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目的了解住院的首次复治肺结核病人的基本情况,为制定规范合理的化疗方案,提高治愈率和加强防治管理工作提供依据。方法回顾性调查和分析2003年1月—2005年12月在上海市肺科医院住院的肺结核病人中属于首次复治的病人的临床特点和导致复治的可能危险因素。结果首次复治病人498例,占同期所有住院肺结核病人的13.1%。涂阳病人占52.8%。S,H,R,E耐药率分别为34.8%,46.8%,28.4%和24.8%。同时耐异烟肼利福平者占26.2%。51.7%有不同程度的合并症,其中以合并糖尿病、肝脏基础疾病及低蛋白血症最为常见。有81例次在本次住院前后发生了药物不良反应。35.1%的患者有不规则治疗史,导致不规则治疗原因以药物不良反应为最多见。本市初次复治病人以45岁以上年龄组(70%)为多,特别是60岁以上占43.7%。非本市病人在小于45岁年龄组占60%以上。结论住院治疗的首次复治病人有其特殊性。耐药、基础情况差、合并症多、合并有肺外结核、营养不良、药物不良反应多及不规则治疗可能是导致复治肺结核的危险因素。
Objective To understand the basic situation of the first re-treatment of tuberculosis patients in hospital and provide the basis for standardizing reasonable chemotherapy regimen, improving cure rate and strengthening prevention and control. Methods The clinical characteristics and the possible risk factors of retreatment were retrospectively investigated and analyzed in patients with first-episode pulmonary tuberculosis who were hospitalized in Shanghai Pulmonary Hospital from January 2003 to December 2005. Results The first retreatment patients 498 cases, accounting for 13.1% of all hospitalized tuberculosis patients in the same period. Smear positive patients accounted for 52.8%. The resistance rates of S, H, R and E were 34.8%, 46.8%, 28.4% and 24.8%, respectively. At the same time resistant isoniazid rifampicin accounted for 26.2%. 51.7% had different degrees of comorbidities, of which the most common were diabetes mellitus, liver diseases and hypoproteinemia. 81 cases occurred in this hospital before and after adverse drug reactions. 35.1% of patients have irregular treatment history, leading to irregular treatment of the most adverse drug reactions. The city’s first re-treatment of patients over the age group of 45 (70%) as more, especially over the age of 60 accounted for 43.7%. Non-city patients in less than 45 years of age group accounted for more than 60%. Conclusion The first hospitalized retreatment patients have their own particularity. Drug resistance, poor basic conditions, multiple complications, combined with extrapulmonary tuberculosis, malnutrition, adverse drug reactions and irregular treatment may be the risk factors for re-treatment of tuberculosis.