耐药率为46.67%,获得性耐多药率为20.0%。HIV抗体阴性结核病组的2152株结核分枝杆菌,总耐多药、初始耐多药及获得性耐多药率分别为15.94%、8.25%、32.36%。结果显示,HIV抗体阳性组初始耐多药率较HIV抗体阴性组高,两者差异有统计学意义（P〈0.01）。结论 HIV/TB双重感染的结核分枝杆菌,对药物的耐药性流行水平有上升趋势,同时多重耐药株增多。结核分枝杆菌耐药性的监测结果 ,是指导临床治疗用药的重要依据。     

Perspectives for personalized therapy for patients with multidrug‐resistant tuberculosis

According to the World Health Organization (WHO), tuberculosis is the leading cause of death attributed to a single microbial pathogen worldwide. In addition to the large number of patients affected by tuberculosis, the emergence of Mycobacterium tuberculosis drug‐resistance is complicating tuberculosis control in many high‐burden countries. During the past 5 years, the global number of patients identified with multidrug‐resistant tuberculosis (MDR‐TB), defined as bacillary resistance at least against rifampicin and isoniazid, the two most active drugs in a treatment regimen, has increased by more than 20% annually. Today we experience a historical peak in the number of patients affected by MDR‐TB. The management of MDR‐TB is characterized by delayed diagnosis, uncertainty of the extent of bacillary drug‐resistance, imprecise standardized drug regimens and dosages, very long duration of therapy and high frequency of adverse events which all translate into a poor prognosis for many of the affected patients. Major scientific and technological advances in recent years provide new perspectives through treatment regimens tailor‐made to individual needs. Where available, such personalized treatment has major implications on the treatment outcomes of patients with MDR‐TB. The challenge now is to bring these adances to those patients that need them most.     

218例涂阳肺结核吡嗪酰胺耐药情况分析

目的 了解肺结核患者对吡嗪酰胺的耐药情况,为临床结核病防治提供参考。 方法 采用WHO推荐的BACTEC MGIT-960系统法对218例涂阳肺结核进行吡嗪酰胺耐药性检测分析。 结果 218例涂阳肺结核中耐吡嗪酰胺39例,占17.9%。其中163例初治患者耐吡嗪酰胺23例,占14.1%,55例复治患者耐吡嗪酰胺16例,占29.1%; 91例耐多药(MDR)患者耐吡嗪酰胺36例,占39.6%,127例非MDR患者耐吡嗪酰胺3例,占2.4%。复治患者吡嗪酰胺耐药率明显高于初治患者(P＜0.05),MDR患者吡嗪酰胺耐药率明显高于非MDR患者(P＜0.01)。 结论 MDR肺结核耐吡嗪酰胺率较高,应重视对复治涂阳肺结核,尤其是MDR肺结核的吡嗪酰胺耐药性检测,以便采用更合理有效的方案治疗MDR肺结核。     

MDR- and XDR-TB among suspected drug-resistant TB patients in a tertiary care hospital in India

Aim: To study the anti‐tubercular drug resistance pattern among suspected cases of drug‐resistant TB. Materials and Methods: First and second line drug susceptibility data were retrospectively analysed for all suspected cases of drug‐resistant tuberculosis (TB), presenting to the Pulmonary Medicine department of tertiary care hospital in South India from 2003 to 2007. Results and Discussion: Out of 177 cases of suspected drug‐resistant TB, 103 (58.2%) cases were multi‐drug‐resistant tuberculosis (MDR‐TB). Out of 75 cases of MDR‐TB for whom second‐line drug susceptibility test was performed, 45 (60.0%) cases met the criteria of extensively drug–resistant (XDR) TB, which is very high when compared with existing worldwide data on XDR‐TB (6.6% cases of MDR‐TB). In comparison with non‐MDR‐TB cases, MDR and XDR‐TB cases had a history of significantly higher duration of anti‐TB treatment (ATT) and significantly higher exposure to multiple ATT regimens. Past exposure to second‐line anti‐TB drugs was significantly high in XDR‐TB cases than in MDR‐TB and non MDR‐TB cases. Conclusion: This study highlights the high burden of XDR‐ and MDR‐TB among TB patients coming to tertiary care hospitals in India. Please cite this paper as: James P, Gupta R, Christopher DJ, Thankagunam B and Veeraraghavan B. MDR and XDR‐TB among suspected drug resistant TB patients in a tertiary care hospital in India. Clin Respir J 2011; 5: 19–25.     

