發(fā)布時間：2018-12-07 14:50

【摘要】：目的探討耐多藥肺結(jié)核患者既往治療情況對治療效果的影響。方法采用回顧性分析,診斷為耐多藥肺結(jié)核并接受治療的患者。所有患者均采用含有丁胺卡那、左氧氟沙星、丙硫異煙胺、對氨基水楊酸6個月注射期抗結(jié)核治療方案治療。觀察資料包括患者年齡、抗結(jié)核治療史、治療前痰菌情況、耐藥情況、胸部影像學(xué)資料等數(shù)據(jù),通過X2檢驗分析不同情況下的治療效果,多因素logistic回歸分析治療最終結(jié)果的影響因素。結(jié)果治療6個月末痰菌陰轉(zhuǎn)77例(61.1%);男性痰菌陰轉(zhuǎn)率為55.6%,女性75.0%(X2=4.091,P=0.043)。既往累計治療≤12個月、13~24個月及≥25個月陰轉(zhuǎn)率分別為79.1%、66.7%和40.4%(X2=14.765,P=0.001)。既往有二線藥物治療史患者陰轉(zhuǎn)率為51.6%,無二線藥物治療史陰轉(zhuǎn)率為85.7%(X2=12.343,P0.001)。治療前痰涂片菌量(++)及以下患者陰轉(zhuǎn)率為74.3%,治療前痰涂片菌量(+++)及以上患者陰轉(zhuǎn)率為42.3%(X2=13.173,P0.001)。多因素logistic回歸分析顯示:男性、累計治療時間超過2年、既往有二線藥物抗結(jié)核病史、治療前痰細(xì)菌負(fù)荷量是耐多藥肺結(jié)核患者治療6個月未陰轉(zhuǎn)的獨立危險因素。結(jié)論男性、累計治療時間超過2年、既往有二線藥物抗結(jié)核病史、治療前痰細(xì)菌負(fù)荷量對耐多藥肺結(jié)核患者6個月療效有影響。規(guī)范二線藥物使用,重視耐多藥結(jié)核的初次治療,在治療早期根據(jù)藥敏調(diào)整用藥方案是提高耐多藥肺結(jié)核陰轉(zhuǎn)率和治愈率的關(guān)鍵。
[Abstract]:Objective to investigate the effect of previous treatment on multi-drug resistant pulmonary tuberculosis (MDR). Methods A retrospective analysis was carried out in patients with multi-drug-resistant pulmonary tuberculosis (MDR). All patients were treated with amikacin, levofloxacin, prothiazinamide, and aminosalicylic acid injection for 6 months. The observed data included age of patients, history of anti-tuberculosis treatment, sputum bacteria before treatment, drug resistance, chest imaging data and so on. X2 test was used to analyze the effect of treatment under different conditions. Factors influencing the final outcome of multivariate logistic regression analysis. Results at the end of 6 months, 77 cases (61.1%) were treated with sputum negative conversion, the rate of sputum negative conversion was 55.6% in male and 75.0% in female (X _ 2P _ (4.091) P _ (0.043). The cumulative negative conversion rates of 12 months, 1324 months and 鈮，

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