大连市全球基金项目耐多药结核防治领域中期疗效评价

发布时间：2018-07-10 18:16

本文选题：结核 + 耐多药　；参考：《大连医科大学》2016年硕士论文

【摘要】：目的:分析和评价大连市全球基金耐多药结核防治领域实施情况,为进一步建立规范和科学的耐多药结核防治技术策略提供依据。方法:采用比例法对INH(异烟肼)、RFP(利福平)、Am(阿米卡星)、Cm(卷曲霉素)、Lfx(左氧氟沙星)、Mfx(莫西沙星)、PAS(对氨基水杨酸)、Pto(丙硫异烟胺)、EMB(乙胺丁醇)等9种药物进行耐药检测。对筛选出的耐多药结核和广泛耐药结核纳入全球基金耐多药项目治疗。将完成12月疗程的118例耐多药结核病人分为MDR(耐多药)、Pre-XDR(广泛耐药前期)、XDR(广泛耐药)作为研究对象。每月复查体温、痰结核菌涂片、痰结核菌培养、血常规、ESR(红细胞沉降率)、CRP(C-反应蛋白)、PCT(降钙素原)、肝功、肾功、电解质和体重。每3个月复查1次胸片。TSH(促甲状腺激素)、听力、视力如有异常及时复查。痰结核菌涂片阴转率,痰结核菌培养阴转率及副反应发生率,采用SPSS19.0软件进行统计分析,采用卡方检验。痰菌阴转的变化采用Excel进行曲线分析。结果:MDR经12个月治疗后,6个月末与12个月末痰涂片与痰培养的阴性率比较,痰涂片阴性率分别为6个月末82.6%(38/46)及12个月末78.3%(36/46)。痰培养阴性率6个月末84.8%(39/46)及12月末痰培养阴性率73.9%(36/46),无统计学意义,P0.05。Pre-XDR经治疗,6月末痰菌阴转率达到82.4%(42/51),明显高于12个月末痰培养阴性率66.7%(34/51),X 2=0.97,P0.01,差异有统计学意义。痰涂片6个月末阴转率为82.4%(42/51),12个月末时为72.5%(37/51),差异无统计学意义,P0.05。XDR组6个月末与12个月末痰涂片阴性率分别为81.0%(17/21)和71.4(15/21),痰培养的阴性率6个月末76.2%(16/21),12个月末阴性率为76.2%(16/21),差异无统计学意义,均P0.05。耐多药结核按照治疗前登记类型分为初治、复治和慢传三组,分别考核化疗效果。在治疗12个月末三组间的痰涂片和培养阴性率的比较中,初治较复治、慢传的差异均有统计学意义,X 2值分别为4.50,7.71,5.08和4.73,均P0.05。药物不良反应探究中,XDR方案组的电解质紊乱71.4%(15/21)和胃肠道反应66.7%(14/21)明显高于MDR方案组电解质紊乱13.4%(13/97)和胃肠道反应44.3%(43/97),有明显的统计学意义,X 2值分别为31.84和3.42,P0.05。经抗结核治疗12个月后,病变总体显著吸收率和好转率分别为48.3%(57/118)、24.6%(29/118)。结论:大连市全球基金耐多药项目实施进展顺利,中期疗效痰菌阴转率达到预期成果。进行早期发现和早期治疗,是提高耐多药结核治愈率的有效途径。Pre-XDR治疗需得到足够重视,采用MDR化疗方案具有一定风险。
[Abstract]:Objective: to analyze and evaluate the implementation of MDR-TB prevention and treatment in Dalian Global Fund, and to provide the basis for further establishment of standardized and scientific strategy for MDR-TB prevention and treatment. Methods: the resistance of INH (isoniazid) and RFP (rifampicin) am (crithromycin) Lfx (levofloxacin) Mfx (moxifloxacin) and pas (p-aminosalicylic acid) Pto (propyl isoniacinamide) EMB (ethambutanol) were determined by proportional method. Selected MDR TB and XDR-TB are included in the Global Fund MDR program. A total of 118 patients with MDR were divided into two groups: MDR (multidrug resistance) Pre-XDR (pre-drug resistance) and XDR (extensive drug resistance). Body temperature, sputum smear, sputum culture, erythrocyte sedimentation rate, CRP (C-reactive protein), liver function, renal function, electrolyte and body weight were reviewed monthly. Every 3 months, chest radiographs. TSH (thyroid stimulating hormone), hearing, visual acuity if abnormal timely review. The sputum smear negative conversion rate, sputum tuberculous bacteria culture negative conversion rate and side effects were analyzed by SPSS 19.0 software and chi-square test. The changes of sputum negative transformation were analyzed by Excel. Results the negative rate of sputum smear and sputum culture was 82.6% (38 / 46) at the 6th month and 78.3% (36 / 46) at the 12th month after 12 months treatment. The negative rate of sputum culture was 84.8% (39 / 46) at the end of 6 months and 73.9% (36 / 46) at the end of December. The negative rate of sputum culture was 82.4% (42 / 51) at the end of 6 months, which was significantly higher than that of 66.7% (34 / 51) at the end of 12 months (P 0.01). The negative rate of sputum smear was 82.4% (42 / 51) at the end of 6 months and 72.5% (37 / 51) at the end of 12 months. The negative rate of sputum smear was 81.0% (17 / 21) and 71.4% (15 / 21) in 6 month and 12 month groups respectively in P0.05.XDR group. The negative rate of sputum culture was 76.2% (16 / 21) at the end of 6 months, and 76.2% (16 / 21) at the end of 12 months. There is no statistical significance. Average P0.05. Multidrug resistant tuberculosis (MDR) was divided into three groups according to the type of registration before treatment: primary treatment, relapse and slow transmission. In the comparison of sputum smear and culture negative rate between the three groups at the end of 12 months of treatment, the difference of the initial treatment was higher than that of the re-treatment, and the difference of slow transmission was statistically significant (P < 0.05). The difference of the two groups was 4.50 ~ 7.71 ~ 5.08 and 4.73, respectively. The electrolyte disturbance and gastrointestinal reaction in XDR group were 71.4% (15 / 21) and 66.7% (14 / 21), respectively, which were significantly higher than those in MDR group (13.4% (13 / 97) and 44.3% (43 / 97). After 12 months of antituberculous treatment, the overall absorption rate and improvement rate were 48.3% (57 / 118) and 24.6% (29 / 118), respectively. Conclusion: the implementation of multi-drug resistance project in Dalian Global Fund is progressing smoothly and the sputum negative rate of the mid-term curative effect has reached the expected results. Early detection and early treatment is an effective way to improve the cure rate of MDR tuberculosis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R52;R183

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