实施项目干预措施对耐多药肺结核治疗效果评价

目的为评价实施耐多药肺结核控制项目对耐多药肺结核病人治疗预后影响。方法将2007年至2009年登记的20例省财政项目支持的耐多药肺结核病人治疗资料,与项目结束后登记的34例无项目支持的耐多药肺结核病例治疗结果进行对比。结果有项目支持的20例病人完成标准化方案者占85.0%,治愈率达70.0%,失败率15.0%,死亡率15.0%;非项目组的34例病人均没有接受耐多药肺结核标准化方案进行治疗,治愈率达15.0%,失败率38.0%,丢失率44.0%,死亡率3.0%。结论在经济不发达的中西部地区,需采取必要的项目干预措施才能遏制耐多药结核病疫情。     

如皋市耐多药肺结核患者发现、治疗转归情况分析

目的了解如皋市确诊耐多药肺结核患者来源及治疗转归情况。方法收集2010年7月-2013年6月如皋市中国全球基金结核病项目(-期)基础资料、病案信息、督导汇总表、服药卡和督导表等,分析不同分类肺结核的耐多药肺结核患者检出和治疗转归情况。结果 3年间确诊耐多药肺结核患者36例,检出率为11.92%。初治涂阳肺结核耐多药检出率为3.70%,MDR-TB高危人群为18.56%,差异有统计学意义(χ2=12.59,P0.05)。纳入治疗耐多药肺结核患者34例,治愈率为39.29%,死亡率为14.71%,失败率为14.71%,治疗成功率为55.88%。结论如皋市耐多药肺结核疫情低于全国平均水平,DOTS-PLUS策略是MDR-TB防治最重要的策略。     

安徽省肺科医院2003～2004年肺结核病人耐药情况分析

目的　研究肺结核病人耐药原因 ,探讨耐药肺结核病防治对策。方法　对 5 6 6例痰菌培阳肺结核病人耐药性情况进行统计分析。结果　 5 6 6例痰菌培阳肺结核病例中 ,耐药患者 345例 ,占 6 0 .9% ;其中耐多药的有 2 5 0例 ,占总患者的 4 4 .2 % ,占耐药患者的 72 .5 %。导致病人耐多药的主要原因是不规则用药。结论　我省肺结核病人耐药情况严重。应加强病人管理 ,运用有效、合理的治疗方案治病。     

江西省全球基金肺结核项目地区耐多药可疑者 筛查情况分析

摘要:目的　分析江西省全球基金耐多药肺结核项目地区耐多药肺结核患者筛查情况,为江西省下一步在全省开展耐多药肺结核防治发现工作提供借鉴。方法　收集、分析项目地市2012年1月1日-2013年9月30日间,耐多药肺结核可疑者相关报表资料。结果　对耐多药肺结核可疑者757例开展痰培养,培养阳性627例（占90.5%）;开展药敏试验的610例可疑者中,确诊耐多药肺结核患者和广泛耐药肺结核患者分别为90例和3例,初治失败、复治失败和其他患者中确诊耐多药及广泛耐药肺结核率分别为61.57%、71.5%和66.7%,结论　以5类高危人群和反复多年治疗不愈患者作为主要筛查对象,更符合成本效益的防治原则。     

耐多药肺结核病人治疗依从性分析及干预对策

目的 了解耐多药肺结核病人治疗依从性的情况及影响因素,探讨干预对策. 方法调查湖南省结核病医院2006年10月-2008年3月收治的110例耐多药肺结核病人,了解规律治疗情况及影响因素. 结果 110例耐多药肺结核病人均为复治,其中男性78例(70.9%),女性32例(29.1%),年龄18～70岁.病人来自农村102例(92.7%),城镇8例(7.3%).依从性良好的21例(19.1%),依从性差的89例(80.9%).治疗依从性与病人的文化程度、对该病的知晓情况、病情和家庭经济状况等因素有关. 结论应重视耐多药肺结核病人的治疗管理工作,.采取综合、有效的干预对策,提高治疗依从性.     

