223例复治涂阳肺结核患者治疗现状分析

目的了解北京市复治涂阳肺结核患者治疗现状及效果。方法选择2006—2007年北京市户籍复治涂阳患者,依其年龄、初治地点及就诊机构、初治管理方式、复治疗前药敏试验及合并症、并发病等,对使用2HRZE(S)/6HRE标准复治化疗方案(简称"标化方案")的疗效及非标准复治化疗方案(简称"非标化方案")使用情况进行分析。结果 223例,以中老年居多,占65.5%。治疗前54例进行药敏试验,耐药25例,耐药率46.3%(25/54),耐多药率13.0%(7/54)。使用标化复治方案170例,占76.2%,平均治愈率为75.9%。初治失败者治愈率为50%。使用非标化方案53例,占23.8%,原因为耐药、药物不良反应、伴有合并症、并发病等。结论为进一步提高复治病例的治愈率,在标化复治方案的基础上,对初治失败者复治前应作一、二线抗结核药品的药物敏感试验,并根据试验结果及个体状况。对不宜采用标化方案者可制定有效的个体化方案。

Treatment status of 223 cases of retreatment smear positive pulmonary tuberculosis

Objective To understand the treatment status and the effect of retreatment smear positive pulmonary tuberculosis in Beijing. Methods Local retreatment smear positive cases registered during 2006—2007 were selected. Analysis was made in terms of age, place for initial treatment, treatment institution, initial management mode, drug susceptibility test （DST） before retreatment and the complication, treatment outcome of the cases with standardized chemotherapy regimen and non-standard regimen. Results Results Among the total 223 cases, middle-aged patients account for 65.5%. 54 cases did DST before retreatment, 25 were drug resistant, the drug resistant rate was 46.3%（25/54）, multi-drug resistant rate was 13.0%（7/54）. 170 cases adopted standardized regimen, accounting for 76.2%, For them, average cure rate was 75.9% and the cure rate for patients failing in initial treatment was 50%. 53 cases adopted non-standard regimen, accounting for 23.8%. Reasons for non-standard regimen were explained as drug resistance, adverse drug reaction, or accompanied by complications. Conclusions In order to improve the cure rate of the retreatment cases, DST for the first and the second line drugs should be done for patients failing in initial treatment based on the standardized chemotherapy regimen. For patients who could not fit for standard regimen, individualized regimen should be developed based on the result of the DST and patient’s situation.