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预防医学  2018, Vol. 30 Issue (10): 987-991    DOI: 10.19485/j.cnki.issn2096-5087.2018.10.004
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丽水市耐多药肺结核治疗效果及影响因素分析
郭净,刘忠达,张尊敬,叶春富,谢小涛,周光闹,章晓伟
丽水市中医院,浙江 丽水 323000
Efficacy and influencing factors of treatment for multidrug-resistant tuberculosis in Lishui
GUO Jing,LIU Zhong-da,ZHANG Zun-jing,YE Chun-fu,XIE Xiao-tao,ZHOU Guang-nao,ZHANG Xiao-wei
Lishui Hospital of Traditional Chinese Medicine,Lishui,Zhejiang 323000,China
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摘要 目的 了解丽水市耐多药肺结核患者采用标准化治疗方案的治疗效果及影响因素。方法 选取2010年4月—2016年12月丽水市中医院确诊并同意接受标准化方案治疗的耐多药肺结核患者,观察和记录转归情况,采用Logistic回归模型分析转归的影响因素。结果 共纳入耐多药肺结核患者68例,治愈28例,占41.18%;完成疗程9例,占13.23%;治疗失败12例,占17.65%;治疗中断或丢失12例,占17.65%;死亡7例,占10.29%。20例患者发生不良反应23例次,其中18例次停用相关抗结核药物,占78.26%。常见的不良反应为胃肠道反应,其次为肝功能损害。Logistic回归分析结果显示,治疗期间影像学病灶无好转(OR=34.930,95%CI:4.669~261.324)、治疗6个月后痰细菌学未阴转(OR=15.846,95%CI:2.004~125.321)、不良反应造成治疗终止或永久性更改方案(OR=10.762,95%CI:1.134~102.124)是耐多药肺结核患者出现治疗不良结局(失败、死亡和中断或丢失)的影响因素。结论 丽水市耐多药肺结核的治疗成功率不高,治疗期间影像学和细菌学检查结果无好转、不良反应多是影响治疗效果的主要因素。
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郭净,刘忠达,张尊敬,叶春富,谢小涛,周光闹,章晓伟
关键词 耐多药肺结核标准化治疗疗效不良反应    
AbstractObjective To understand the efficacy of standardized treatment for multidrug-resistant tuberculosis(MDR-TB)and the influencing factors for the treatment outcomes in Lishui. Methods From April 2010 to December 2016,MDR-TB patients who were confirmed and agreed to be treated with standardized regimen in Lishui were observed and recorded. Logistic regression model was used to analyze the influencing factors for the treatment outcomes. Results A total of 68 MDR-TB patients were enrolled in the study,of which 28 cases were cured(41.18%),9 cases completed the treatment course(13.23%),12 cases failed(17.65%),12 cases were interrupted or lost(17.65%)and 7 cases(10.29%)died. Adverse drug reaction was observed in 23 cases and treatment was terminated or changed permanently in 18(78.26%)of these cases. The most common adverse reaction was gastrointestinal reactions. The logistic regression analysis showed that the risk factors for adverse outcome(failure,death and interruption or loss)in MDR-TB patients were lesion without improvement in radiography during treatment(OR=34.930,95%CI:4.669-261.324),positive sputum culture for tuberculosis after 6-month treatment(OR= 15.846,95%CI:2.004-125.321)and termination of treatment due to adverse reaction(OR=10.762,95%CI:1.134- 102.124). Conclusion The treatment success rate of MDR-TB is low and this is associated with no improvement in radiography,no negative sputum culture and too many adverse reactions during treatment.
Key wordsMultidrug-resistant tuberculosis    Standardized treatment    Efficacy    Adverse effect
     出版日期: 2018-09-26
ZTFLH:  R521  
基金资助:浙江省科技计划项目(2017C33198);丽水市高层次人才项目(2015RC34)
通信作者: 刘忠达,E-mail:895930458@qq.com   
作者简介: 郭净,硕士,主治中医师,主要从事中西医结合防治结核病工作
引用本文:   
郭净,刘忠达,张尊敬,叶春富,谢小涛,周光闹,章晓伟. 丽水市耐多药肺结核治疗效果及影响因素分析[J]. 预防医学, 2018, 30(10): 987-991.
GUO Jing,LIU Zhong-da,ZHANG Zun-jing,YE Chun-fu,XIE Xiao-tao,ZHOU Guang-nao,ZHANG Xiao-wei. Efficacy and influencing factors of treatment for multidrug-resistant tuberculosis in Lishui. Preventive Medicine, 2018, 30(10): 987-991.
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http://www.zjyfyxzz.com/CN/10.19485/j.cnki.issn2096-5087.2018.10.004      或      http://www.zjyfyxzz.com/CN/Y2018/V30/I10/987
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