浙江省5地市耐多药结核病防治策略效果评价

目的评估浙江省5个试点地市耐多药结核病防治策略实施效果,为今后耐多药结核病预防控制提供依据。方法对浙江省杭州、湖州、绍兴、衢州与丽水5个地市共7 140例涂阳肺结核患者进行耐多药筛查,按照统一的技术方案对耐多药肺结核患者进行治疗与管理,运用描述性统计和单因素分析方法对试点地区登记的耐多药结核患者发现、治疗等监测数据进行分析。结果试点地区在评估时间段内共确诊耐多药结核病患者537例,351例患者进行了标准耐药治疗;患者6个月末培养转阴率为71.4%,完成疗程患者治愈率为71.0%;复治失败和初治失败肺结核患者药敏检出耐多药比例分别为67.4%与52.4%,而新涂阳患者检出比例为2.5%;患者未进行耐药治疗主要原因为原方案治疗有效26.2%、迁出或失访20.6%、缺乏有效治疗方案19.8%、治疗前死亡15.1%。结论浙江省耐多药肺结核防治模式取得了一定效果,但患者纳入治疗比例较低,中断治疗比例偏高,副反应与远期疗效观察等问题需进一步研究解决。     

开封市涂阳肺结核患者耐多药情况调查

目的了解开封市涂阳肺结核患者的耐多药水平以及耐多药肺结核患者的病史特征,为制定耐多药结核病的防控策略提供参考依据。方法对开封市2011年3-9月登记的442例涂阳肺结核患者留取痰标本进行传统罗氏培养和药敏试验,并对被诊断为耐多药的19例肺结核患者进行关于病史情况的问卷调查。结果开封市涂阳肺结核患者的痰标本培养阳性率为95.5%(422/442),总耐多药率为4.5%(19/422),新涂阳和复治涂阳肺结核患者耐多药率分别为1.5%(5/331)和15.4%(14/91)。在耐多药涂阳肺结核患者中,47.4%(9/19)耐HRS,42.1%(8/19)耐HRES。在耐多药复治涂阳肺结核患者中,100.0%(14/14)的患者有≥1年的病史,78.6%(11/14)有>1个月的不规则治疗或中断治疗,50.0%(7/14)曾未完成规定疗程,50.0%(7/14)的既往治疗次数≥2次。结论虽然开封市涂阳肺结核患者的耐多药率低于全国平均水平,耐药谱较为集中,但复治涂阳肺结核患者的耐多药率仍然较高,耐多药的复治涂阳肺结核患者既往治疗依从性普遍较差,仍需要从提高基础DOTS质量方面进一步加强耐药结核病防治工作。     

南京市耐多药肺结核患者的发现及纳入治疗情况分析

目的分析南京市耐多药肺结核患者的发现和纳入治疗情况,为制定针对性的防治策略提供科学依据。方法2013年1月-2016年12月,对涂片阳性的慢性和复治失败、复治、初治2、3月末阳性患者及耐多药肺结核的密切接触者开展培养和药敏试验,分析不同人群中耐多药肺结核的检出情况。结果共筛查耐多药肺结核可疑者2 389例,培养阳性率64.54%。药敏试验1 383例,确诊耐多药肺结核患者144例,检出率10.41%。其中,复治失败检出率最高52.94%,各登记分类患者检出率差异有统计学意义((χ~2=29.24,P0.001)。男性耐多药检出率10.81%高于女性9.09%。青壮年、中年及60岁~组耐多药检出率较高,各年龄组检出率差异有统计学意义(χ~2=44.13,P0.001)。各区耐多药检出率在2.97%~20.61%之间,差异有统计学意义(χ~2=48.72,P0.001)。耐多药肺结核患者纳入治疗率79.86%。结论南京市耐多药肺结核检出率高于全国,患者产生与登记分类、性别、年龄及地区有关,在耐多药防治工作中应重点考虑。     

耐多药肺结核治疗现状

耐多药肺结核(MDR-TB)是指耐异烟肼和利福平2种以上抗结核药物的结核分支杆菌引起的结核病,具有治疗时间长、难度大、费用高、治愈率低、死亡率高等特点,而且是结核病重要传染源。世界范围内初始耐多药率中位数为1.2%,获得性耐多药率中位数7.7%,据世界卫生组织估计,每年新发现30~60万耐多药结核病人,全世界有大约100万耐多药结核病患者^〔1〕。中国是全球22个结核病高负担国家之一,结核病耐药情况突出。现对国内外耐多药肺结核治疗现状进行综述,为耐多药肺结核控制提供依据。     

