中华流行病学杂志
中華流行病學雜誌
중화류행병학잡지
CHINESE JOURNAL OF EPIDEMIOLOGY
2008年
6期
540-544
,共5页
胡屹%蒋伟利%王伟炳%徐飚
鬍屹%蔣偉利%王偉炳%徐飚
호흘%장위리%왕위병%서표
耐多药结核病%直接督导下短程化疗%治疗效果
耐多藥結覈病%直接督導下短程化療%治療效果
내다약결핵병%직접독도하단정화료%치료효과
Multi-drug resistant tuberculosis%Directly observed treatment,short course%Therapeutic effect
目的 描述中国东部两个县农村地区耐药结核病治疗完成情况,评价短程督导化疗对耐药结核病的治疗效果及其影响因素.方法 将德清县182例和灌云县217例菌阳肺结核病患者为研究对象进行队列研究.患者在开始化疗时进入队列并接受问卷调查,在短程督导化疗期间(6-8个月)获得3次随访.药物敏感试验采用WHO推荐的直接比例法.通过χ2检验、Kaplan-Meier生存分析、Cox多元回归等方法分析耐药结核病患者在治疗阶段痰涂片转阴的过程、结局和影响因素.结果 德清县和灌云县耐多药、其他耐药和药物全敏感结核病治愈率分别为58.3%、91.0%、98.7%和51.3%、89.5%、93.5%.耐药类型和既往治疗史是影响耐药结核病治疗效果的主要因素.在耐多药结核病患者中,肝不良反应(RR=0.18,95%CI:0.04～0.69)和既往治疗史(RR=0.26,95%CI:0.07～0.93)严重影响治疗效果;而其他耐药结核病的治疗效果与既往治疗史(RR=0.66,95%CI:0.44～0.98)和病例延误(＞2周)(RR=0.67,95%CI:0.46～0.97)有关.结论 有效监测控制不良反应,发展快速的药物敏感试验并根据耐药类型调整治疗方案是提高耐多药结核病治疗效果的关键.
目的 描述中國東部兩箇縣農村地區耐藥結覈病治療完成情況,評價短程督導化療對耐藥結覈病的治療效果及其影響因素.方法 將德清縣182例和灌雲縣217例菌暘肺結覈病患者為研究對象進行隊列研究.患者在開始化療時進入隊列併接受問捲調查,在短程督導化療期間(6-8箇月)穫得3次隨訪.藥物敏感試驗採用WHO推薦的直接比例法.通過χ2檢驗、Kaplan-Meier生存分析、Cox多元迴歸等方法分析耐藥結覈病患者在治療階段痰塗片轉陰的過程、結跼和影響因素.結果 德清縣和灌雲縣耐多藥、其他耐藥和藥物全敏感結覈病治愈率分彆為58.3%、91.0%、98.7%和51.3%、89.5%、93.5%.耐藥類型和既往治療史是影響耐藥結覈病治療效果的主要因素.在耐多藥結覈病患者中,肝不良反應(RR=0.18,95%CI:0.04～0.69)和既往治療史(RR=0.26,95%CI:0.07～0.93)嚴重影響治療效果;而其他耐藥結覈病的治療效果與既往治療史(RR=0.66,95%CI:0.44～0.98)和病例延誤(＞2週)(RR=0.67,95%CI:0.46～0.97)有關.結論 有效鑑測控製不良反應,髮展快速的藥物敏感試驗併根據耐藥類型調整治療方案是提高耐多藥結覈病治療效果的關鍵.
목적 묘술중국동부량개현농촌지구내약결핵병치료완성정황,평개단정독도화료대내약결핵병적치료효과급기영향인소.방법 장덕청현182례화관운현217례균양폐결핵병환자위연구대상진행대렬연구.환자재개시화료시진입대렬병접수문권조사,재단정독도화료기간(6-8개월)획득3차수방.약물민감시험채용WHO추천적직접비례법.통과χ2검험、Kaplan-Meier생존분석、Cox다원회귀등방법분석내약결핵병환자재치료계단담도편전음적과정、결국화영향인소.결과 덕청현화관운현내다약、기타내약화약물전민감결핵병치유솔분별위58.3%、91.0%、98.7%화51.3%、89.5%、93.5%.내약류형화기왕치료사시영향내약결핵병치료효과적주요인소.재내다약결핵병환자중,간불량반응(RR=0.18,95%CI:0.04～0.69)화기왕치료사(RR=0.26,95%CI:0.07～0.93)엄중영향치료효과;이기타내약결핵병적치료효과여기왕치료사(RR=0.66,95%CI:0.44～0.98)화병례연오(＞2주)(RR=0.67,95%CI:0.46～0.97)유관.결론 유효감측공제불량반응,발전쾌속적약물민감시험병근거내약류형조정치료방안시제고내다약결핵병치료효과적관건.
Objective To investigate the therapeutic efficacy of short course chemotherapy (SCC)on drug resistant tuberculosis (DR-TB) cases and related influencing socioeconomic factors. TB patients registered in local county TB dispensaries of two rural counties were followed up in Deqing and Guanyun of Eastern China, during 2004/2005. Methods Culture-positive patients (Deqing: 182, Guanyun: 217)were selected as subjects of this study. A cohort of TB patients was established at the beginning of their treatment and each patient was followed-up three times by questionnaires. Proportional method of drug susceptibility test was used to define the resistance to the 1st-line anti-TB drugs.χ2 test Kaplan-Meier method and Cox analysis were applied in multivariate analysis to investigate the negative conversion of smear positive sputum, treatment result of SCC and its socioeconomic influencing factors. Results The cure rates of multi-drug resistant TB (MDR-TB),other drug resistant TB (ODR-TB) and pan-drug susceptible TB,were 58.3%, 91.0%, 98.7% and 51.3%, 89.5%, 93.5% respectively in Deqing and Guanyun. The liver dysfunction (RR = 0.18, 95% CI:0. 04-0. 69 ) and previous treatment history (RR = 0.26,95% CI:0.07-0.93) were associated with treatment result among MDR-TB. Result on treatment in ODR-TB was influenced by previous treatment history (RR = 0.66, 95% CI:0. 44-0. 98 ) and Patient delay (＞2 weeks)(RR = 0.67, 95% CI: 0.46-0.97). Conclusion The priority in treating MDR-TB would include:managing side effect, developing the fast sensitive drug susceptibility test and modifying the treatment regimen corresponding to drug resistance.
