涂阳肺结核初复治比例变化趋势分析

目的　了解涂阳肺结核初复治病人比例变化规律及影响因素。方法 采用直线相关分析,对1993—2000年涂阳肺结核病人登记报表资料进行统计分析。结果 1993—2000年初治涂阳肺结核病人治愈率,复治涂阳肺结核病人占涂阳肺结核病人的比例呈逐年下降趋势,呈明显负相关关系,经统计学处理,两者相关系数r=-0.7156,P<0.05,有统计学意义。结论 强化落实DOTS策略,提高初治涂阳肺结核治愈率,预防和减少复治肺结核病人     

茂名市卫Ⅴ项目实施效果

目的　评论价结核病控制项目实施过程中所取得的社会和经济效益。方法 通过各种形式宣传项目的有关政策和结核病知识,加强各级医疗单位可疑肺结核病人的归口管理,按结控项目管理模式,组织实施病人发现、治疗和管理。结果 全市发现活动性肺结核病人16664例,其中新、复发涂阳12633例,其他涂阳1892例,初治涂阳治愈率较项目前42.9%提高至96.2%,复治涂阳治愈率较项目前55.5%提高至82.4%。结论 以控制传染源为重点,全面推行DOTS策略,使归口管理法制、制度化是结核病控制可持续性发展的保证。     

平谷县山区实施DOTS 10年质量和效果评价

目的　评价平谷县山区实施直接督导下短程化疗(DOTS)10年质量,比较医务人员与非医务人员实施监化的效果。方法 对完成疗程的76例新发初治涂阳肺结核病人进行回顾分析,对病人、家属、村医进行调查,对病历、中心登记卡片、胸片及痰菌检查结果进行复核。结果 76例病人中实施直接督导下短程化疗(DOTS)69例,DOTS落实率为90.8%。全医监治愈率为100%;非医监治愈率为81.8%。结论 由医务人员参与实施DOTS的质量及效果最好,非医务人员监化与自服药的结果相近,质量及效果差。     

不同全间歇短化方案治疗初治涂阳肺结核疗效的研究

目的　用2H₂R₂Z₂S₂(E₂)/4H₂R₂和2H₃R₃Z₃S₃(E₃)/4H₂R₂方案治疗初治涂阳肺结核,并与世行项目方案作对照,以探索最佳化疗方案。方法 随机抽取20个县(市)作为研究现场。将初治涂阳病人随机分为Ⅰ、Ⅱ、Ⅲ组且分别用不同的化疗方案,全程督导管理,观察痰菌阴转率和细菌学复发率。结果 3组6月末痰菌阴转率分别为95.96%、97.98%、97.37%,无统计学差异(P>0.05)。Ⅰ组副反应发生率与Ⅱ、Ⅲ组之间有统计学差异(P<0.05),但Ⅱ、Ⅲ组之间无统计学差异(P>0.05);复发率分别为4.86%、3.70%、2.76%,无统计学差异(P>0.05)。总疗程服药情况为Ⅰ、Ⅱ组病人较Ⅲ组服药次数明显减少。结论 研究方案与世行项目方案具有相似的化疗效果,Ⅰ组副反应发生率相对较低,其他2组之间无差异。研究组病人所需医药服务费用明显降低。     

天津市监狱局囚犯中肺结核病人的DOTS管理及效果分析

目的　评价监狱系统囚犯肺结核病人实施DOTS管理及治疗效果。方法 对2000年天津市监狱局囚犯中发现确诊的369例肺结核病人,实行直接面视下的短程化疗管理(DOTS),并分析其病情转归。结果 初治涂阳肺结核治愈率为93.8%,复治涂阳治愈率为69.2%;涂阳病人规律服药率为92.7%;涂阴病人规律服药率为90.1%。涂阳肺结核病人占全部确诊肺结核病人的14.9%;因释放停止治疗的肺结核病人占7.1%。结论 对监狱系统囚犯肺结核病人实施DOTS管理并取得了一定的成绩。     

1993～1999年深圳市宝安区初治涂阳肺结核病人队列分析

目的　评价深圳市宝安区1993～1999年常住、暂住初治涂阳肺结核病人直接督导化疗的转归。方法 1993～1999年门诊登记的初治涂阳包括暂住肺结核病人在内纳入结控项目同步管理。结果 共登记肺结核病人3360例,其中初治涂阳1693例。规则治疗率常住、暂住分别为98.2%和97.5%;治愈率常住、暂住分别为97.4%和96.7%。两者无显著性差异(P>0.05)。结论 政府重视、经费到位和建立健全的三级防痨网,扎扎实实地推行DOTS,包括暂住人口在内的肺结核病人能取得良好的疗效。     