云南省涂阳耐多药肺结核患者特征及影响因素分析

目的 了解云南省涂阳肺结核患者耐多药的影响因素,为耐多药肺结核的有效控制和科学管理提供决策依据。方法 利用《结核病信息管理系统》登记的涂阳耐多药肺结核可疑者病案资料进行分析。结果 2013-2015年全省累计筛查出5 271例涂阳耐多药肺结核可疑者,其中280例患者确诊为耐多药肺结核,耐多药检出率为5.31%。多因素Logistic回归分析表明:外地户籍;患者登记分类为初治失败、复治失败、复发和返回、初治2、3月末阳性以及其它涂阳患者;首次抗结核治疗在综合医院是肺结核患者发生耐多药的危险因素。结论 我省应根据影响肺结核患者耐多药的危险因素制定针对性的干预措施,提高医疗服务的可及性,落实早发现、早诊断、早治疗的防治策略。     

耐多药肺结核医疗与预防合作现状调查

目的对5个地市耐多药肺结核医防合作现状进行分析,为耐多药肺结核规范化治疗管理政策提供依据。方法采用结构式问卷调查耐多药肺结核患者求医行为。对关键知情人进行深入访谈。结果住院耐多药肺结核患者中,31.2%是来自结防机构,36.7%一直在专科医院进行治疗,32.1%来自其他医疗卫生机构。出院后9.2%转诊到结防机构,68.8%继续在专科医院门诊治疗,20.2%前往其他医疗卫生机构门诊治疗,1.8%自服药。结论开展耐多药肺结核治疗管理的地区,需建立囊括综合医院、专科医院和结防机构三位一体的耐多药肺结核可疑者推荐检测体系。对今后开展耐多药肺结核规范化治疗管理的地区,应重点加强耐多药肺结核患者出院后的转诊工作,加强对专科医院医务人员的培训,建立健全专科医院与结防机构的双向转诊系统。     

耐多药结核病流行现状与防制对策

当前,耐多药结核病是我国结核病防制工作面临的三大新挑战之一。全球结核病耐多药率呈上升趋势,我国的耐药结核病流行态势也日趋严重。引起结核病耐药的主要危险因素有不规范治疗、滥用二线药、贫困、诊断滞后及随意使用替代化疗方案等。针对引起耐多药的原因,目前国内外通过严格执行直接督导短程化疗（DOTS）策略、加强机构合作、强化二线药物管理、加强监测、规范药物使用、设立耐多药定点医院、增加政府投入完善医保补偿及加强实验室能力建设等措施加强防控耐多药结核病,取得了一定成绩。今后要继续加强对耐多药肺结核病患者治疗的管理,完善医疗保障等措施,不断加大科学研究与开发,以提升我国耐多药结核病领域科研和防治水平。     

Control and prevention of healthcare-associated tuberculosis: the role of respiratory isolation and personal respiratory protection

Although the prevalence of tuberculosis continues to decline in most developed countries, the risk of healthcare-associated tuberculosis, remains for patients or healthcare staff. Outbreaks of healthcare-associated tuberculosis are usually associated with delays in diagnosis and treatment, or the care of patients in sub-optimal facilities. The control and prevention of tuberculosis in hospitals is best achieved by three approaches, namely administrative (early investigation diagnosis, etc.), engineering (physical facilities e.g. ventilated isolation rooms) and personal respiratory protection (face sealing masks which are filtered). Recent guidelines on the prevention of tuberculosis in healthcare facilities from Europe and the USA have many common themes. In the UK, however, negative pressure isolation rooms are recommended only for patients with suspected multi-drug resistant TB and personal respiratory protection, i.e. filtered masks, are not considered necessary unless multi-drug resistant TB is suspected, or where aerosol-generating procedures are likely. In the US, the standard of care for patients with infectious tuberculosis is a negative pressure ventilated room and the use of personal respiratory protection for all healthcare workers entering the room of a patient with suspected or confirmed tuberculosis. The absence of clinical trials in this area precludes dogmatic recommendations. Nonetheless, observational studies and mathematical modelling suggest that all measures are required for effective prevention. Even when policies and facilities are optimal, there is a need to regularly review and audit these as sometimes compliance is less than optimal. The differences in recommendations may reflect the variations in epidemiology and the greater use of BCG vaccination in the UK compared with the United States. There is a strong argument for advising ventilated facilities and personal respiratory protection for the care of all patients with tuberculosis, as multi-drug tuberculosis may not always be apparent on admission, and these measures minimise transmission of all cases of TB to other patients and healthcare staff.     

