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目的分析个体化治疗耐多药肺结核病(MDR-TB)失败的影响因素。方法选取本溪市第六人民医院2014年3月—2015年11月收治的MDR-TB患者120例,均采用个性化治疗方法,根据治疗结果将所有患者分为成功组和失败组,各60例。回顾性分析患者的临床资料,并采用多因素非条件logistic回归分析个体化治疗MDR-TB失败的影响因素。结果两组患者性别、年龄、婚姻情况、户籍、肺部病变、接受抗结核治疗次数及加免疫增强剂者所占比例、外科手术史者所占比例、纤维支气管镜介入治疗者所占比例比较,差异无统计学意义(P>0.05);失败组患者耐药率、规则治疗者所占比例、化疗方案合理者所占比例低于成功组,肺部空洞性病灶发生率高于成功组(P<0.05)。多因素logistic回归分析结果显示,未规则治疗、不合理的化疗方案、肺部存在空洞性病灶是影响肺结核治疗失败的主要危险因素(P<0.05)。结论未规则治疗、不合理的化疗方案、肺部存在空洞性病灶是影响肺结核治疗失败的主要危险因素,因此在临床治疗中,需根据患者肺部空洞情况制定合理的治疗方案,强化管理。
Objective To analyze the factors influencing the failure of individualized treatment of multidrug-resistant pulmonary tuberculosis (MDR-TB). Methods 120 cases of MDR-TB patients were selected from the Sixth People’s Hospital of Benxi City from March 2014 to November 2015. All the patients were divided into two groups: successful group and failure group . The clinical data of the patients were retrospectively analyzed. The multivariate non-conditional logistic regression analysis was used to analyze the factors influencing the failure of individualized MDR-TB therapy. Results The gender, age, marital status, household registration, lung disease, the number of anti-tuberculosis treatment and immunostimulants, the proportion of surgical history, the proportion of patients with bronchoscopic intervention , The difference was not statistically significant (P> 0.05). In the failure group, the rate of drug resistance, the ratio of regular treatment, the proportion of reasonable chemotherapy were lower than that of the successful group, and the incidence of pulmonary empty lesions was higher than that of the successful group P <0.05). Multivariate logistic regression analysis showed that unregulated treatment, unreasonable chemotherapy regimen and presence of empty lung lesions were the main risk factors that affected the failure of pulmonary tuberculosis treatment (P <0.05). Conclusion Irregular treatment, unreasonable chemotherapy regimen and empty lung lesions are the main risk factors affecting the failure of pulmonary tuberculosis treatment. Therefore, in the clinical treatment, reasonable treatment plan should be worked out according to the pneumoconiosis in the patients to strengthen the management.