初治涂阳肺结核强化期住院督导的短程化疗效果分析

目的 观察初治涂阳肺结核病人强化期住院督导的短程化疗效果。方法 将168例初治菌阳肺结核患者，随机分为住院督导组和门诊全程管理组，观察疗程满1、2个月痰菌阴转率，满2个月X线病灶改变及6个月的转归队列分析。结果 住院督导组和门诊全程管理组满1、2个月痰菌阴转率分别占81．8％、88．6％和63．8％、75．0％、；X线胸片明显改善，住院督导组和门诊全程管理组病灶吸收分别占80．7％、67．7％，6个月治愈率分别为95．5％和80．0％。结论 实施强化期住院督导治疗初治涂阳肺结核病人取得显著成效，对门诊治疗不能保证规律用药者可考虑强化期住院督导治疗。     

初治涂阳肺结核病人规范管理和全程督导短程化疗实施性研究

目的　探索适合我国广大农村,特别是老少边穷地区有效的病人管理方式。方法 在河北省20个县选取初治涂阳肺结核病人,以病人所在乡为单位随机分入两组,即规范管理组和全程督导组。两组病人均应用初治涂阳短程化疗方案 (2H₃R₃Z₃E₃(S₃)/4H₃R₃)进行治疗。观察两种管理方式下病人的疗效及中断治疗情况。结果 疗程结束时,规范管理组与全程督导组病人的痰菌阴转率分别为97.1%和98.5%,断药率分别为0.2%和0.12%,均无明显差异。结论 规范管理可获得与全程督导同样的效果。     

初治涂阳肺结核不固定化疗期全程间歇短化效果观察

目的　观察不固定化疗期全程间歇短化方案治疗初治涂阳肺结核病人的近远期疗效及缩短疗程的可能性。方法 选取440例初治涂阳肺结核病人,随机分为新方案组和原方案组。新方案组病人采用不固定化疗期全程间歇短化方案(2～3)H₃R₃Z₃S₃(E₃)/(2～6)H₃R₃,原方案组病人采用6个月疗程的全程间歇短化方案2H₃R₃Z₃S₃(E₃)/4H₃R₃。结果 两组病人满疗程痰菌阴转率分别为98.6%和98.2%。随访一年复发率分别为1.5%和2.0%。以上两组结果比较无显著性差异(P>0.05)。新方案组平均疗程为4.8个月。比原方案组疗程缩短1.2个月。结论 不固定化疗期全程间歇短化方案治疗初治涂阳肺结核病人,获得与固定化疗期方案相同的近远期疗效。不固定化疗期疗法可使6个月固定化疗期方案疗程缩短,减少服药次数,节省病人医药费用、使病人易于配合。但在日常工作中使用是否有问题有待观察。     

影响初治菌阳肺结核病人强化期痰菌阴转因素研究

目的研究影响初治菌阳肺结核病人强化期痰菌阴转因素,探讨提高病人痰菌转阴率的有效方法。方法 从患者初诊痰菌菌量、病变累及范围、空洞存在情况、有否合并糖尿病、强化期服药次数、痰菌复查时间以及耐药情况等方面,统计分析其对初治菌阳肺结核病人强化期末痰菌阴转情况的影响。结果 当病人初诊痰菌菌量为3次涂阳、2次涂阳、1次涂阳和涂阴培阳组时,强化期末痰菌转阴率分别为66.7%、81.2%、92.5%和95.7%,3次涂阳组中当标本含菌量在4+、3+、2+、1+时,其痰菌转阴率分别只有51.0%、60.5%、66.2%和81.2%。单一耐药病例强化期痰菌转阴率为87.2%。耐2、3、4药病例的强化期痰菌转阴率分别为82.8%、74.3%和70.6%。耐多药病例强化期痰菌转阴率为73.3%。当病灶范围分布在16个肺野时,强化期末痰菌转阴率分别为93.6%、88.7%、77.9%、65.1%、62.4%和68.0%。无空洞病例强化期末痰菌转阴率可达87.6%,单空洞病例的痰菌转阴率也能达77.4%,而多空洞病例的痰菌转阴率则只有47.6%。单纯肺结核病患者强化期末痰菌转阴率为83.3%,而肺结核合并糖尿病患者强化期末痰菌转阴率则只是63.5%。对上述各影响因素进行多因素Logistic回归分析,结果 显示患者初诊痰菌菌量、病变累及范围、有否合并糖尿病及耐药种数等4个因素变量的组间（阴转组与非阴转组）差异有统计学意义,是影响强化期末痰菌阴转的独立因素。结论 患者细菌载荷量、病变累及范围、耐药种数及有否合并糖尿病等均为影响初治菌阳肺结核患者强化期末痰菌阴转的重要因素。而落实结核病人归口管理制度,提高病人配合治疗、查痰的依从性,正确确定强化期查痰时间也是提高初治菌阳肺结核病人强化期痰菌阴转的重要措施。     