Effectiveness of standard short-course chemotherapy for treating tuberculosis and the impact of drug resistance on its outcome

Background Treating tuberculosis (TB) with short-course chemotherapy is recommended by the World Health Organization tuberculosis program and is one of the five packages of directly observed treatment short-course (DOTS) strategy. Objectives To investigate the effectiveness of short-course chemotherapy for treating new and retreatment TB patients and to assess the impact of drug resistance on its outcomes. Search strategy and selection criteria Published studies from the electronic databases such as Cochrane Library, DARE, Medline, Embase, Current Contents, CINAHL, Expanded Academic Index, PsycInfo, AustHealth and unpublished studies from Dissertation Abstract International, Index to These, Cochrane Reviewer Handbook were searched between 1993-2002. Studies addressing the treatment of patients with short-course regimen and the association between drug resistance and treatment outcomes were included. Two reviewers independently assessed study quality and extracted data. Results and discussion Eleven cohort studies met the inclusion criteria. Treatment with 6-month daily regimens was effective for new TB patients with success rate (percentage of cure cases and treatment completed cases) of over 80%. Implementation of 100% directly observed treatment was necessary to achieve over 80% treatment success in new cases treated with the intermittent regimen. The intermittent regimens did not work effectively for retreatment cases since success rate was only 68.5% even in the setting using 100% directly observed treatment in Peru. Short-course regimens were effective against drug-sensitive TB with the success rate of 87%; ineffective for patients with multi-drug resistance (rate of treatment failure in new cases ranged 22.3%-35.5% and rate of treatment failure in retreatment cases ranged 16.3-37.1%). Drug resistance had a negative impact on the outcome of short-course therapy and multi-drug resistance had a huge negative impact on the effectiveness of chemotherapy for TB. Conclusion The evidence suggests that the World Health Organization-targeted cure rate of 85% in new smear-positive TB cases is not achievable using the intermittent regimen and the target rate should be adjusted. DOTS-plus multi-drug resistant TB program of the world Health Organization should be adopted. However, the evidence is limited and the level of evidence was III-2.     

2012 - 2014年云南省结核分枝杆菌耐药分析

摘要:目的 掌握云南省结核分枝杆菌耐药情况。方法 对2012-2014年云南省结核分支杆菌省级参比实验室分离的结核分枝杆菌进行异烟肼（Isoniazide INH）、利福平（Rifampicin,RFP）、链霉素（Streptomycin, SM）、乙胺丁醇（Ethambutol ,EMB）、氧氟沙星（Ofloxacin ,OFX）、卡那霉素（Kanamycin ,KM）药物敏感性检测。结果 2012 - 2014年,共计分离得到人型结核分枝菌628株;总耐药率为48.89%,耐多药率为27.07%,氧氟沙星耐药率为15.61%;耐药顺位为INH＞RFP＞SM＞OFX＞EMB＞KM;不同年龄组间总耐药率（χ2 = 9.96,P =0.041）和耐多药率（χ2 = 18.30,P = 0.001）差异具有统计学意义,30～44岁年龄组为总耐药率和耐多药率最高人群;初治和复治患者间总耐药率（χ2 = 29.48,P ＜0.001,OR =3.63）、耐多药率（χ2 = 44.17,P ＜0.001,OR=4.26）和氧氟沙星耐药率（χ2 = 26.33,P ＜0.001,OR =3.45）差异均有统计学意义。结论 云南省耐药结核病疫情严峻,初复治是耐药的危险因素。应加强随访管理力度,提升病人治愈率,同时规范氧氟沙星的使用,以达到有效控制耐药结核病疫情的目的。     

