本文選題：結(jié)核 + 耐多藥��； 參考：《大連醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:分析和評(píng)價(jià)大連市全球基金耐多藥結(jié)核防治領(lǐng)域?qū)嵤┣闆r,為進(jìn)一步建立規(guī)范和科學(xué)的耐多藥結(jié)核防治技術(shù)策略提供依據(jù)。方法:采用比例法對(duì)INH(異煙肼)、RFP(利福平)、Am(阿米卡星)、Cm(卷曲霉素)、Lfx(左氧氟沙星)、Mfx(莫西沙星)、PAS(對(duì)氨基水楊酸)、Pto(丙硫異煙胺)、EMB(乙胺丁醇)等9種藥物進(jìn)行耐藥檢測(cè)。對(duì)篩選出的耐多藥結(jié)核和廣泛耐藥結(jié)核納入全球基金耐多藥項(xiàng)目治療。將完成12月療程的118例耐多藥結(jié)核病人分為MDR(耐多藥)、Pre-XDR(廣泛耐藥前期)、XDR(廣泛耐藥)作為研究對(duì)象。每月復(fù)查體溫、痰結(jié)核菌涂片、痰結(jié)核菌培養(yǎng)、血常規(guī)、ESR(紅細(xì)胞沉降率)、CRP(C-反應(yīng)蛋白)、PCT(降鈣素原)、肝功、腎功、電解質(zhì)和體重。每3個(gè)月復(fù)查1次胸片。TSH(促甲狀腺激素)、聽(tīng)力、視力如有異常及時(shí)復(fù)查。痰結(jié)核菌涂片陰轉(zhuǎn)率,痰結(jié)核菌培養(yǎng)陰轉(zhuǎn)率及副反應(yīng)發(fā)生率,采用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)分析,采用卡方檢驗(yàn)。痰菌陰轉(zhuǎn)的變化采用Excel進(jìn)行曲線分析。結(jié)果:MDR經(jīng)12個(gè)月治療后,6個(gè)月末與12個(gè)月末痰涂片與痰培養(yǎng)的陰性率比較,痰涂片陰性率分別為6個(gè)月末82.6%(38/46)及12個(gè)月末78.3%(36/46)。痰培養(yǎng)陰性率6個(gè)月末84.8%(39/46)及12月末痰培養(yǎng)陰性率73.9%(36/46),無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。Pre-XDR經(jīng)治療,6月末痰菌陰轉(zhuǎn)率達(dá)到82.4%(42/51),明顯高于12個(gè)月末痰培養(yǎng)陰性率66.7%(34/51),X 2=0.97,P0.01,差異有統(tǒng)計(jì)學(xué)意義。痰涂片6個(gè)月末陰轉(zhuǎn)率為82.4%(42/51),12個(gè)月末時(shí)為72.5%(37/51),差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。XDR組6個(gè)月末與12個(gè)月末痰涂片陰性率分別為81.0%(17/21)和71.4(15/21),痰培養(yǎng)的陰性率6個(gè)月末76.2%(16/21),12個(gè)月末陰性率為76.2%(16/21),差異無(wú)統(tǒng)計(jì)學(xué)意義,均P0.05。耐多藥結(jié)核按照治療前登記類型分為初治、復(fù)治和慢傳三組,分別考核化療效果。在治療12個(gè)月末三組間的痰涂片和培養(yǎng)陰性率的比較中,初治較復(fù)治、慢傳的差異均有統(tǒng)計(jì)學(xué)意義,X 2值分別為4.50,7.71,5.08和4.73,均P0.05。藥物不良反應(yīng)探究中,XDR方案組的電解質(zhì)紊亂71.4%(15/21)和胃腸道反應(yīng)66.7%(14/21)明顯高于MDR方案組電解質(zhì)紊亂13.4%(13/97)和胃腸道反應(yīng)44.3%(43/97),有明顯的統(tǒng)計(jì)學(xué)意義,X 2值分別為31.84和3.42,P0.05。經(jīng)抗結(jié)核治療12個(gè)月后,病變總體顯著吸收率和好轉(zhuǎn)率分別為48.3%(57/118)、24.6%(29/118)。結(jié)論:大連市全球基金耐多藥項(xiàng)目實(shí)施進(jìn)展順利,中期療效痰菌陰轉(zhuǎn)率達(dá)到預(yù)期成果。進(jìn)行早期發(fā)現(xiàn)和早期治療,是提高耐多藥結(jié)核治愈率的有效途徑。Pre-XDR治療需得到足夠重視,采用MDR化療方案具有一定風(fēng)險(xiǎn)。
[Abstract]:Objective: to analyze and evaluate the implementation of MDR-TB prevention and treatment in Dalian Global Fund, and to provide the basis for further establishment of standardized and scientific strategy for MDR-TB prevention and treatment. Methods: the resistance of INH (isoniazid) and RFP (rifampicin) am (crithromycin) Lfx (levofloxacin) Mfx (moxifloxacin) and pas (p-aminosalicylic acid) Pto (propyl isoniacinamide) EMB (ethambutanol) were determined by proportional method. Selected MDR TB and XDR-TB are included in the Global Fund MDR program. A total of 118 patients with MDR were divided into two groups: MDR (multidrug resistance) Pre-XDR (pre-drug resistance) and XDR (extensive drug resistance). Body temperature, sputum smear, sputum