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。     

广西南宁市3个县结核病防治效果分析

目的　分析南宁市3个县结核病防治效果。方法 对南宁市3个县2002-2005年结核病防治工作资料进行汇总分析。结果 南宁市3个县加强结核病控制工作,传染源发现和治疗效果逐年提高,4年来共接诊可疑肺结核症状者18513例,发现活动性肺结核病人7354例,其中涂阳病人2674例,涂阳病人登记率从2002年的11.37/10万上升到2005年的32.97/10万,初治涂阳病人治愈率从2002年的76.7%提高到2005年的89.9%。结论 南宁市3个县结核病控制工作取得明显效果,只有实施高质量的DOTS策略,才能保证高发现率、高治愈率。     

广东省东莞市暂住人口结核病控制项目治疗效果分析

目的　掌握暂住人口结核病控制项目管理和治疗的效果,方法 对在东莞市确诊并登记的暂住人口肺结核病人提供与常住人口相同的免费诊疗政策和实施DOTS管理。结果 对2001年8月—2004年6月登记的1171例在东莞市居住满6个月以上暂住人口的初治涂阳和有空洞或血行播散性涂阴肺结核病人进行管理和治疗。初治涂阳治愈率98.5%,达到常住人口治疗效果。结论 对暂住人口肺结核病人实施DOTS策略是可行和有效的。     

海南省黎族集居地初治涂阳肺结核病人队列分析

目的　评价海南省黎族集居地1992-2001年期间汉族、黎族初治涂阳肺结核病人直接督导化疗的转归。方法 对1992-2001年登记的初治涂阳肺结核病人的发现、登记、治疗管理及转归等进行评价。结果 黎族集居地共发现初治涂阳病人5037例,其中汉族1604例,黎族3433例,汉族初治涂阳病人治愈率97.1%,黎族初治涂阳病人治愈率95.9%,平均治愈率96.3%。结论 政府重视、经费到位和建立健全的三级防痨网,扎扎实实地推行DOTS,是海南省黎族自治县(市)的肺结核病疫情明显改善的基础。     

北京市通州区痰涂片阳性肺结核病人实施全面监督化学疗法的研究

目的 探讨通州区长期实施全监化疗的可行性?方法 对全区涂阳肺结核病人实施不住院全监化疗 ,建立健全三级防痨网 ,区?乡?村各级医生明确职责分工 ,区卫生局实施行政管理 ,各项工作实行质量控制监测?结果 1.979～1.997年对 1.648例涂阳病人中的 1.42.1例进行全监化疗 ,全监化疗率 86.2 % ,坚持监化率 90.4 % ,一年痰菌阴转率 95.3 % ,二年复发率 3.2 % ,人口传染源率从 1.980年的 81 /1.0万下降到1 997年的 2 3 /1.0万 ,下降 97.2 % ,使 1.3万健康人避免了结核菌感染 ,保护劳动力创造产值 659万元 ,节约医药费 2 557万元?结论 通过制定统一的化疗方案和建立三级防痨网 ,以卫生行政管理手段保证三级防痨网稳定?高效地工作 ,可在通州区长期对涂阳病人实施全监化疗 ,并取得预期效果?     

A comparison of two methods of undertaking directly observed therapy in a rural indian setting.

SETTING: Jharkhand State, rural India. OBJECTIVES: To compare the completion rates of the two tuberculosis control programmes of the Nav Jivan Hospital, Tumbagara, and to show that even in difficult areas, a DOTS programme can be successfully implemented. DESIGN: A retrospective analysis of two DOTS programmes centred on a small rural hospital based on an analysis of case outcome. METHODS: Comparative study between two ways of delivering a DOTS programme. RESULTS: At the end of the treatment period, 359 patients in the hospital unsupervised programme and 158 in the directly observed and hospital checked programme were available for analysis. Completion/cure rates were 64% in the former group and 89.2% in the latter, compared with completion/cure rates of 17% before either programme was adopted. Sputum smear positivity rates were 79.3% and 76.5%, respectively, compared with 6% before the programmes. CONCLUSIONS: A hospital supervised and directly observed treatment (DOT) programme using independent DOT observers can exceed WHO targets for cure/ completion rates even in the poorest rural setting.     