北京市昌平区初治涂阳肺结核病人短程督导化疗的近、远期效果

目的　观察初治涂阳肺结核短程化学治疗的近期及远期疗效。方法 回顾性分析、调查昌平区1992—1994年155例经6个月短程化学治疗的疗效及1、2、10年的随访结果 。结果 治疗结束时,痰菌阴转率、肺部病变吸收好转率各为96.8%和97.0%,治疗结束后1、2、10年的随访未见复发病人。结论 全程督导下短化具有很好的近、远期效果。     

初治涂阳肺结核不固定化疗期短程化疗远期疗效观察

目的　在6个月固定化疗期全程每日给药化疗方案的基础上,观察进一步缩短化疗期的远期疗效。方法 采用2HRZS(E)/XH₃R₃化疗方案治疗初治涂阳肺结核,经涂片检查痰菌阴转后连续3个月阴性为治疗停药标准,并注意抓好研究过程中的环节质量控制。结果 符合选例标准95例,92例完成规则治疗,累计痰菌阴转率为98.9%,91例治愈,平均化疗期为5.1个月,2年随访率为91.2%,细菌学复发率为2.3%。结论 本研究与国内6个月标准短化相比,其复发率相近。说明本方案治愈率高,可缩短治疗期。     

母牛分枝杆菌菌苗辅助治疗初治菌阳肺结核的临床分析

目的　观察和评价母牛分枝杆菌菌苗 (微卡菌苗)在初治菌阳肺结核治疗中的作用。方法 采用随机配对分组法,分微卡菌苗治疗组 (A组,84例 )和对照组 (B组,84例 )。 2组化疗方案均为2HRZE 4HR,A组加用微卡菌苗治疗 2月,B组不用微卡菌苗。结果 A组第 1月涂片阴转率36.9%,培养阴转率 47.6%;第 2月涂片阴转率 79.8%,培养阴转率 85.7%。B组第 1月涂片阴转率19.0%,培养阴转率 17.9%;第 2月涂片阴转率 53.8%,培养阴转率 67.9%。前 2月痰菌阴转率A组显著高于B组 (P＜0.01 )。疗程满 6个月后A组涂片阴转率 98.8%,培养阴转率 97.6%;B组涂片阴转率 96.4%,培养阴转率 97.6%。A组和B组治疗 6个月痰菌阴转率无显著性差异 (P＞0.05)。病灶吸收好转及空洞缩小关闭速度,A组优于B组。A组的细胞免疫功能显著改善。随访A组和B组的细菌学复发率分别为 1.3%和 2.6% (P＞0.05)。结论 微卡菌苗能改善初治菌阳肺结核患者的细胞免疫功能,加快痰菌阴转、病灶吸收及空洞缩小关闭的速度,不良反应少且轻微。微卡菌苗可用作初治菌阳肺结核的免疫治疗。     

家庭督导与全程督导化疗对初治涂阳肺结核患者疗效对比

目的 比较家庭督导法与全程督导法对涂阳肺结核患者的治疗效果.方法 于2003-04/2007-12,将小金县疾病预防控制中心所有登记治疗的初治涂阳肺结核232例患者,随机分成两组,全程督导法组100例,家庭程督导法组132例,观察2个月后痰转阴率,满疗程后2个月痰阴转率,即治愈率.结果 两个月后,家庭督导法治疗组痰转阴率96.21%,全程督导法治疗组转阴率93.00%,满疗程后,家庭督导法治疗组痰转阴率94.70%,全程督导法治疗组转阴率90.00%,两组间比较P均<0.05,差异均有统计学意义.结论 家庭督导法治疗优于全程督导法,提示在少数民族地区采用家庭督导法更能有效治疗肺结核.     

