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目的通过对四川省2009-2014年6年间发现的耐多药肺结核患者的治疗和管理效果分析,探索适合四川省的耐多药结核病治疗管理策略,提高耐多药结核病患者治疗成功率。方法收集四川省6年间耐多药结核病监测季报表、年报表及全球基金结核病项目数据库,进行回顾性分析研究。结果 6年间四川省共确诊565例耐多药肺结核患者,纳入治疗412例(72.92%),新患者中MDR-TB患者纳入治疗的比例高于复治患者,91.26%的患者采用标准化治疗方案治疗,6月末培养阴转率79.95%,12月末培养阴转率63.28%,治疗成功率28%,新患者治疗成功率高于复治患者,差别有统计学意义(χ2=60.25,P<0.05);标准化治疗患者治疗成功率高于个体化治疗患者,差别有统计学意义(χ2=4.72,P<0.05)。治疗失败的原因中不良反应导致的失败占比例最大。未纳入治疗患者中拒治患者比例最高。结论四川省耐多药结核病患者纳入治疗率、6月末及12月末培养阴转率均较高,但治疗成功率较低,应加强MDR-TB患者第二年疗程的治疗管理。新患者中MDR-TB患者纳入治疗率和治疗成功率均高于复治患者,在新患者中开展MDR-TB筛查有一定意义。在制定MDR-TB患者治疗时应优先采用标准化治疗方案。
Objective To explore the treatment and management of MDR-TB patients in Sichuan province in 2009-2014, and to explore strategies for the management and treatment of MDR-TB in Sichuan and to improve the success rate of MDR-TB treatment. Methods Six years of Sichuan Province collected the quarterly reports of MDR-M monitoring quarterly, the annual reports and the Global Fund for Tuberculosis Project database for retrospective analysis. Results A total of 565 MDR-TB patients were diagnosed in Sichuan Province during the past 6 years. 412 cases (72.92%) were included in the treatment. The proportion of MDR-TB patients in the new patients was higher than that in the retreatment patients, and 91.26% were treated by standardized treatment , The negative conversion rate was 79.95% at the end of June, the negative conversion rate was 63.28% at the end of December, and the successful treatment rate was 28%. The successful rate of new patients was higher than that of retreatment patients (χ2 = 60.25, P <0.05) ; The standardized treatment of patients with higher success rate than individualized treatment, the difference was statistically significant (χ2 = 4.72, P <0.05). Among the causes of treatment failure, adverse reactions caused the largest proportion of failures. Not included in the treatment of patients refused to treat the highest proportion of patients. Conclusions Incidence rates of MDR-TB patients in Sichuan province are high, and the negative rates of culture are higher in late June and the end of December, but the success rate of treatment is lower. The second year of MDR-TB treatment should be strengthened. MDR-TB patients with new patients included in the treatment rate and treatment success rate were higher than patients with re-treatment, MDR-TB screening in new patients have some significance. In developing MDR-TB patients should give priority to standardized treatment.