Cost-effectiveness analysis of directly observed therapy for patients with tuberculosis at low risk for treatment default.

To determine the incremental cost of directly observed therapy (DOT) for patients with tuberculosis at low risk for treatment default, we applied a model of DOT effectiveness to 1,377 low-risk patients in California during 1995. The default rate for this cohort, which consisted of those with no recent history of substance abuse, homelessness, or incarceration, was 1.7%. The model predicted that DOT and self-administered therapy (SAT) cured 93.1 and 90.8% of these patients, respectively. DOT would initially cost $1.83 million more than SAT, but avert $569,191 in treatment cost for relapse cases and their contacts, for a net incremental cost of $1.27 million ($919 per patient treated), or $40,620 per additional case cured. The cost-effectiveness of DOT was sensitive to the default rate and relapse rate after completing SAT. DOT would generate cost savings only when the default and relapse rates were more than 32.2 and 9.2%, respectively. Given the low default rate and resulting high incremental cost of DOT, provision of DOT to low-risk patients in California should be evaluated in the context of resource availability, competing program priorities, and program success in completing self-administered therapy with a low relapse rate.     

黑龙江省耐多药与非耐多药肺结核患者在DOTS策略下远期治疗效果分析

目的 分析在DOTS策略下使用一线抗结核药治疗的耐多药与非耐多药肺结核患者成功治疗后的远期治疗效果。 方法 采用回顾性队列研究方法,随访2004年黑龙江省耐药监测期间确诊并成功治疗的耐多药肺结核（MDR-TB）患者（暴露组,随访194例患者,访视到111例）及按1：1比例为存活MDR-TB患者配对的非MDR-TB患者(对照组,选择并访视患者71例,其中对所有药物均敏感41例,耐多药以外耐药30例),观察其4年来复发情况,分析存活病例中耐多药（71例）与非耐多药（敏感41例,耐多药以外耐药30例）、治疗分类（初治80例,复治62例）及治疗方案（规划方案124例,科研方案18例）对患者成功治疗后4年复发情况的影响。 结果 暴露组,4年复发率为46.85%（52/111）。在暴露组患者中死亡40例,4年复发率为67.50%(27/40);存活71例,4年复发率为35.21%（25/71）。对照组71例,复发17例,4年复发率为23.94%（17/71）。存活MDR-TB的复发风险高于对一线抗结核药完全敏感患者（χ²=4.19,P=0.041;RR=2.06,95% CI：0.98～4.34)。复治患者的复发率（40.32%,25/62）高于初治（21.25%,17/80）（χ²=6.10,P=0.014;RR=1.90,95%CI：1.13～3.19)。采用规划方案、科研方案患者的4年复发率分别为29.84%（37/124）和27.78%（5/18）,两者间差异无统计学意义（χ²=0.02,P=0.894)。结论 对MDR-TB患者采用DOTS策略治疗成功后的4年复发率高,复治患者复发风险高于初治。     

流动暂住人口实施结核病控制项目效果分析

深圳市宝安区将外来流动性大的暂住人口的结核病人纳入世界银行贷款中国结核病控制项目，与常住人口的涂阳肺结核病人同步采用全程间歇短化方案治疗，实施全程督导化疗管理（Ｄｉｒｅｃｔｌｙ ｏｂ－ｓｅｒｖｅｄ ｔｒｅａｔｍｅｎｔ， ｓｈｏｒｔ－ｃｏｕｒｓｅ ｃｈｅｍｏｔｈｅｒａｐｙ， ＤＯＴＳ）。结果显示：１９９３年５月至１９９５年１２月，３３４例初治涂阳病人治疗复盖率为１００％，完成治疗率达９７．３％，督导管理率及规则治疗率均为９７．３％，治愈率为９５．８％。取得对大数量流动暂住人口肺结核控制工作的成功。     

Study of drug resistance in previously treated tuberculosis patients in Gujarat, India.

