起始耐药与非耐药肺结核患者近、远期疗效观察

目的：观察起始耐药与非耐药肺结核患使用2H33S3Z3／4H3R3方案的近远期治疗效果，分析不同耐药程度对患疗效的影响。方法：于1998年开始，对山东省30个耐药监测点上的777例初始涂阳肺结核患进行近远期治疗效果随访。结果：疗程结束时痰菌阴转率为98．2％，总失败率为1．8％，其中敏感患失败率为1．6％，耐药患为2．6％。随访半年复阳率为2．7％，敏感患和耐药患的复阳率分别为1．2％和8．5％（P＜0．005）。1年复阳率为2．6％，敏感患和耐药患的复阳率分别为1．6％和6．9％（P＜0．005）；2年复阳率为1．3％，敏感患和耐药患的复阳率分别为1．3％和1．0％。152例耐药患中，疗程结束时，痰菌仍阳性2．6％，而耐多药病例为10．3％；半年随访复阳率为8．5％，耐多药病例复阳率为37．0％；1年复阳率为6．9％，耐多药病例为6．3％；2年复阳率为1．0％，而耐多药病例为6．7％。结论：在国家结核病防治规划下，初治肺结核患使用6个月间歇方案是可行的。耐多药患的近期治愈率低，远期复发率很高。

The short-term and long-term treatment outcomes in patients with pulmonary tuberculosis positive for drug-resistant and sensitive strains

OBJECTIVES: To analyze the treatment outcomes in patients with smear positive tuberculosis, and to compare the difference in treatment response among patients infected with drug-sensitive and drug-resistant strains. METHODS: From 1998 to 2000, seven hundred and seventy-seven patients with primary smear-positive tuberculosis, which were from 30 surveillance sites, were followed for two years to monitor their treatment outcomes. RESULTS: At the completion of the 6 months' therapy, the overall rate of treatment failure was 1.8%, 2.6% for the drug-resistant cases and 1.6% for the drug-sensitive cases. Six-month follow-up showed a positive conversion rate of 2.7% in all the cases, 8.5% and 1.2% (P < 0.005) in the drug-resistant and the drug-sensitive cases respectively. One year follow-up showed that the positive conversion rate was 2.6% in all the cases, 6.9% and 1.6% (P < 0.005) in the drug-resistant and the drug-sensitive cases, respectively. Two-year follow-up showed an overall positive conversion rate of 1.3%, 1.0% and 1.3% in the drug-resistant and the drug-sensitive cases, respectively. Of the 152 drug-resistant cases, the rate of treatment failure was 2.6% at the completion of 6 months' therapy, but in cases with MDR-TB the rate was 10.3%. Six-month follow-up showed an overall positive conversion rate of 8.5%, but the rate reached 37.0% in cases with MDR-TB. One-year and two-year follow-up showed that the positive conversion rates were 6.9% and 1.0% respectively in all the drug-resistant cases, but 6.3% and 6.7% respectively in the MDR cases. CONCLUSIONS: Under the guidelines of the National Tuberculosis Program (NTP), the 2H(3)R(3)S(3)Z(3)/4H(3)R(3) regimen for primary smear-positive pulmonary TB was effective. But the cure rate was lower and the positive conversion rate higher in patients with MDR-TB.