2015-2018年陕西某医院结核分枝杆菌耐药趋势分析

目的分析本院结核分枝杆菌的耐药情况及趋势,为耐药结核病的预防及治疗提供参考依据。方法对2015-2018年本院门诊、住院病人,共9050例结核分枝杆菌的一线和二线抗结核药物耐药情况进行回顾性分析。结果:四年中,本院结核菌培养的阳性率有所上升,但是总体耐药率基本不变(平均35.03%)。单耐药的耐药率有所下降(X²=13.76,P=0.003),而耐多药和一线4种耐药的耐药率有所上升(耐多药X²=19.84,P<0.001;一线4种耐药X²=18.97,P<0.001)。异烟肼、链霉素、乙胺丁醇、利福平、阿米卡星和丙硫异烟胺的耐药率都有所上升(分别为X²=12.57,P=0.006;X²=17.02,P=0.001;X²=13.68,P=0.003;X²=25.60,P<0.001;X²=12.82,P=0.005;X²=11.19,P=0.011)。结论单耐药减少,但耐多药...     

The potential role of garlic (Allium sativum) against the multi-drug resistant tuberculosis pandemic: a review

Worldly data show the increasing incidence of Mycobacterium tuberculosis (MTB) and particularly of multi-drug resistant tuberculosis (MDR-TB). In developing countries, TB control programmes are overwhelmed by the complexity of treating MDR-TB infected people, as current tools and therapies are inadequate. MDR-TB could become the main form of TB. Risk factors that make South Africa into one of the main epicentres are analysed. A review of the studies carried out about antitubercular properties of Allium sativum both in vitro and in vivo is provided. The researches about the garlic extracts effectiveness against clinical isolates of MDR-TB are of scientific importance. Allium sativum offers a hope for developing alternative drugs. The involvement of traditional healers (TH) in the TB health management could facilitate the administration of garlic extracts to the infected patients.     

Therapeutic vaccines for tuberculosis—A systematic review

For eradication of tuberculosis (TB) by 2050, the declared aim of the Stop TB Partnership, novel treatment strategies are indispensable. The emerging epidemic of multi-drug resistant (MDR) TB has fuelled the debate about TB vaccines, as increasing numbers of patients can no longer be cured by pharmacotherapy. Of several proposed modalities, TB vaccines administered in therapeutic manner represents a promising alternative, despite the controversial history due to the occurrence of exacerbated immune response. A modified concept of immunotherapy is required in order to justify further exploration. In this paper we systematically reviewed the most advanced therapeutic vaccines for TB. We address the rationale of immunotherapeutic vaccination combined with optimized pharmacotherapy in active TB. We summarize preclinical and patient data regarding the five most advanced therapeutic vaccines currently in the pipeline. Of the five products that have been tested in animal models and in humans during active or latent TB, the quality of the published clinical reports of two of these products justify further studies in patients with active TB. This systematic review fuels further clinical evaluation eventually including head-to-head comparative studies.     

耐多药肺结核患者发现和纳入治疗情况分析

摘要：目的　通过分析中国全球基金结核病项目地区耐多药肺结核患者发现和纳入治疗情况,为制定中国
耐多药肺结核防治模式提供参考资料和科学依据。方法　收集整理中国全球结核病项目月度报表,分析不
同登记分类涂阳肺结核患者中涂阳培阳率,耐多药肺结核检出率以及确诊耐多药肺结核患者的纳入比例。
结果　截至２０１２ 年１２ 月底合计筛查涂阳肺结核患者６４５２６ 例, 培养阳性５０５５６ 例, 涂阳培阳率为
７８．８％;开展药敏试验４９３９９例,确诊耐多药肺结核患者７１３９例,耐多药肺结核检出率为１４．５％;其中
复治失败、初治失败、复发、初治３月末阳性和新患者中检出的耐多药肺结核患者数分别为１４４３例、６０５
例、２２８４例、１０５例和１４９６例,耐多药肺结核检出率分别为５５．８％、３７．９％、２６．０％、２４．３％和４．８％;
确诊耐多药肺结核患者纳入治疗的比例为６４．８％。结论　高危人群应该作为耐多药肺结核筛查的重点人
群,应通过加强患者健康教育、保证药物不间断供应等多方面措施提高确诊患者纳入规范化治疗的比例。
关键词：耐多药;结核／肺;培养;药物敏感试验;治疗
中图分类号：Ｒ１８３．３　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０６ ０５４６ ０４