化疗加人工气腹治疗耐多药肺结核的研究

目的 观察和评价人工气腹辅助治疗耐多药肺结核（MDR－PTB）的疗效。方法 经人工气腹加药物治疗MDR－PTB 22例，与单纯药物治疗24例进行对照。结果 经人工气腹治疗组疗程结束时痰菌阴转率86．4％，病灶吸收显效率90．9％，空洞闭合率89．5％，均显高于单纯药物对照组的33．3％、37．5％及35．3％（P＜0．01），且无明显并发症及副反应。经最长3年、最短1年随访，治疗组和对照组细菌学复发率分别为5．3％和50．0％，差异有显性意义（P＜0．01）。结论 人工气腹加化疗治疗MDR－PTB，疗效显优于单纯化疗，有推广前景。     

Gen-XpertMTB/RIF和荧光PCR熔解曲线法在耐药结核病快速诊断中的意义

目的 Gen-XpertMTB/RIF和荧光PCR熔解曲线法(MeltPro)在耐药结核病快速诊断中的意义。方法 选取2019年1月至12月陕西省结核病防治院收治的TB患者850例,均行表型药敏和Gen-XpertMTB/RIF检测,对Gen-XpertMTB/RIF检测阳性样本中利福平(RFP)耐药患者行MeltPro。以药敏法为金标准,分析Gen-XpertMTB/RIF对TB患者RFP耐药的诊断价值、成本效果比(C/E)和检测时间;分析Gen-XpertMTB/RIF联合MeltPro对耐多药(MDR)和准广泛耐药(Pre-XDR)的诊断价值、C/E和检测时间。结果 Gen-XpertMTB/RIF对TB患者RFP耐药的诊断准确率为94.59%(804/850)。GenXpert MTB/RIF和药敏法对TB初治和复治患者RFP耐药的诊断一致性均较好。Gen-XpertMTB/RIF联合MeltPro诊断TB患者MDR的准确率为98.71%(839/850),且和药敏法对TB初治和复治患者MDR的诊断一致性均较好。Gen-XpertMTB/RIF诊断RFP耐药的C/E和诊断时间均...     

Secular trends in susceptibility patterns of Mycobacterium tuberculosis isolates in Kuwait, 1996-2005

OBJECTIVE: To determine the incidence and trends of drug resistance among all Mycobacterium tuberculosis strains isolated during a 10-year period in Kuwait. DESIGN: Drug susceptibility data for M. tuberculosis isolates recovered from all pulmonary and extra-pulmonary tuberculosis (TB) patients in Kuwait from January 1996 to December 2005 were collected and analysed. Patients were divided into Kuwaiti nationals and expatriates. Prior treatment status was not recorded. RESULTS: From 1996 to 2005, 5399 non-repetitive culture-positive TB cases (56% from pulmonary sites and 44% from extra-pulmonary sites) among 917 (17%) Kuwaiti nationals and 4482 (83%) expatriates were identified throughout Kuwait. Overall resistance rates were as follows: any drug 12.5%, isoniazid (INH) 9.1%; rifampicin (RMP) 1.1%, ethambutol (EMB) 2.0%, streptomycin 4.3% and multidrug resistance (MDR) 0.9%. The resistance rates over the 10-year period remained nearly same. However, significant differences were noted in resistance rates for RMP and MDR among pulmonary vs. extra-pulmonary cases and for any drug, INH and EMB among isolates from Kuwaiti vs. expatriate patients. CONCLUSIONS: Moderate and stable single drug resistance (<10%) and low MDR rates (<1%) were found among TB cases in Kuwait. These findings highlight the importance of ongoing control measures to limit the development and spread of drug-resistant M. tuberculosis in Kuwait.