短化后复发肺结核的流行病学影响因素分析

目的　探讨河南省结核病控制项目短程督导化疗后肺结核复发的流行病学情况及其影响因素。方法 追踪河南省结核病控制项目治疗管理的涂阳肺结核病人,了解细菌学复发情况。结果 随访观察的涂阳肺结核患者经河南省结核病控制项目短程督导化疗方案治愈后复发率为3.12%;治疗后2、3个月及以后痰菌阴转的患者复发率分别是2.1%、4.2%和8.8%(P＜0.01);初、复治患者复发率分别为2.4%、4.7%(P＜0.01);不同年龄别复发率差异有显著性(P＜0.01);不同职业复发率差异有显著性(P＜0.01);年龄、肺部空洞型病灶、家庭经济贫困及痰菌阴转时间是复发的危险因素,遵守医嘱规则服药是保护性因素。结论 河南省结核病控制项目病人短程督导化疗后复发率与痰菌阴转时间高度相关,治愈后1年内复发率最高,完成疗程应随访观察1年。家庭经济贫困以及老年空洞型肺结核患者是复发的高危人群,应作为重点随访对象。     

济南农村地区涂阳肺结核病人DOTS执行情况调查分析

目的　了解农村地区涂阳肺结核病人DOTS执行情况和存在的问题。方法 调查4个县结防机构的1996、1997年收入和支出,县、乡、村防痨医生和126例新发涂阳肺结核病人状况。结果 全程督导病人为19.0%、强化期督导为74.6%,95.2%病人无漏服药,发现登记治疗病人占项目估算59.6%。结论 大部分病人得到了强化期督导管理,漏服药病人少,但全程督导病人少。     

Tuberculosis annual report 2009--series 9. Treatment of TB (2)

The standard treatment for tuberculosis (TB) is the key to its control. Here, we report on the statistics of treatment status and the duration of hospitalization/treatment. The place of initial treatment was observed among newly notified TB patients (n = 24,170) in 2009. The proportion receiving treatment in hospital was highest (91.8%) in sputum smear-positive pulmonary TB patients (n = 9,675) including 2.3% hospitalized mainly due to other diseases. The proportion receiving treatment in hospital was the least (25.1%) among bacteriologically negative pulmonary TB cases, including 10.4 % hospitalized mainly due to other diseases. Among sputum smear-positive pulmonary TB cases the proportion of patients receiving treatment in hospital did not differ with age, but among bacteriologically negative pulmonary TB cases, this proportion differed markedly according to age group (e.g., 7.7% of those in their 20s, 24.4% of those in their 50s and 48.8% of those in their 80s). The duration of hospitalization for TB treatment among newly notified cases in 2008 was observed. The median hospitalization periods were 73 days, 78 days, 45 days, 36 days and 46 days, among new sputum smear-positive pulmonary TB cases, retreatment sputum smear-positive pulmonary TB cases, other bacillus-positive pulmonary TB cases, bacilli-negative pulmonary TB cases and extra-pulmonary TB cases, respectively. The duration of TB treatment among newly notified cases in 2008 was observed at the end of 2009. The median treatment duration among all forms of TB was 272 days. The longest median treatment duration was 286 days for retreatment of sputum smear-positive pulmonary TB cases and the shortest was 198 days for bacteriologically negative pulmonary TB cases.     

