结核病耐药与用药史关系的研究

目的 研究结核病耐药与用药史的关系，提高医务人员，尤其是结核病防治工作者对耐药结核病的认识并指导临床治疗。方法 应用2001年河南省第二轮结核病耐药监测资料，病例入选、药敏试验及耐药标准按照世界卫生组织（WHO）／国际防痨与肺部疾病联合会（IUATLD）结核病耐药监测指南，采用整群抽样、比例法，选取30个监测县共1487例结核病患者，其中初治1222例，复治265例；详细询问患者用药史并填写临床资料调查表，对药敏结果和用药史进行分析。结果 初治失败患者耐药率和耐多药率最高，分别为90．0％和80．0％，其次为慢性排菌者，其耐药率和耐多药率均为73．3％；耐药率和耐多药率均随用药时间的增加呈升高趋势，且从未化疗及化疗〈1个月者耐药率及耐多药率均低于化疗2个月及以上各组。结论对初治失败及慢性菌患者实行个体化治疗是十分必要的，应落实直接面视下的短程督导化疗（DOTS）策略，加强强化期督导管理，防止耐药产生。

Relationship of drug resistance tuberculosis and chemotherapy history

Objective To improve the understanding of health providers to drug resistant tuberculosis,and to guide the treatment to tuberculosis cases.Methods The data of the second drug resistant surveillance in tuberculosis in Henan Province in 2001,and the clinical information questionnaire recording treatment history of all smear positive pulmonary tuberculosis cases enrolled,were analyzed.The survey chose 30 counties in monitor,totaling (1 487) cases of lung tuberculosis,among them,initial treatment (1 222) cases,re-treatment 265 cases.Results Any drug resistant rate and multi-drug resistant (MDR) rate in initial failure cases are (90.0%) and (80.0%),respectively,the highest among all cases.The second highest rate is that in chronic smear positive cases,and both of their any drug resistant rate and MDR rate are (73.3%).The trends of any drug resistant rate and MDR rate increase with the increasing of treatment period.Their any drug resistant rate and MDR rate of cases who have never been treated and whose treatment period was less than one month are significantly lower than those who were treated 2 months or more.Conclusion Individualized chemotherapy is necessary for initial failure cases and chronic smear positive cases.To prevent the worsening of drug resistance and MDR,directly observed treatment,short-course(DOTS) strategy should be strengthened,especially in the intensive phase of chemotherapy.