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目的:确定新发涂阳结核病治疗后失败与复发患者的获得耐药性情况。方法:对越南新发涂阳结核病患者2901例的队列进行登记,登记时收集、贮存痰标本。治疗失败或复发时再次留痰。将二次痰标本进行培养、药敏试验及限制性内切酶片段长度多态性(RFLP)分型。结果:40例失败患者中,有17例在初次登记时即为耐多药结核病(MDR)。非原发MDR的23例失败 患者中有15例(65％)为获得性MDR病例。39例复发患者及 143例对照者中均无原发MDR病例。结论:原发耐药性对治疗失败,复发及进一步产生的获得耐药性都是有明显影响的危险因素。因为80％的失败病例为 MDR,因此在对新病例具有高治愈率的控制规划中,失败病例不宜采用标准复治方案。
OBJECTIVE: To determine the acquired resistance of patients with relapsed and failed new smear-positive tuberculosis. Methods: A total of 2901 new smear-positive tuberculosis patients in Vietnam were enrolled in the cohort. During registration, sputum samples were collected and stored. Treatment failure or relapse when leaving phlegm. Secondary sputum samples were cultured, susceptibility testing and restriction fragment length polymorphism (RFLP) typing. Results: Of the 40 failed patients, 17 were MDR-TB at initial registration. Fifteen (65%) of the 23 failed patients with non-primary MDR were acquired MDR. There were no primary MDR cases in 39 relapsed patients and 143 controls. CONCLUSIONS: Primary drug resistance is a risk factor for treatment failure, relapse and further drug resistance development. Because 80% of failure cases are MDRs, in a control plan that has a high cure rate for a new case, the standard case should not be used for failure cases.