结核病控制项目中初治涂阳重症肺结核的认定和方案选择

目的 对结核病控制项目中重症肺结核进行不同方案的治愈率和复发率的比较分析.方法对Ⅰ组3 HREZ/6HRE、Ⅱ组3H2R2E2Z2/6H2R2E2、Ⅲ组2HREZ/4HR和Ⅳ组2H2R2E2Z2/4H2R2方案进行组间分层分析比较.评价痰菌阴转率、治愈率、复发率和不良反应.结果(1)强化期痰菌阴转和疗程结束痰菌阴转情况:Ⅰ组和Ⅱ组痰菌阴转优于Ⅲ组和Ⅳ组；(2)强化期结束和疗程结束X线吸收情况:Ⅰ组和Ⅱ组X线吸收优于Ⅲ组和Ⅳ组；(3)3年内细菌学复发Ⅰ组和Ⅲ组、Ⅳ组存在显著性差异；(4)不良反应各组无差异.结论 结控项目中重症肺结核9个月方案疗效明显优于6个月方案.

Diagnosis and treatment of smear positive severe pulmonary tuberculosis in Tuberculosis control project

Objective To analyze the cure rate and recurrence rate of treatment for severe tuberculosis and discuss the treatment’s rationality.Methods Four regimens(Ⅰ3HREZ/6HRE,Ⅱ 3H2R2E2Z2/6H2R2E2,Ⅲ 2HREZ/4HR,and Ⅳ 2H2R2E2Z2/4H2R2) were analyzed and compared to evaluate its sputum conversion rate,cure rate,recurrence rate and adverse reactions.Results At the end of intensive phase and treatment,the sputum conversion rates in the Ⅰ group and Ⅱ group were significantly higher than those in the Ⅲ group and Ⅳ group.And also,the obvious absorption of disease in the Ⅰ group and Ⅱ group were significantly better than those in the Ⅲ group and Ⅳ group.3-year bacteriological relapses rate in the Ⅲ group and Ⅳ group was significantly higher than those in the Ⅰ group and Ⅱ group.The regimens were well tolerated with a low incidence of major side effects.Conclusion The 9-months regimens are better than the 6-months regimens in smear positive severe pulmonary tuberculosis in Tuberculosis control project.