武汉市耐多药肺结核防治项目患者发现和近期治疗效果分析

目的 分析和评价武汉市耐多药肺结核防治项目患者发现及近期治疗效果，为进一步开展MDR-TB防治提供参考。 方法 收集2006年12月1日至2010年6月30日武汉市结核病防治所登记的第五轮中国全球基金结核病项目基础资料、报表数据、病案信息等，进行分析和总结。共筛查慢性患者、初治失败、复发、其他复治共4类涂阳患者998例，经菌型鉴定Mtb感染893例。结果 893例Mtb感染者中慢性患者127例、初治失败59例、复发451例、其他复治256例，共确诊MDR-TB患者 229例（25.6%，229/893），其中慢性患者、初治失败、复发及其他复治患者MDR-TB检出率分别为35.4%（45/127）、33.9%（20/59）、26.4%(119/451)和17.6%(45/256)。慢性患者与初治失败患者MDR-TB检出率差异无统计学意义（χ²=0.04，P＞0.05），但高于复发及其他复治患者（χ²=3.99，χ²=15.05；P值均＜0.05）。接受耐多药方案治疗128例（55.9%，128/229）；不良反应发生率85.2%（109/128）；治疗至6个月末痰涂片阴转率87.5%（98/112），痰培养阴转率89.3%（100/112）。43例MDR-TB患者完成疗程，治愈率60.5%（26/43）。结论 慢性患者、初治失败、复治涂阳是发现MDR-TB患者的主要目标人群；MDR-TB患者接受治疗率和治愈率不高，不良反应发生率高；控制MDR-TB疫情需要预防和治疗并重。

Analysis of the case detection and short-term treatment effect of the Wuhan MDR-TB project

Objective To analyze and evaluate the case detection and short-term treatment effect of the Wuhan MDR-TB project,and provide reference for MDR-TB control. Methods The baseline information,data reports and case medical records between December 2006 and June 2010 was collected for analysis and evaluation.A total of 998 smear positive patients dropping into four categories of registration-chronic,initial treatment failure,relapse and other relapse-were screened and 893 cases have been identified as MTB infection. Results Among the 893 cases,127 cases were chronic patients,59 cases were initial treatment failure patients,451 cases were relapse patients and 256 cases were other relapses.All of them were administered to drug susceptible test(DST),229 cases(25.6%,229/893) were confirmed as MDR-TB cases;the MDR-TB detection rate for chronic patients,initial treatment failure patients,relapse and other relapse patients were 35.4%(45/127),33.9%(20/59),26.4%(119/451) and 17.6%(45/256) respectively;In terms of MDR detection rate,there is no significant difference between chronic and initial treatment failure patients(χ2=0.04,P>0.05),however,these rate are notably higher than relapse and other relapse patients(χ2=3.99,χ2=15.05,P<0.05);among 229 cases of confirmed MDR-TB,128 cases(55.9%,128/229) had been treated with MDR-TB regimens;the adverse reaction incidence was 85.2%(109/128);sputum smear and culture conversion rates at the end of 6-months treatment was 87.5%(98/112),89.3%(100/112) respectively;43 cases of MDR-TB had completed the full course of treatment,the cure rate was 60.5%(26/43). Conclusion Chronic,initial treatment failure and relapsed smear positive patients are main source of MDR-TB patients.MDR-TB patients have a low treatment reception rate and cure rate,high incidence of adverse reaction.Prevention and treatment are equally important in MDR-TB control.