耐多药肺结核患者既往治疗情况对治疗效果的影响

发布时间：2018-12-07 14:50

【摘要】：目的探讨耐多药肺结核患者既往治疗情况对治疗效果的影响。方法采用回顾性分析,诊断为耐多药肺结核并接受治疗的患者。所有患者均采用含有丁胺卡那、左氧氟沙星、丙硫异烟胺、对氨基水杨酸6个月注射期抗结核治疗方案治疗。观察资料包括患者年龄、抗结核治疗史、治疗前痰菌情况、耐药情况、胸部影像学资料等数据,通过X2检验分析不同情况下的治疗效果,多因素logistic回归分析治疗最终结果的影响因素。结果治疗6个月末痰菌阴转77例(61.1%);男性痰菌阴转率为55.6%,女性75.0%(X2=4.091,P=0.043)。既往累计治疗≤12个月、13~24个月及≥25个月阴转率分别为79.1%、66.7%和40.4%(X2=14.765,P=0.001)。既往有二线药物治疗史患者阴转率为51.6%,无二线药物治疗史阴转率为85.7%(X2=12.343,P0.001)。治疗前痰涂片菌量(++)及以下患者阴转率为74.3%,治疗前痰涂片菌量(+++)及以上患者阴转率为42.3%(X2=13.173,P0.001)。多因素logistic回归分析显示:男性、累计治疗时间超过2年、既往有二线药物抗结核病史、治疗前痰细菌负荷量是耐多药肺结核患者治疗6个月未阴转的独立危险因素。结论男性、累计治疗时间超过2年、既往有二线药物抗结核病史、治疗前痰细菌负荷量对耐多药肺结核患者6个月疗效有影响。规范二线药物使用,重视耐多药结核的初次治疗,在治疗早期根据药敏调整用药方案是提高耐多药肺结核阴转率和治愈率的关键。
[Abstract]:Objective to investigate the effect of previous treatment on multi-drug resistant pulmonary tuberculosis (MDR). Methods A retrospective analysis was carried out in patients with multi-drug-resistant pulmonary tuberculosis (MDR). All patients were treated with amikacin, levofloxacin, prothiazinamide, and aminosalicylic acid injection for 6 months. The observed data included age of patients, history of anti-tuberculosis treatment, sputum bacteria before treatment, drug resistance, chest imaging data and so on. X2 test was used to analyze the effect of treatment under different conditions. Factors influencing the final outcome of multivariate logistic regression analysis. Results at the end of 6 months, 77 cases (61.1%) were treated with sputum negative conversion, the rate of sputum negative conversion was 55.6% in male and 75.0% in female (X _ 2P _ (4.091) P _ (0.043). The cumulative negative conversion rates of 12 months, 1324 months and 鈮，

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