摘要
目的探讨复治菌阳肺结核患者痰菌量与治疗失败和再次复发的关系,为研究复治肺结核诊疗提供参考。方法回顾性分析2009年7月至2012年7月22家结核病诊疗机构纳入的400例非耐多药及广泛耐药复治菌阳肺结核患者资料,采取复治新方案和复治标准方案治疗,对治疗成功患者随访至2019年7月(共随访7年)。将治疗中失败者51例作为失败组,治疗成功后随访再次复发者23例作为复发组。对两组患者的临床相关资料进行逐一对比分析。结果失败组与复发组在既往使用低剂量利福霉素类药物[低剂量70.2%(33/47)和52.2%(12/23)、正常剂量29.8%(14/47)和47.8%(11/23)]、复治类型[复发51.0%(26/51)和56.6%(13/23)、初治失败23.5%(12/51)和21.7%(5/23)、其他复治25.5%(13/51)和21.7%(5/23)]、治疗前药物敏感性试验结果[敏感34.0%(17/50)和31.8%(7/22)、耐异烟肼32.0%(16/50)和31.8%(7/22)、耐利福平12.0%(6/50)和13.7%(3/22)、其他耐药22.0%(11/50)和22.7%(5/22)]、既往累计用药时间[<6个月24.0%(12/50)和21.7%(5/23)、≥6个月76.0%(38/50)和78.3%(18/23)]和复治次数[1次78.4%(40/51)和87.0%(20/23)、≥2次21.6%(11/51)和13.0%(3/23)]方面比较,两组差异均无统计学意义(χ2=2.189,P=0.139;χ2=0.206,P=0.902;Fisher确切概率法,P>0.999;χ2=0.045,P=0.832;χ2=0.298,P=0.585)。失败组治疗前痰涂片和痰培养菌量检测>2+的比例分别为44.9%(22/49)和63.9%(23/36),均高于复发组8.7%(2/23)和12.5%(2/16),两组间比较差异均有统计学意义(χ2值分别为9.232和11.718,P值分别为0.002和0.001)。结论复治菌阳肺结核在治疗前痰菌量大的患者治疗失败率高于复发率,在制定复治新方案时应予以重视。
Objective To analyze the relationship between bacterial load and treatment failure and recurrence of sputum positive retreatment pulmonary tuberculosis patients,providing reference for the diagnosis and treatment of retreatment tuberculosis. Methods A retrospective cohort study including 400 patients of sputum positive retreatment pulmonary tuberculosis except multidrug-resistant and extensive drug-resistant in 22 tuberculosis designated institutions from July 2009 to July 2012 were conducted.New treatment regimen and standard treatment regimen for retreatment tuberculosis patients were adopted.All patients with successful treatment were followed up to July 2019(a total of 7 years).Fifty-one cases of retreatment failure were selected as failure group and 23 cases of recurrence after successful treatment were selected as recurrence group.Clinical data between failure group and recurrence group were analyzed. Results The previous dosage of rifampicin drugs(low dosage 70.2%(33/47)and 52.2%(12/23),normal dosage 29.8%(14/47)and 47.8%(11/23)),retreatment types(recurrence 51.0%(26/51)and 56.6%(13/23),initial treatment failure 23.5%(12/51)and 21.7%(5/23),other retreatment25.5%(13/51)and 21.7%(5/23)),drug susceptibility test result before treatment(sensitive 34.0%(17/50)and31.8%(7/22),isoniazid resistance 32.0%(16/50)and 31.8%(7/22),rifampicin resistance 12.0%(6/50)and13.7%(3/22),other drugs resistance 22.0%(11/50)and 22.7%(5/22)),previous accumulated treatment duration(<6 month 24.0%(12/50)and 21.7%(5/23),≥6 month 76.0%(38/50)and 78.3%(18/23))and the number of retreatment(1 time 78.4%(40/51)and 87.0%(20/23),≥2 times 21.6%(11/51)and 13.0%(3/23))were all compared between failure and recurrence group and there were no statistical significance (χ2=2.189,P=0.139;χ2=0.206,P=0.902;Fisher exact probability test,P>0.999;χ2=0.045,P=0.832;χ2=0.298,P=0.585).The proportions of Mycobacterium tuberculosis load >2+in sputum smear testing and culture testing before treatment in failure group(44.9%(22/49)and 63.9%(23/36))were higher than in recurrence group(8.7%(2/23)and 12.5%(2/16))and the differences between the two groups were statistically significant(χ2 values were 9.232 and 11.718,Pvalues were 0.002 and 0.001)respectively. Conclusion The failure rate of sputum positive retreatment pulmonary tuberculosis patients with high bacterial load was higher than the recurrence rate,and it should be paid more attention when designing the new retreatment regimen.
作者
张立杰
韩喜琴
王敬萍
陈瑜晖
陈盛玉
陈玲
李波
林明贵
黎友伦
石莲
席秀娥
马丽萍
王鑫
王飞
赵彩燕
王芙蓉
陈森林
吴湘
李钋
张朋
冷学艳
张海晴
曹文利
舒薇
孙玙贤
谢仕恒
田希忠
黄学锐
杜建
高微微
ZHANG Li-jie;HAN Xi-qin;WANG Jing-ping;CHEN Yu-hui;CHEN Sheng-yu;CHEN Ling;LI Bo;LIN Ming-gui;LI You-lun;SHI Lian;XI Xiu-e;MA Li-ping;WANG Xin;WANG Fei;ZHAO Cai-yan;WANG Fu-rong;CHEN Sen-lin;WU Xiang;LI Po;ZHANG Peng;LENG Xue-yan;ZHANG Hai-qing;CAO Wen-li;SHU Wei;SUN Yu-xian;XIE Shi-heng;TIAN Xi-zhong;HUANG Xue-rui;DU Jian;GAO Wei-wei(Beijing Chest Hospital,Capital Medical University,Clinical Center on TB,China CDC,Beijing 101149,China;不详)
出处
《中国防痨杂志》
CAS
CSCD
2021年第4期335-340,共6页
Chinese Journal of Antituberculosis
基金
“十一五”国家科技重大专项(2008ZX10003-015-2)
“十二五”国家科技重大专项(2013ZX10003009-001-007)
“十三五”国家科技重大专项(2018ZX10722302-003)。
关键词
结核
肺
再治疗
分枝杆菌
结核
痰
治疗失败
复发
Tuberculosis
pulmonary
Retreatment
Mycobacterium tuberculosis
Sputum
Treatment failure
Recurrence
