104例不同程度耐多药肺结核的临床分析

目的　临床分析耐多药肺结核产生的相关因素和不同程度耐多药（MDR、XDR、TDR）肺结核病个体化治疗效果。方法 采取回顾性分析,选择具有24个月临床观察结果者104例。组间比较采用x2检验。结果 1.耐多药产生:主要集中在不规律用药、原发耐药和规律用药完成疗程后,三者共占耐多药产生总原因的近80%,分别是31.7%、27.9%和20.2%。2.MDR,XDR和TDR24个月痰菌阴转率分别为52.2%,40.9%和0;MDR和XDR之间治疗效果接近,无显著性差异（P<0.05）,而MDR和XDR分别与其TDR之间治疗后比较则分别有高显著性差异（P<0.01）和统计学意义（P<0.05）。结论 对初治肺结核彻底治愈是预防耐药产生的关键;应警惕和早期发现耐药病例,尽早采取干预,以提高MDR-PTB的治愈率。

Clinical analysis of 104 multi-drug resistance pulmonary tuberculosis of different patterns

Objective To analyze the factors of MDR-TB from clinical point of view and the out- come of individualized regimen for different patterns of drug resistance(MDR,XDR and TDR). Methods Retrospective study was adopted to analyze the risk of multi-drug resistance and clinical response for 104 MDR-TB cases,which had both laboratory DST Results and 24-month follow-up outcome.Chi-square test was used for statistic analysis between each group.Results (1)The cau- ses of MDR were mainly focused on irregular use of anti-TB drugs and primary drug resistance and resistance after regular treatment,which respectively contribute 31.7%,27.9% and 20.2% of all the MDR reasons analyzed(with the total of 79.8%).(2)The sputum conversion rate at the end of therapeutic course in the group of MDR-TB,XDR-TB and TDR-TB were 52.20%,40.9% and 0% respectively.The treatment outcome did not show statistically difference between MDR and XDR (P>0.05).However,there was significant differences between TDR and MDR(P<0.01),TDR and XDR for MDR(P<0.05).Conclusions Guideline should be developed to completely cure the new PTB cases and to prevent MDR,XDR and TDR gradually.Early diagnosis and timely treat- ment to MDR-TB patients is essential to increase the cure rate of MDR.