标准短程化疗方案治疗初治复治肺结核失败原因分析

目的探讨标准短程化疗方案治疗初复治肺结核失败的影响因素,特别是与耐药的关系,以便针对有相关性的因素进行控制,为结核病的治疗,尤其是耐药结核病的治疗提供依据。方法采用队列研究方法,追踪观察标准短程间歇化疗方案收治的初复治结核病患者的治疗效果,收集患者的各种信息,采用单因素和多因素方法分析,探讨导致患者治疗失败的因素。结果初治患者中,性别、职业、医疗费支出类型、是否漏服药和耐药情况与治疗失败有关,耐多药患者的失败风险是敏感患者的2.0倍;复治患者中,家庭年收入、耐药类型和最近一次治疗的结果是影响治疗失败的因素,耐药患者的失败风险是敏感患者的4.7倍。结论要降低结核病治疗失败率,控制结核病疫情,应该增加对贫困患者提供的救助,加强患者的督导管理,提高服药依从性,控制耐药的发生,开展对复治患者治疗方案的实施性研究。

Factors influencing the failure of initial and further treatment of pulmonary tuberculosis in patients treated with standard short-course chemotherapy

Objective To explore the factors influencing the failure of initial and further treatment of pulmonary tuberculosis in patients treated with standard short-course chemotherapy,and drug resistance in particular.This was done to control factors influencing of failure of treatment,and especially MDR-TB treatment.Methods A cohort study was performed to track the treatment outcomes of patients with TB.Patient information was collected,and univariate and multivariate analyses were used to analyze the relevant factors leading to failure of treatment in patients treated with standard short-course chemotherapy.Results In patients receiving initial treatment,gender,occupation,and method of payment for treatment expenses,failure to comply with medication,and drug resistance were risk factors for the failure of treatment.In patients receiving further treatment,family income,type of drug resistance,and results of the latest round of treatment were factors for the failure of treatment.Conclusion To reduce the failure rate of TB treatment and control the prevalence of tuberculosis,financial relief should be increased for poor patients,and patient supervision and management should be enhanced to improve compliance with treatment.Steps should be taken to control drug resistance,and treatment regimens should be explored for patients receiving further treatment.