Smear-positive pulmonary tuberculosis diagnosed in a general hospital

In Japan, patients with smear-positive pulmonary tuberculosis (SPTB) are hospitalized in a sanatorium because of the law for the prevention of tuberculosis, and not in a general hospital. According to our experience, however, some of the patients with SPTB are hospitalized in a general hospital. In order to study if it is possible to prevent the admission of patients with SPTB to a general hospital, we retrospectively reviewed and compared the medical records of pulmonary TB patients whose sputum was smear-positive for Mycobacterium tuberculosis at our outpatient clinic (Group B; n = 61), and patients whose sputum was smear-positive after the admission to our hospital (Group A; n = 17). The Group A patients were significantly older than the Group B patients [mean age, Group A, 67 years vs Group B, 56 years; (p = 0.01)]. Compared with the Group B patients, the Group A patients more often suffered from underlying diseases [percentage of patients with underlying disease, Group A, 88.2% vs Group B, 37.7%; p < 0.001]; more often showed atypical infiltrative patterns of pulmonary tuberculosis [percentage of cases showing atypical chest roentgenograms, 70.6% vs 19.7%; p < 0.001]; and were in a more serious condition [percentage of deaths during treatment, 47.1% vs 1.7%; p < 0.001]. We conclude that hospitalization of SPTB patients in general hospitals is inevitable, because SPTB can not always be accurately diagnosed before admission, and because it is sometimes difficult to send severely ill SPTB patients to a sanatorium which is inconveniently located in the countryside. We propose to provide facilities for the treatment of SPTB at all general hospitals in Japan.     

提高结核病人和可疑者转诊到位率的研究

目的研究进一步提高结核病人及可疑者转诊到位率的方法及可行性,以提高病人发现率。方法在黑龙江省人口30万以上县中按一定比例随机选取20个县作为项目县,各项目县在常规工作基础上,采取一系列干预措施,同时选取20个县(区)作为对照,观察肺结核病人和可疑者的转诊与到位情况。结果项目期间20个项目县综合医院报告转诊肺结核病人及可疑者总体到位率达到82.5%,对照县总体到位率为58.8%(χ²=1016.5104,P<0.01)。项目县共发现活动性、涂阳和新涂阳肺结核病人比上年同期分别增加了10.6%、11.1%和12.7%;而对照县与上年同期相比,活动性病例增加了11.2%,涂阳和新涂阳病例减少了1.9%和1.3%。结论在病人发现基线较低的地区通过采取加强转诊和追踪系统的干预措施可以提高病人发现率。     

'Lost' smear-positive pulmonary tuberculosis cases: where are they and why did we lose them?

SETTING: Ntcheu District, rural Malawi. OBJECTIVES: 1) To locate smear-positive pulmonary tuberculosis patients who were identified during the first 6 months of 2000 but did not start treatment ('lost cases'); 2) to describe these patients' pathways to diagnosis, health status and socio-demographic characteristics; and 3) to explore why these patients did not start treatment. METHODS: Lost cases were traced from programme registers and interviewed using the qualitative research critical incidents narrative (CIN) interviews technique. Results were triangulated with responses from health care workers through focus group discussions. RESULTS: The laboratory registered 157 new smear-positive patients. Twenty three (15%) of these were 'lost' (did not appear in the treatment register). CIN interviews were conducted with five lost patients and 14 carers of lost patients who had died. Long pathways to diagnosis were the norm. Health system structural barriers were the main factors behind these pathways, including requirement for hospital attendance, delays in symptom recognition and receipt of sputum results, and the misconception that negative smears excluded tuberculosis. CONCLUSION: Some smear-positive cases experience very long pathways to diagnosis and are lost from this free public health system. The diagnostic process needs to become more responsive to patients' needs.     

利福喷汀替代利福平治疗129例老年初治涂阳肺结核的临床观察

目的观察利福喷汀对老年肺结核的有效性及安全性。方法选取老年初治涂阳肺结核患者129例,分为治疗组（2HL₂ZE/4HL₂）、对照组（2HRZE/4HR）,观察痰菌阴转率、X线好转率、1年复发率及药物不良反应。结果治疗组3个月、疗程结束痰菌阴转率分别为87.1%、98.4%,对照组分别为85.2%、96.3%,2组疗效比较差异无统计学意义（χ²₁=0.09,χ²₂=0.02,P＞0.05）;X线有效率分别为了90.3%、87.0%、（P＞0.05）;空洞闭合率分别为36.7%、32.6%（P＞0.05）;1年随访痰菌复发率分别为6.4%、7.4%（P＞0.05）。在不良反应方面,治疗组和对照组胃肠道反应分别为19.4%、38.9%,两组差异有统计学意义（χ²=5.41 P＜0.05）,肝功能损害分别为4.8%、24.1%,两组差异有统计学意义（χ²=7.44 P＜0.01）。结论利福喷汀替代利福平治疗老年初治涂阳肺结核取得满意疗效,不良反应少,值得临床应用。     

Microscopic examination and treatment outcomes of new pulmonary tuberculosis cases in Istanbul dispensaries between 1998 and 2000.