culture, erythrocyte sedimentation rate, CRP (C-reactive protein), liver function, renal function, electrolyte and body weight were reviewed monthly. Every 3 months, chest radiographs. TSH (thyroid stimulating hormone), hearing, visual acuity if abnormal timely review. The sputum smear negative conversion rate, sputum tuberculous bacteria culture negative conversion rate and side effects were analyzed by SPSS 19.0 software and chi-square test. The changes of sputum negative transformation were analyzed by Excel. Results the negative rate of sputum smear and sputum culture was 82.6% (38 / 46) at the 6th month and 78.3% (36 / 46) at the 12th month after 12 months treatment. The negative rate of sputum culture was 84.8% (39 / 46) at the end of 6 months and 73.9% (36 / 46) at the end of December. The negative rate of sputum culture was 82.4% (42 / 51) at the end of 6 months, which was significantly higher than that of 66.7% (34 / 51) at the end of 12 months (P 0.01). The negative rate of sputum smear was 82.4% (42 / 51) at the end of 6 months and 72.5% (37 / 51) at the end of 12 months. The negative rate of sputum smear was 81.0% (17 / 21) and 71.4% (15 / 21) in 6 month and 12 month groups respectively in P0.05.XDR group. The negative rate of sputum culture was 76.2% (16 / 21) at the end of 6 months, and 76.2% (16 / 21) at the end of 12 months. There is no statistical significance. Average P0.05. Multidrug resistant tuberculosis (MDR) was divided into three groups according to the type of registration before treatment: primary treatment, relapse and slow transmission. In the comparison of sputum smear and culture negative rate between the three groups at the end of 12 months of treatment, the difference of the initial treatment was higher than that of the re-treatment, and the difference of slow transmission was statistically significant (P < 0.05). The difference of the two groups was 4.50 ~ 7.71 ~ 5.08 and 4.73, respectively. The electrolyte disturbance and gastrointestinal reaction in XDR group were 71.4% (15 / 21) and 66.7% (14 / 21), respectively, which were significantly higher than those in MDR group (13.4% (13 / 97) and 44.3% (43 / 97). After 12 months of antituberculous treatment, the overall absorption rate and improvement rate were 48.3% (57 / 118) and 24.6% (29 / 118), respectively. Conclusion: the implementation of multi-drug resistance project in Dalian Global Fund is progressing smoothly and the sputum negative rate of the mid-term curative effect has reached the expected results. Early detection and early treatment is an effective way to improve the cure rate of MDR tuberculosis.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R52;R183

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