175例耐多药肺结核患者治疗转归情况分析

目的分析江苏省全球基金项目地市（徐州、南通、镇江）耐多药肺结核患者治疗转归情况。方法从2009年1月1日至2010年12月31日，镇江、徐州、南通三市共纳入项目治疗的MDRTB患者为175例。纳入治疗的175例MDR-TB患者中，男133例，女42例，年龄范围19-88岁，平均年龄（49．74±15．24）岁；对纳入治疗的175例患者采用标准化治疗方案或者个体化治疗方案，治疗24个月（强化期6个月，巩固期18个月，两种治疗方案均是如此）。175例患者中，87例采用标准化治疗方案治疗，88例采用个体化治疗方案。治疗过程中（前6个月每月1次，后18个月每2个月1次）对患者进行痰涂片、痰菌培养、肝功能、血尿常规、胸片、体质量等项目的检查和监测。治疗全程实施IX）TS管理。分类资料用“率”描述，采用Excel表建立数据库，SPSS13．0软件进行统计学分析。组问比较采用卡方检验。结果纳入治疗的175例MDR-TB患者中治愈84例，完成治疗11例，治疗成功率为54．29％（95／175）。失败53例，失败率为30．29％；其中不良反应停药18例，治疗失败35例（含9例转为XDR-TB治疗）。丢失11例，丢失率为6．29％；死亡14例，另有2例患者转出治疗而治疗转归未知。所有的MDR-TB患者中初治患者治疗成功率为63．64％（7／11），复治患者治疗成功率为62．65％（52／83），其他复治患者（返回、初治失败、初治3个月末阳性、复治失败患者）治疗成功率为44．44％（36／81），三者间差异有统计学意义（X2=11．03，P=0．004）。患者采用标准化方案治疗的成功率为51．72％（45／87），采用个体化方案治疗的成功率为56．82％（50／88），两者差异无统计学意义（X2=0．46，P〉0．05）。对治疗6个月末不同培养结果患者的治疗成功率进行统计学分析，6个月末痰检阴性患者治疗成功率高达73．73％（87／118），与6个月末痰检阳性18．18Voo（6／33）及未查痰的患者治疗成功率8．33％（2／24）做比较，差异有统计学意义（X2=55．73，P〈0．001）。结论全球基金耐多药项目的成功实施、耐多药结核病患者治疗转归结果较好，为江苏省耐多药控制工作的进一步开展提供了一个可参考的经验。

Analysis on the treatment outcome of 175 muitidru-resistant pulmonary tuberculosis cases

Objective To analysis the treatment outcome of multidrug-resistant tuberculosis （MDR-TB） cases in three cities （Xuzhou city, Nantong city and Zhenjiang city） of Jiangsu province. Methods one hundred and seventy-five muhidrug-resistant tuberculosis （MDR-TB） cases were enrolled in this study from 1 January 2009 to 31 December 2010 in these three cities. Among 175 MDR-TB cases 133 were male and 42 were female. These patients aged from 19 years to 88 years with mean age （49.74±15.24） years. Treatment period lasted for 24 months （injection period of 6 months, intensive period of 18 months）. Eighty seven MDRTB patients were treated with standardized treatment regimen and 88 MDR-TB patients were treated with individualized regimen. During the treatment period, examinations of sputum smear, sputum culture, liver function, blood and urine routine tests, chest radiography and body mass were carried out for patient surveillance （monthly in injection period, once every two months in intensive period）. DOTS managements were carried out throughout the treatment. Rate was used todescribe categorical va-riables, Excel worksheet was used to establish database. SPSS 13.0 software was applied for statistical analysis and chi-square test was used for comparison between groups. Results Among 175 MDR TB cases, 84 cases were cured, 11 completed the full treatment course with the treatment success rate 54.29% （95/175）. 53 （30.29%） cases were treatment failure, among whom 18 cases stopped taking drugs because of adverse reactions and 35 cases were treatment failure （including 9 cases developed XDR-TB）. 11 （6.29~） cases defaulted, 14 cases died and 2 cases transferred out. The treatment success rate was 63.64% （7/11） in new patients, and 62. 650/oo （52/83） in relapse patients and 44.44% （36/81） in other previously treated patients. The difference of treatment success rate among the three groups was statistical significance X2= 11.03, P = 0. 004）. The treatment success rates were 51.72% （45/87） in patients with standardized treatment regimen and 56.82% （50/88） in patients with individua-lized regimen, and there was no significant difference between the two groups （X2= 0.46, P〉0. 05）. There was a significance difference X2 =55.73, P〈0. 001） of treatment outcome among patients with different sputum culture results at the end of 6th month. The highest treatment success rate was 73.73% （87/118） in the patients with ne-gative sputum culture at the end of 6th month. Conclusion The treatment of MDR-TB in project areas is effective, and it can provide reference for MDR-TB control work in Jiangsu province.