SETTING: Twenty-four public tuberculosis dispensaries in Istanbul. OBJECTIVE: To investigate microscopic examination of new pulmonary tuberculosis (TB) cases and treatment outcomes of smear-positive cases. DESIGN: A retrospective analysis of 12572 new pulmonary tuberculosis cases between 1998 and 2000. METHODS: Microscopic examination of sputum smears of all patients and treatment outcomes of smear-positive cases were evaluated. RESULTS: Of 12572 new TB cases registered between 1998 and 2000, 78.1% (n = 9822) were pulmonary and 21.9% (n = 2750) were extra-pulmonary TB cases. Of 9822 new pulmonary TB cases, 5438 (55.4%) were sputum smear-positive and 2154 (21.9%) had no sputum examination. In smear-positive pulmonary cases, treatment outcomes were classified as follows: 2521 (46.4%) cured, 1926 (35.4%) treatment completed, 128 (2.4%) treatment failure, 514 (9.4%) default, 260 (4.8%) transfer out and 72 (1.3%) died. Treatment success was 81.8% (n = 4447). Between 1998 and 2000, the smear-positive case rate improved from 47.5% to 61.5% and the cure rate improved from 41.8% to 51.1%. CONCLUSION: The microscopic diagnosis and cure rates are low in Istanbul dispensaries. The laboratories should be re-organised and directly observed treatment should be performed.     

郴州市实施结核病防治规划中期效果评价

目的了解实施《规划》中期目标效果，总结经验为如期实现《规划》目标提供依据。方法统一制定评估标准和方法，逐级培训，各结防机构负责表格填写、资料收集和审核。结果涂阳肺结核登记率由2001年的35．83／10万增加至2005年的52．31／10万，贫困县老年人新涂阳登记率高达73．88／万；治愈率初治91．5％，复治83．4％；投入结防经费比规划前增长2．7倍。结论形成了规范化、科学化归口管理体系，建立起以DOTS为主的结核病控制工作模式，达到高发现率、高治愈率效果。     

郴州市实施结核病防治规划中期效果评价

目的了解实施《规划》中期目标效果,总结经验为如期实现《规划》目标提供依据。方法统一制定评估标准和方法,逐级培训,各结防机构负责表格填写、资料收集和审核。结果涂阳肺结核登记率由2001年的35.83/10万增加至2005年的52.31/10万,贫困县老年人新涂阳登记率高达73.88/万;治愈率初治91.5%,复治83.4%;投入结防经费比规划前增长2.7倍。结论形成了规范化、科学化归口管理体系,建立起以DOTS为主的结核病控制工作模式,达到高发现率、高治愈率效果。     

浙江省CIDA/WHO中国结核病控制项目实施效果分析

目的　评价CIDA-WHO中国结核病控制项目实施二轮的效果。方法 收集各项目县季报表及督导检查有关资料进行分析。结果 第一轮共发现涂阳肺结核病人6526例,涂阳新登记率32.15/10万,传染源发现率为69.9%,治愈率达86.9%;第二轮共发现涂阳肺结核病人8674例,涂阳新登记率34.92/10万,传染源发现率为75.9%。均达到项目各项指标要求。结论 浙江省CIDA-WHO中国结核病控制项目实施二轮成效显著,实现了高发现率和高治愈率的项目目标,为浙江省结核病控制工作可持续发展提供了成功模式。     

2002—2007年安徽省肺结核病人发现及治疗转归分析

目的评价2002—2007全省肺结核病人发现及治疗效果。方法利用各结核病项目执行单位的月报表、季报表、网络专报督导及检查资料进行分析。结果2002—2007年全省发现活动性肺结核病人分别为9158、30279、41157、54869、50878、47628例,其中新发涂阳肺结核病人分别为2743、5846、12751、28329、28840、27836例,新涂阳登记率分别为10万人口中4.3、9.2、19.9、44.2、44.8和42.8,2002—2006年新发涂阳肺结核病人治愈百分率分别为82.8、82.8、89.3、91.4 和91.7。结论全面实施DOTS策略后,病人的发现率、治愈率都有了较大的提高。