原发耐药对初治涂阳肺结核控制影响评价的探讨

目的　了解不同类型原发耐药病例的短程化疗效果,以此为基础,评价不同原发耐药率地区原发耐药对初治涂阳肺结核控制的影响。方法 回顾分析北京市1996-2001年登记的初治涂阳培阳并有原发耐药性检测结果经复核资料完整的肺结核334例,按药物敏感性不同分为4组,Ⅰ组:HRSE敏感组;Ⅱ组:耐H、S、E中任何1至3种药;Ⅲ组:耐R或同时耐S、E但不耐H;Ⅳ组:同时耐RH或以上药物为耐多药(MDR-TB)组。以各组的短程化疗近期失败率为基础,计算不同情况原发耐药率地区的加权失败率。结果 Ⅱ组失败率4.26%,与Ⅰ组1.04%相比无统计学差异,Ⅲ组、Ⅳ组失败率分别为11.11%、30.00%,与Ⅰ组相比均有显著性差异(P<0.05)。原发耐药使北京、浙江、河南3地区近期治疗失败率分别增加了0.83百分点、1.76百分点、5.92百分点。结论 原发耐药对治疗效果的影响,主要决定于耐R,特别是耐RH的水平;对本地区的影响主要决定于原发耐R,特别是耐RH率的高低。

A evaluation on control influence of the initial drug-resistant towards new pulmonary tuberculosis patients with smear-positive

Objective To study the therapentic effect of short-course chemotherapy on various types of initial drug-resistant pulmonary tuberculosis patients,and to evaluate the impact of the initial drug-resistant on the TB control.Methods To review 334 new pulmonary tuberculosis cases with initial drug-resistance tested 1996-2001 in Beijing.All the 334 patients could be classified into four groups,groupⅠ:sensitive pulmonary tuberculosis patients;groupⅡ:resistant to 1-3 of INH,SM,EB;groupⅢ:RFP resistant or SE resistant;groupⅣ: multidrug-resistant (MDR-TB);and based on the treatment failure rate of each group,we calculated weighted failure rate for Beijing,Zhejiang,Henan districts.Results The treatment failure rate of groupⅡ (4.26%) was identical with that of groupⅠ (1.04%),and the treatment failure rate of groupⅢ,groupⅣ were different from that of groupⅠ (11.11%,30.00% versus 1.04%) statistically. Initial drug-resistance increased the failure rate by 0.83,1.76,5.92 percent respectively in Beijing,Zhejiang,Henan districts.Conclusions The influence of the initial drug-resistance on the treatment outcome mainly depended on the RFP resistant level,particularly multidrug-resistant level;The influence of that on local district depended on the height of RFP initial resistant, particularly that of multidrug-resistant.