【摘要】 目的 分析耐多药肺结核患者治疗转归情况并探讨影响治疗成功的相关因素。方法 于2013年1月至2014年12月,选取在江苏省徐州市、镇江市、连云港市和南通市纳入完成治疗的耐多药患者(至少同时耐利福平与异烟肼)524例作为回顾性调查研究对象;剔除21例广泛耐多药患者,3例耐多药孕产妇患者,51例有严重胃肠道疾病或精神疾病患者,28例不愿配合参与调查的患者,最终共纳入耐多药肺结核患者421例。以病案资料调查为主、电话访谈方式为辅获取研究资料,采用卡方检验进行单因素分析,logistic回归分析对变量进行多因素分析,探索可能影响耐多药肺结核患者治疗转归的影响因素。结果 耐多药患者治疗成功率为52.7%(222/421),其中完成治疗率7.6%(32/421),治愈率45.1%(190/421),治疗失败、丢失与因其他原因而终止治疗的患者占39.7%(167/421),因结核病死亡的患者占5.5%(23/421),因非结核病死亡的患者占2.1%(9/421)。多因素logistic回归分析显示55岁以上患者(aRR=2.643,95%CI=1.409～4.959,P=0.002)(aRR=adjusted RR)、不良反应史(aRR=1.872,95%CI=1.041～3.365,P=0.036)、治疗前痰涂片阳性等级为++～++++(aRR=2.835,95%CI=1.476～5.446,P=0.002)、复治患者(aRR=4.512,95%CI=1.283～15.872,P=0.019)是耐多药肺结核患者治疗成功的负面影响因素。结论 55岁以上、有不良反应史、治疗前痰涂片阳性等级为“++”～“++++”患者以及复治患者容易治疗不成功。更多还原

【Abstract】 Objective To analyze the treatment outcome of multidrug-resistant tuberculosis patients and to investigate factors that affect the success of treatment. Methods From January 2013 to December 2014,524 multidrug-resistant patients(at least simultaneously resistant to rifampin and isoniazid)in Xuzhou,Zhenjiang,Lianyungang and Nantong City of Jiangsu Province,were invited to join this retrospective study.In the end,421 patients were included,excluding 3 pregnant women with MDR-TB,51 patients with severe gastrointestinal diseases or mental disorders and 28 patients who were unwilling to cooperate with the investigate.Research data was based primarily on the investigation of medical records and additional telephone interviews.Univariate analysis was performed by chi square test,and multivariable logistic regression analysis was applied to explore factors that might affect the treatment success of MDR patients. Results Out of the 421 subjects included in this study,the successful rate of treatment was 52.7%(222/421).The complete treatment rate was 7.6%(32/421),and the cure rate was 45.1%(190/421).Treatment failure,loss and discontinue treatment cases accounted for 39.7%(167/421),5.5%(23/421)died due to tuberculosis,and 2.1%(9/421)died due to non-tuberculosis.In the multivariable logistic regression analysis,age(aRR=2.643,95%CI=1.409-4.959,P=0.002)(aRRis an adjusted RRvalue),adverse reaction history(aRR =1.872,95%CI=1.041-3.365,P =0.036),positive sputum smear before treatment(aRR=2.835,95%CI=1.476-5.446,P=0.002),and retreatment patients(aRR=4.512,95%CI=1.283-15.872,P=0.019)were the factors negatively affecting the success of multidrug-resistant pulmonary tuberculosis treatment. Conclusion Patients who are over 55-years-old,or had a history of adverse reactions,or had ++-++++ positive grade of sputum smear before treatment,and retreatment patients tend to unsuccessful treatment.更多还原