【摘要】 目的:为耐多药结核病(MDR-TB)患者合理使用抗结核药及减少药品不良反应(ADR)提供参考。方法:选取2012年2月-2015年5月我院结核病住院患者,按照疑似MDR-TB(202例)和确诊MDR-TB(162例)分为两组,进行药物组化疗法,并依据患者病情选择不同的治疗管理方式,并观察ADR发生情况。两组患者的治疗管理期均为18个月。结果:疑似MDR-TB组患者对一线药物的耐药率均≥26.24%,其中对异烟肼和利福平的耐药率为40%左右;对二线药物的耐药率均≥4.95%,其中对丙硫异烟胺耐药率最高,为46.04%;药敏试验结果显示,一线药物全敏感为44.06%,单耐药为14.36%,多耐药为9.90%,耐多药为31.68%;一、二线药物全敏感为21.78%,单耐药为24.75%,多耐药为17.82%,耐多药为32.67%,广泛耐药为2.97%。MDR-TB患者治疗管理方案中,结防机构治疗占56.17%;转诊于专科医院治疗占14.81%;未治疗者占22.22%;其他因素导致改变治疗方案或无法继续治疗占6.79%。确诊MDR-TB患者较疑似MDR-TB患者二线方案诊疗的ADR发生率较高,组间比较差异有统计学意义(P<0.05)。经后期对症治疗均有所好转。结论:对于MDR-TB患者根据病情可有效寻找合适的治疗管理方案,提高疗效,降低ADR发生率,控制结核杆菌的传播与发展。更多还原

【Abstract】 OBJECTIVE:To provide reference for rational use of antituberculosis drugs and reduce the occurrence of ADR in multiple-drug resistance tuberculosis(MDR-TB)patients. METHODS:TB inpatients were selected from our hospital during Feb. 2012-May 2015,and then divided into suspected MDR-TB group(202 cases) and diagnosed MDR-TB group(162 cases). According to the patient’s condition,different treatment management modes were chosen,and the incidence of ADR were observed. Treatment and management period of 2 groups were 18 months. RESULTS:In suspected MDR-TB group,the drug resistance rates to first line drugs were greater than or equal to 26.24%,among which drug resistance rates to isoniazid and rifampicin were about 40%. Resistance rates to second line-drugs were greater than or equal to 4.95%,among which resistance rate to protionamide was the highest,being 46.04%. The results of drug sensitivity tests showed that44.06% of patients were sensitive to all first-line drugs,14.36% of patients were resistant to single drug,9.90% of patients were usually resistant to drugs and 31.68% of patients were resistant to multiple drugs. 21.78% of patients were sensitive to all first-line drugs and second-line drugs,24.75% of patients were resistant to single drug,17.82% of patients were usually resistant to drugs,32.67% of patients were resistant to multiple drugs and 2.97% of patients were extensively resistant to drugs. In the management plan of MDR-TB patients therapy,56.17% were treated in tuberculosis control institutions;referral to special hospital for treatment accounted for 14.81%;22.22% didn’t receive any treatment;other factors lead to a change in treatment or unable to continue to treat accounted for 6.79%. The incidence of ADR in MDR-TB patients was higher than suspected MDR-TB patients,there was statistical significance between 2 groups(P<0.05). After the following symptomatic treatment,all patients were improved. CONCLUSIONS:For patients with MDR-TB,according to disease condition,appropriate treatment management program can be found so as to improve therapeutic efficacy,reduce the incidence of ADR,control spreading and development of tubercle bacillus.更多还原