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目的分析耐药监测项目中肺结核治疗失败的主要影响因素,为黑龙江省结核病患者的治疗管理提供参考依据。方法对2004年黑龙江省按WHO/IUATLD《结核病耐药监测指南》发现的肺结核病患者的耐药监测信息和短程督导化疗后的治疗转归信息进行整理分析。结果(1)1995例菌阳肺结核中,初治1574例(78.9%);复治421例(21.1%)。初、复治肺结核病患者的耐药情况差异有统计学意义(P<0.001);(2)治疗失败患者的影响因素分析中,除复治是一个主要的影响因素外,初治病例中影响治疗失败的主要因素为居住地(P<0.05调整OR 0.36,95%CI[0.17-0.76])、耐多药(MDR-TB)(P<0.05调整OR 4.70,95%CI[1.76-12.51])和痰涂片载量(P<0.05调整OR 5.52,95%CI[1.84-16.61]);(3)复治患者中影响治疗失败的主要因素为耐多药(P<0.05调整OR5.58,95%CI[1.44-21.69])以及复治的次数(P<0.05调整OR3.34,95%CI[1.31-8.5])。结论初复治患者间的耐药差异表明在选择治疗方案时应根据药敏试验选择敏感性药物;采用基于一线药的治疗方案在治疗耐药肺结核病方面存在不足,尤其是耐多药患者,确定一个病例耐药之后应根据其药敏结果尽快调整其治疗方案;同时应关注影响治疗失败的危险因素,采取相应措施,减少治疗失败和耐药的产生。
Objective To analyze the main influencing factors of failure of tuberculosis in drug resistance surveillance project and provide reference for the treatment and management of tuberculosis patients in Heilongjiang Province. Methods The surveillance information of tuberculosis patients detected by WHO / IUATLD Guidelines for Monitoring Tuberculosis Drug Resistance in Heilongjiang Province in 2004 and the treatment prognosis information after short-range supervision and chemotherapy were collected and analyzed. Results (1) Of the 1995 cases of bacillary positive pulmonary tuberculosis, 1574 (78.9%) were initially treated and 421 (21.1%) were retreatment. (2) In the analysis of the influencing factors of the patients with failed treatment, except the relapse-recuperation was a major influencing factor, the effect of initial treatment was significantly different The main factors contributing to the failure of treatment were place of residence (P <0.05 adjusted OR 0.36, 95% CI [0.17-0.76]), MDR-TB (adjusted P <0.05 OR 4.70, 95% CI [1.76-12.51] ) And sputum smear load (P <0.05 adjusted OR 5.52, 95% CI [1.84-16.61]); (3) The main factors influencing treatment failure in refractory patients were MDR (P <0.05 adjusted OR5.58 , 95% CI [1.44-21.69]) and the number of retreatment (P <0.05 adjusted OR3.34, 95% CI [1.31-8.5]). Conclusions The difference of drug resistance in patients with early re-treatment indicates that the choice of treatment options should be based on drug susceptibility testing of choice of sensitive drugs; the use of first-line drug-based treatment of drug-resistant tuberculosis in the treatment of inadequate, especially in patients with multi-drug resistance, After determining a case of drug resistance should be based on its susceptibility results as soon as possible to adjust its treatment options; the same time, attention should be focused on the risk factors for treatment failure, take appropriate measures to reduce treatment failure and drug resistance.