【摘要】 目的 了解我国六省(自治区)全球基金项目地区耐多药肺结核患者诊断、治疗、转归情况及影响因素。方法 采用回顾性调查方法 ,收集并分析2010年1月至2011年12月在内蒙古、山东、河南、湖北、浙江和广东六省(自治区)全球基金项目点就诊的19 056例耐多药肺结核高危人群的筛查、治疗、转归情况及影响因素。结果 对耐多药肺结核高危人群19056例进行筛查,耐多药肺结核检出率为12.3%(2338/19 056)。2338例耐多药肺结核患者纳入治疗率为68.4%(1599/2338);739例患者未纳入项目治疗,主要原因为拒治(19.9%,147/739)。纳入治疗的1599例患者治疗6个月末痰菌阴转率为63.9%(1022/1599),其中,初治患者的痰菌阴转率(70.8%,206/291)明显高于复治失败者(56.5%,187/331),差异有统计学意义(X~2=17.11,P=0.009);随着年龄的增长,耐多药肺结核患者治疗6个月末痰菌阴转率逐步下降,0~24岁组痰菌阴转率(72.2%,130/180)明显高于45~64岁组(62.0%,376/606)和65岁以上年龄组(44.5%,69/155),差异有统计学意义(X~2=36.20,P<0.01)。纳入治疗患者的治疗成功率为43.2%(691/1599),其中,初治患者治疗成功率(48.5%,141/291)明显高于复治失败患者(38.1%,126/331),差异有统计学意义(X~2=15.37,P=0.018);女性患者治疗成功率(47.4%,213/449)高明显于男性患者(41.6%,478/1150),差异有统计学意义(X~2=4.54,P=0.033);随着年龄的增长,患者治疗成功率逐步下降,0~24岁组治疗成功率(54.4%,98/180)明显高于45~64岁组(38.4%,233/606)和65岁以上组(23.2%,36/155),差异有统计学意义(X~2=49.83,P<0.01)。结论 耐多药肺结核可疑者筛查工作需要引起足够重视,采用标准化方案治疗耐多药肺结核的治疗成功率不理想,尤其是复治失败、男性及老年患者的治疗效果有待进一步提高。更多还原

【Abstract】 Objective To analyze the diagnosis,treatment,outcome,and prognostic factors of multidrugresistant tuberculosis( MDR-TB) in 6 Global Fund supported provinces(or autonomous regions) in China.Methods A retrospective survey was conducted on 19 056 high-risk MDR-TB patients who were involved in the Global Fund Project in 6 provinces(autonomous regions) including Inner-Mongolia, Shandong.Henan, Hubei,Zhejiang and Guangdong from January 2010 to December 2011.The data regarding screening, treatment, and outcome of MDR-TB were collected and the prognostic factors for MDR-TB were analyzed.Results 19 056 highrisk MDR-TB cases were screened,and MDR-TB detection rate was 12.3%(2338/19 056).Of the 2338 confirmed MDR-TB cases, 68.4%(1599/2338) were enrolled in the treatment project; 739 cases were not included in the project, mainly due to their rejection(19.9%, 147/739).Among the 1599 cases who were enrolled into the treatment project, the conversion rate at the end of 6 month of treatment was 63.9%(1022/1599).New cases(70.8%,206/291) got higher conversion rate than retreatment failure cases(56.5%, 187/331); difference was statistically significant(X~2 =17.11,P=0.009).With the increase in age, the conversion rate at the end of 6 months of treatment was gradually decreased.The conversion rate of 0-24 years age group(72.2%, 130/180) was much higher than that of 45-64 years age group(62.0%, 376/606) and older than 65 years age group(44.5%, 69/155);difference was statistically significant(X~2 =36.20, P<0.01).The treatment success rate was 43.2%(691/1599)among patients enrolled in treatment.New cases(48.5%,141/291) achieved higher success rate than retreatment failure cases(38.1%, 126/331); difference was statistically significant(X~2=15.37, P = 0.018).The successful rate of females(47.4%, 213/449) was much higher than that of males(41.6%, 478/1150); difference was statistically significant(X~2=4.54, P=0.033).With the increase in age,the successful rate was gradually decreased.The successful rate of 0-24 years age group(54.4%, 98/180) was much higher than that of 45-64 years age group(38.4%, 233/606) and older than 65 years age group(23.2%, 36/155); the difference was statistically significant(X~2 =49.83,P<0.01).Conclusion We should pay more attention to the screening of MDR-TB suspects.The treatment outcome of MDR-TB using standardized regimen did not reach the expectation level,especially for retreatment failure, male and elderly patients.更多还原