SETTING: Department of Tuberculosis and Chest Diseases and State Tuberculosis Diagnosis and Training Centre (STDTC), a DOTS centre in Ahmedabad, Gujarat State, India. The study was carried out by retrospectively reviewing patient data between January 2000 and August 2001. OBJECTIVE: To evaluate the pattern of drug resistance among previously treated tuberculosis patients who remained symptomatic or smear-positive despite receiving anti-tuberculosis drugs under DOTS for a minimum of 5 months. DESIGN: A total of 1472 pulmonary tuberculosis patients who had taken anti-tuberculosis treatment were evaluated retrospectively with respect to their drug resistance pattern by sputum culture for acid-fast bacilli (AFB) and sensitivity testing with isoniazid, rifampicin, streptomycin and ethambutol (E). RESULT: Of the 1472 patients evaluated, 804 (54.6%) were treatment failure cases and 668 (45.4%) were relapse cases; 822 patients (373 failure and 449 relapse) were culture-positive. Of these 822 patients, 482 (58.64%, 261 failure and 221 relapse) were resistant to one or more drugs. Resistance to one drug was observed in 86 patients (10.46%), to two drugs in 149 (18.13%), to three drugs in 122 (14.84%) and to four drugs in 125 (15.21%). Single drug resistance was most commonly seen with isoniazid (62 patients, 7.5%), followed by streptomycin (12 patients, 1.4%), rifampicin (eight patients, 0.97%) and ethambutol (four patients, 0.4%). Resistance to isoniazid plus rifampicin alone was seen in 76 patients (9.2%). CONCLUSION: Drug resistance is a major problem in the treatment of pulmonary tuberculosis. Detection of drug resistance patterns and treatment with second-line anti-tuberculosis drugs in appropriate regimens are necessary in the treatment of failure and relapse cases in order to reduce the emergence of multidrug-resistant tuberculosis.     

复发肺结核的耐药状况及化疗效果

目的 了解复发肺结核的耐药状况及有关因素,评价复发肺结核的化疗效果。方法 分析北京市１９８８～１９９７年培养阳性,有药物敏感试验结果的４４８例复发肺结核病例的而药状况和既往疗史。所有新登记复发病例在全程监督下采用２ＲＨＺＳ（Ｅ）／２ＲＨＺＳ（Ｅ）／６ＲＨ方案,并进行逐年转归的队列分析。结果 ４４８例复发病例中而１种或以上抗结核药物１５３例（３４．２％）,耐Ｈ２０．９％、Ｓ１７．６％、Ｒ１１．１％     

Efficacy of alternate day Directly Observed Treatment Short-course (DOTS) in skeletal tuberculosis – A retrospective study

Objective

To assess the efficacy of alternate day (thrice a week) Directly Observed Treatment Short-course (DOTS) regimen spanning six to nine months in providing sustained cure for skeletal tuberculosis (TB) under programmatic conditions.

北京市大兴县1985～1999年新发涂阳病例化疗效果评价

目的　评价北京市大兴县15年新登记初治涂阳病例不住院监督化疗的效果。方法 对1985～1999年975例初治涂阳肺结核病例的治疗方案、监化、痰菌阴转、一年转归等资料进行总结分析。结果 1985～1989年使用12个月传统化疗方案,监化率为82%,疗程结束时痰菌阴转率为93%,队列分析治愈率为86%。1990年以后调整为HR(L)ZS(E)6个月短化方案,监化率在97%以上,阴转率在96%以上,队列分析治愈率在90%以上。结论 在地域广阔,人口居住分散,经济条件相对滞后的农村地区,把结核病控制工作纳入初级卫生保健,开展不住院监督短程化疗,严格执行DOTS策略,是当前结核病控制最有效的方法。     

Progress in global tuberculosis control 1995-1996, with emphasis on 22 high-incidence countries. Global Monitoring and Surveillance Project.

OBJECTIVE: To review global tuberculosis case notifications and treatment outcomes, and to assess progress in TB control 1995-1996, especially in the 22 countries that carry 80% of all incident cases. DESIGN: Compilation of case notifications; cohort analysis of treatment outcomes in DOTS and non-DOTS programmes. RESULTS: The 181 of 212 countries (85%) that reported data to WHO in 1997 covered 97% of the global population. They reported 3.81 million cases of tuberculosis, of which 1.29 million were smear-positive, representing case detection rates of approximately 39% and 51%, respectively. DOTS programmes diagnosed 67% of new pulmonary cases to be smear-positive (65% expected), compared with 30% in other control programmes. They evaluated a higher fraction of registered cases (94% vs 55%), achieved higher treatment success rates (78% vs 45%), and a higher fraction of patients was shown to be cured by smear conversion (72% vs 23%). Despite the apparent advantages of DOTS, only 12% of all estimated cases, and only 15% of smear-positive cases, were treated in such programmes. CONCLUSION: With the exceptions of Vietnam, Peru and Tanzania, none of the 22 highest-incidence countries achieved WHO targets for TB control. The slow progress is of greatest concern in 16 countries, including India, Indonesia, Nigeria and Pakistan.