浙江、广东省耐药监测项目中耐药肺结核治疗现况研究

目的　探讨耐药监测项目中初始耐药与获得性耐药肺结核病人的耐药情况与在完成规范短程化疗方案时的治疗效果,为初始与获得性耐药肺结核病人的管理与治疗提供参考依据。方法 对浙江和广东两省纳入结核病耐药性监测项目的肺结核病患者以比例法测定耐药情况并在短程督导化疗下观察耐药肺结核病人的治疗结果。分析完成规范短程化疗方案的耐药肺结核病人225例的耐药与治疗情况。结果 初始耐药肺结核病人149例,其中耐单药87例,耐多药62例;获得性耐药肺结核病人76例,其中耐单药者38例,耐多药38例。初始耐单药肺结核病人治愈率94.3%;耐多药肺结核病人治愈率88.7%;获得性耐单药肺结核病人治愈率92.1%,耐多药肺结核病人治愈率63.2%。结论 对耐单药的肺结核病人继续应用原规范短程化疗方案,仍可获得较好的治疗效果,而耐多药肺结核病人特别是获得性耐多药肺结核病人的治疗效果较差。对耐药肺结核病人,应结合胸部X片检查以及结核菌培养等综合判断疗效。建议组织开展全国性的肺结核病耐药性的基线调查;开展耐药结核病,特别是耐多药结核病治疗的进一步研究,组织对耐多药结核病治疗的试点;加强结核病痰细菌学检查和药物敏感性试验的质量控制。

Research on treatment efficacy of the patients with drug resistance in the project for drug resistance surveillance in Guangdong and Zhejiang provinces

Objective To probe into the drug resistance situation in the initial and acquired drug resistance PTB(pulmonary tuberculosis),and therapeutic efficacy on their complement of standard short course chemotherpy.To provide the reference to supervision and treatment for them. Method The objeets of this study were TB cases who have been taken in the project for drug resistance surveillance and completed the full course of treatment in Guangdong and Zhejiang provinces.The proportion method for drug susceptibility was used in this study.The drug resistance condition and treatment effection of the 225 patients who have completed the standard short-course chemotherapy were analysed. Results Of the 149 initials drug resistance patients,87 were single drug resistance patients,and 62 were multi-drug resistance patients.Of the 76 acquired drug resistance patients,38 were single drug resistance patients,and 38 were multi-drug resistance patients.The cure rate of initials single drug resistance patients was 94.3%;The cure rate of multi-drug resistance patients was 88.7%;The cure rate of single-drug resistance and multi-drug resistance for the acquired patients were 92.1% and 63.2% respectively. Conclusion The result shows that the short course chemotherapy could achieve good results for single drug resistance patients.But it is not satisfied for multi-drug resistance patients,especially for the acquired ones.The treatment outcome should be evaluated with chest X-Ray,tubercle bacillus culture,and so on.The national PTB drug-resistance baseline survey should be organized all around the country,and the mechanism of drug-resistance TB should be paid more attentions,especially the treatment regiment of the multi-drug resistance PTB.