复治肺结核耐异烟肼患者和耐利福平患者治疗效果的分析

目的 分析耐异烟肼、耐利福平和敏感的复治肺结核患者的治疗结局,探讨耐异烟肼患者的预后。方法 采取回顾性调查的方法,选择2009年7月至2019年7月首都医科大学附属北京胸科医院联合国内20余家结核病防治机构共同合作纳入的资料完整并有治疗转归结果的922例复治菌阳肺结核患者,排除219例耐多药及广泛耐药肺结核患者,排除非利福平和非异烟肼耐药的100例患者,共入选复治菌阳肺结核患者603例。复治肺结核敏感患者的治疗方案采用复治标准化方案,耐异烟肼或耐利福平治疗方案采用个体化方案,对其中药物敏感的485例患者(简称“敏感组”)、耐异烟肼(包含异烟肼单耐药和多耐药)的73例患者(简称“耐异烟肼组”)和耐利福平(包含利福平单耐药和多耐药)的45例患者(简称“耐利福平组”)的治疗转归进行对比分析。结果 在治疗2个月末时,耐异烟肼组痰涂片阴转率(63.6%,42/66)和痰培养阴转率(63.6%,35/55)均分别低于耐利福平组[84.6%(33/39)和70.6%(24/34)]和敏感组[84.2%(388/461)和80.0%(343/429)],差异均有统计学意义(χ²=16.567,P<0.001;χ²=8.500,P=0.014);在治疗6个月末时,耐异烟肼组痰涂片阴转率(79.7%,47/59)和痰培养阴转率(76.5%,39/51)均分别低于耐利福平组[89.2%(33/37)和93.5%(29/31)]和敏感组[91.5%(398/435)和90.8%(367/404)],差异均有统计学意义(χ²=8.127,P=0.017;χ²=10.533,P=0.005)。耐异烟肼组治愈率(53.4%,39/73)低于耐利福平组(60.0%,27/45)和敏感组(69.5%,337/485),差异有统计学意义(χ²=8.407,P=0.015);耐异烟肼组治疗成功率(64.4%,47/73)低于耐利福平组(75.6%,34/45)和敏感组(82.1%,398/485),差异有统计学意义(χ²=12.587,P=0.002)。结论 复治肺结核患者中,耐异烟肼患者痰菌阴转率和治疗成功率均低于耐利福平患者和敏感患者;应重视每一种药品的耐药情况,特别是临床应用时间较长的药品。

Analysis of treatment outcomes of retreated pulmonary tuberculosis patients with isoniazid-resistance and rifampin-resistance

Objective To analyze the treatment outcomes of retreated pulmonary tuberculosis patients (PTB) with isoniazid resistance, rifampicin resistance, and drug sensitive PTB patients, and explore the prognosis of patients with isoniazid resistance. Methods From July 2009 to July 2019, a retrospective investigation was adopted to select 922 retreated bacteriologically positive PTB patients with complete data and treatment outcomes from Beijing Chest Hospital of Capital Medical University and other more than 20 domestic tuberculosis prevention and control institutions. Two hundred and nineteen MDR or XDR cases, and 100 non-rifampicin and non-isoniazid resistance cases were excluded, a total of 603 retreated bacteriologically positive PTB patients were enrolled in this study. The standard retreatment regimen was used for the sensitive and not drug-resistant group while an individualized treatment regimen was used for the isoniazid-resistant or rifampicin-resistant group. The treatment outcomes were compared among 485 patients in “drug-sensitive group”, 73 patients in “isoniazid-resistant group” (including isoniazid mono-drug resistance and poly-drug resistance), and 45 patients in “rifampicin-resistant group” (including rifampicin mono-drug resistance and poly-drug resistance). Results At the end of 2nd month’s treatment, the sputum smear negative conversion rate (63.6%, 42/66) and sputum culture negative conversion rate (63.6%, 35/55) in isoniazid-resistant group were lower than those in rifampicin-resistant group (84.6%, 33/39; 70.6%, 24/34) and drug-sensitive group (84.2%, 388/461; 80.0%, 343429) (χ²=16.567, 8.500; P<0.001, 0.014), respectively. At the end of 6th month’s treatment, the sputum smear negative conversion rate (79.7%, 47/59) and sputum culture negative conversion rate (76.5%, 39/51) in isoniazid-resistant group were lower than those in rifampicin-resistant group (89.2%, 33/37 and 93.5%, 29/31) and drug-sensitive group (91.5%, 398/435 and 90.8%, 367/404) (χ²=8.127, 10.533; P=0.017, 0.005), respectively. The cure rate of isoniazid-resistant group (53.4%, 39/73) was lower than that of rifampicin-resistant group (60.0%, 27/45) and drug-sensitive group (69.5%, 337/485) (χ²=8.407, P=0.015); the treatment success rate of isoniazid-resistant group (64.4%, 47/73) was lower than that of rifampicin-resistant group (75.6%, 34/45) and drug-sensitive group (82.1%, 398/485) (χ²=12.587, P=0.002). Conclusion The negative conversion rates and success rates of treatment in retreated PTB patients with isoniazid resistance were lower than that of rifampicin-resistant group and drug-sensitive group. It is suggested that attention should be paid to the drug resistance of every bactericide, especially for those medicines clinically used for a long period.