【摘要】 目的 分析湖北省耐多药与广泛耐药肺结核患者治疗效果及转归情况。方法 收集湖北省5个全球基金耐多药结核病项目地区于2006年10月至2014年6月登记的12 296例涂阳肺结核患者的耐药筛查及诊治等相关资料。本研究采用以酸性改良罗氏培养基分离培养(简称“传统培养”)筛查为主[99.63%,(12 251/12 296)]、基因芯片筛查为辅[0.36%,(45/12 296)]的方式开展耐多药肺结核筛查。分析涂阳肺结核患者的耐药筛查情况,以及耐多药与广泛耐药肺结核患者发现和纳入治疗情况、治疗6个月末和12个月末痰菌阴转情况、治疗转归情况。结果 共确诊耐多药与广泛耐药肺结核患者1493例(1421例MDR-TB,72例XDR-TB),耐多药与广泛耐药肺结核患者检出率为14.22%(1493/10 501)。复治患者中耐多药与广泛耐药肺结核患者的检出率为25.30%(1195/4724),高于初治患者[5.16%(298/5777)],差异有统计学意义(χ~2=6255.54,P<0.05)。不同登记分类复治患者中,复治失败患者耐多药与广泛耐药肺结核患者检出率高达50.43%(232/460)。耐多药与广泛耐药结核病患者纳入治疗率为68.85%(1028/1493),6个月末和12个月末痰菌培养阴转率分别为72.47%(745/1028)和63.23%(650/1028);耐多药结核病的治疗成功率为62.04%(492/793)。结论 本研究复治涂阳患者耐多药检出率高,提示复治患者是耐多药肺结核筛查的重点人群。耐多药肺结核患者的治疗成功率达到项目要求指标,其经验值得推广。更多还原

【Abstract】 Objective To analyze the treatment outcome of multidrug-resistant tuberculosis(MDR-TB) and extensively drug-resistant tuberculosis(XDR-TB) patients in Hubei province.Methods 12 296 smear positive TB patients are enrolled between October 2006 and June 2014 from 5 regions within China Global Fund MDR-TB program.Information about drug-resistance screening and treatment are collected.This study uses modified acidic Lowenstein-Jensen medium culture( "conventional culture" in short) as the major screening method(99.63%,12 251/12 296),and microarray as the minor screening method(0.36%,45/12 296),to analyze the drug-resistant screening of smear positive TB patients.The diagnosis,enrollment for treatment and sputum conversion rates after6 and 12 months of treatment for MDR-TB and XDR-TB patients are analyzed.Results Of 1493 patients are diagnosed as MDR-TB(1421) or XDR-TB(72).The total detection rate for MDR-TB and XDR-TB is 14.22%(1493/10 501).The detection rates of MDR-TB and XDR-TB are 25.30%(1195/4724) in relapse patients,and5.16%(298/5777) in new patients respectively.The difference is statistically significant(χ~2 =6255.54,P<0.05).In different registration categories,the MDR-TB and XDR-TB detection rate for relapse patients with failed treatment is as high as 50.43%(232/460).The enrollment rate for treatment of MDR-TB and XDR-TB is 68.85%(1028/1493).The sputum culture conversion rates are 72.47%(745/1028) and 63.23%(650/1028) after6 months and 12 months treatment respectively.The treatment success rate for MDR-TB is 62.04%(492/793).Conclusion The detection rate of MDR-TB is high in relapse smear positive patients,which suggests that relapse patients to be the main population for MDR-TB screening.The treatment success rate for MDR-TB has met the program requirement,the experience of which is good for generalization.更多还原