耐多药肺结核治疗及其影响因素分析

目的观察耐多药肺结核(MDR-TB)患者治疗的临床效果及不良反应,探讨MDR-TB影响相关因素,提高抗结核的疗效。方法收集我院2009年3月至2013年9月收治的MDR-TB患者共405例,根据病史将其分为初治组和复治组,记录两组患者的痰菌阴转率、临床疗效及不良反应等,统计分析影响MDR-TB患者治疗转归的相关因素。结果初治组患者3、6、12及24月痰菌阴转率分别68.60%、71.90%、77.69%及81.82%,而复治组为42.61%、43.66%、45.42%及46.13%,差异具有统计学意义(χ2=22.926,27.112,35.695,44.047;P均0.001)。初治组治愈、失败、终止及死亡的患者分别为77.69%、15.70%、4.13%及2.48%,而复治组为55.63%、37.68%、3.52%及3.17%;治愈及失败的例数比较,差异具有统计学意义(χ2=17.554,19.115;P0.001),而终止与死亡差异比较无统计学意义(χ2=0.089,0.708;P0.05)。两组的胃肠道反应、肝毒性、WBC减少及皮疹的不良反应发生率比较无统计学意义(χ2=0.211,0.901,0.006,0.627;P0.05)。将相关因素进行分组分析,结果提示抗结核治疗史、体重指数、吸烟史、空洞范围、白蛋白、血红蛋白是MDR-TB治疗转归的影响因素(P0.05),而与患者的性别、年龄无相关性(P0.05)。非条件Logistic回归分析提示,多次抗结核治疗史、消瘦、吸烟史、多个结核空洞、低白蛋白血症及低血红蛋白血症是MDR-TB治疗转归的独立危险因素(P0.05)。结论 MDR-TB初治组患者的痰菌阴转率及临床疗效均明显高于复治组,而不良反应无差异。治疗中应重视多次抗结核治疗史、消瘦、吸烟史、多个结核空洞、低白蛋白血症及低血红蛋白血症等因素,积极采取相关治疗措施,以提高临床治愈率。

Treatment outcomes and their impact factors of multi-drug resistant tuberculosis patients

Objective To observe the clinical curative effect and adverse reactions of multi-drug resistant tu-berculosis (MDR-TB)patients,and to explore the influencing factors of MDR-TB.Methods A total of 405 patients who were diagnosed with MDR-TB in our hospital from March 2009 to September 2013 were recruited in this study, and they were divided into two groups based on their previous treatment history:the initial treatment group and the re-treatment group.Their treatment response,outcomes and adverse events were observed.Then the clinical manifesta-tions,sputum negative conversion rate and adverse reaction before and after treatment were compared between the two groups.The related factors influencing the treatment of MDR-TB patients outcomes were analyzed.Results The sputum conversion rate at the 3rd,6th,12th and 24th months was significantly higher in the initial treatment group (68.60%,71.90%,77.69% and 81.82%)than in the re-treatment group (42.61%,43.66%,45.42% and 46.13%)(χ2 =22.926,27.112,35.695,44.047;P <0.001).The rate of cure,failure,termination,and death was 77.69%,15.70%,4.13% and 77.69% respectively in the initial treatment group,and 55.63%,37.68%, 3.52% and 55.63% in the re-treatment group.There were significant differences in cure rate and failure rate be-tween the two groups (χ2 =17.554,19.115;P <0.001 ),and termination and mortality showed no significant difference between the two groups (χ2 =0.089,0.708;P >0.05).There was no significant difference in gastroin-testinal reaction,liver toxicity,WBC and rash adverse events rate between the two groups (χ2 =0.211,0.901, 0.006,0.627;P >0.05).The multivariate logistic regression analysis showed that the influencing factors included history of anti-tuberculosis treatment,thin,smoking history,multiple tuberculosis cavity,low serum albumin levels, and low hemoglobin (P <0.05).Conclusion The sputum conversion rate and clinical efficacy are significantly higher in initial treatment group than in the re-treatment group,without significant difference in adverse reactions.It should pay attention to the history of multiple anti-tuberculosis treatment,weight,smoking history,multiple tubercu-losis cavity,low serum albumin levels and low hemoglobin concentration during treatment,and the clinical curative effect can be improved by taking relevant treatment measures actively.