115例结核性毁损肺的耐药分析及临床特点

目的 分析结核性毁损肺耐药情况及临床特征，为耐药肺结核的诊断与治疗提供依据。 方法 对2005年5月至2011年5月住院的结核性毁损肺患者115例的耐药分型、耐药的分布、病变部位情况、结核性毁损肺病程与耐药关系、耐药结核性毁损肺是否规律治疗情况、及肺内临床表现与耐药关系进行分析。并对结核性毁损肺耐药的60例患者，分为病程>5年、1年<病程≤5年和病程≤1年的3组，对病程与耐药情况进行进一步分析统计。应用SPSS 13.0软件进行统计分析。 结果 115例结核性毁损肺中，耐药60例，非耐药55例。结核性毁损肺耐药率为52.2%。在60例耐药的结核性毁损肺中，单耐药3例，占5.0%；多耐药15例，占25.0%；耐多药(MDR-TB)29例，占48.3%；广泛耐药(XDR-TB)13例，占21.7%。单耐药、多耐药、耐多药、广泛耐药比较，耐多药易发生毁损肺，差异有统计学意义（χ²=22.933, P<0.001）。在60例耐药患者中，抗结核药物中最易发生耐药的是利福喷丁（Rft），占90.0%（54/60），其余依次为RFP（占86.7%，52/60）、INH（占71.7%，43/60）、S（占68.3%，41/60）、Lfx（占53.3%，32/60）、丙硫异烟胺(Pto)（占40.0%，24/60），其中卷曲霉素(Cm)和Ofx耐药最低［占10.0%（6/60）和13.3%（8/60）］。60例耐药患者病程与耐药关系：病程≤1年与其他比较易发生耐药，病程>5年（4例）、1年<病程≤5年（14例）和病程≤1年（42例）。3组相比较差异有统计学意义（χ²=38.800，P<0.001），耐药肺结核可能在短时间内（1年内）发生毁损肺，治疗耐药肺结核的关键是第一年。结核性毁损肺耐药患者，不规律治疗易发生耐药规律治疗17例（28.3%），不规律治疗43例（71.7%），差异有统计学意义（χ²=11.267，P<0.05）。 结论 结核性毁损肺耐药情况较为严重，耐药患者以耐多药多见，结核性毁损肺耐药的患者耐药率高与毁损肺本身是互为因果、相辅相成的。

An analysis on drug-resistance status and clinical characteristics in 115 tuberculosis cases with collapsed lung

Objective To analyze the drug-resistance status and clinical characteristics in 115 tuberculosis cases with collapsed lung and provide the evidence for diagnosis and treatment for drug-resistant tuberculosis.Methods 115 tuberculosis cases hospitalized with collapsed lung were enrolled from May 2005 to May 2011 and we analyzed the relationship between drug-resistance with types of drug-resistance,distribution,lesions status,duration,and relationship between drug-resistance with treatment of drug-resistant tuberculosis and lung lesions.And according to the duration of three types of longer than 5 years,shorter than or equal to 5 years,shorter than of equal to 1 year,60 cases with drug-resistance tuberculosis collapsed lung were analyzed the relationship between duration and drug-resistance.Results Among 115 cases with collapsed lung,60(52.2%) cases were drug-resistant,55 were not.Of the 60 cases with drug-resistant collapsed lung,3(5.0%) cases had single drug resistance,15(25.0%) cases had polydrug resistance,29(48.3%) had multidrug resistance(MDR),13(21.7%) cases had extensively drug resistance(XDR).Compared with the status of single drug-resistance,polydrug resistance,MDR and XDR,the cases with MDR were prone to develop collapsed lung(χ2=22.933,P<0.001).Of the 60 cases with drug-resistance,the rates of resistance to anti-tuberculosis drugs were Rifapentine(90.0%,54/60),Rifampin(86.7%,52/60),isoniazid(71.67%,43/60),streptomycin(68.3%,41/60),Levofloxacin(53.3%,32/60),Protionamide(40.0%,24/60),Ofloxacin(13.3%,8/60),capreomycin(10.0%,6/60),in which Rifapentine were highest and Ofloxacin and capreomycin were lower.Of the 60 cases with drug-resistance,cases with duration shorter or equal to 1 year were prone to develop drug-resistance,compared with the other two types of duration(χ2=38.800,P<0.001).Of the cases who showed drug-resistance collapsed lung,the rate of drug-resistance was higher in those whose treatment was irregular than those who received regular treatment,with 43cases(71.7%)and 17 cases(28.3%),respectively(χ2=11.267,P<0.05).The cases with multidrug resistance without regular treatment were prone to develop collapsed lung.Conclusion The situation of drug-resistance to tuberculosis collapsed lung is very serious,especially for multidrug resistance.It would be better to master the first-year which is the key time for treatment drug resistant tuberculosis to decrease the development of collapsed lung.The high rate of drug resistance of collapsed lung and itself is a reciprocal causation.