Objective To investigate the clinical curative effect and outcomes of multidrug-resistant tuberculosis (MDR-TB) in elderly patients.Methods Forty-seven elderly patients with MDR-TB aged above 65 were enrolled and 79 younger patients with MDR-TB aged between 16 and 65 during the same period served as the control group.Clinical data,clinical curative effect and adverse drug reactions of treatment were recorded,and the data of the two-groups were compared using Chi-square tests.Results Compared with those of the younger patients,the clinical symptoms of the elderly patients showed no significant differences except cough,expectoration and shortness of breath.The proportion of complication in the elderly patients (63.83 ％,30/47)was significantly higher than that in the younger group(18.99％,15/79).The proportion patients retreated and irregularly treated in the elderly group(95.74％,45/47;80.85％,38/47)was significantly higher than that in the younger group(77.22％,61/79;49.37％,39/79) (x2 =7.571,P ＜0.05;x2 =12.291,P ＜0.05).The proportion of the patients with lesions involving greater than 3 lung fields in the elderly group was 72.34％ (34/47),higher than that in the younger group (45.57％,36/79).The treatment success rate in the elderly MDR-TB group was 38.30％ (18/47),lower than that in the younger group(62.03％,49/79).The death rate in the elderly group(17.02％,8/47) was significantly higher than that in the younger group(1.27％,1/79)(x2 =7.754,8.773,P ＜ 0.05).The incidences of gastrointestinal reaction,liver injury and leukocytopenia in the elderly group(21.28％,10/47;27.66％,13/47;17.02％,8/47)were higher than those in the younger group (8.86％,7/79;12.67％,10/79;3.80％,3/79) (x2 =3.892,P ＜0.05;x2 =4.444,P ＜0.05;x2 =4.911,P ＜0.05).Compared with the younger patients,the drug resistance of the elderly patients showed no significant differences except levofloxacin resistance.Conclusions The clinical symptoms of multi-drug resistant pulmonary tuberculosis in the elderly patients was not typical.In elderly patients with MDR-TB,the pulmonary lesions were extensive,the number of complication and the incidence of adverse reactions were higher.The degree of drug resistance was severer and the clinical curative effect was bad for elderly patients with MDR-TB.%目的 探讨老年耐多药肺结核患者的临床疗效及其转归.方法 收集126例有完整资料的住院耐多药肺结核患者的临床资料,将其分为老年组47例(年龄≥65岁)和中青年组79例(年龄16～＜65岁).分析两组患者的临床表现、治疗情况以及不良反应的情况等.结果 老年组的症状以咳嗽咳痰和胸闷气喘为主,其他症状与中青年组比较差异无统计学意义.老年组伴有合并症(63.83％,30/47)显著高于中青年组(18.99％,15/79).老年组中有既往抗结核病史和不正规治疗的患者(95.74％,45/47;80.85％,38/47)显著高于中青年组(77.22％,61/79;49.37％,39/79),差异有统计学意义(x2=7.571,12.291,均P＜0.05).老年组的肺部病灶广泛,大于3个肺野的患者(72.34％,34/47)显著高于中青年组患者(45.57％,36/79).老年组的治愈率(38.30％,18/47)低于中青组(62.03％,49/79),病死率(17.02％,8/47)高于中青组患者(1.27％,1/79),两组间比较差异有统计学意义(x2=7.754,8.773,P＜0.05).消化道反应、肝功能损害、血白细胞减少在老年组患者中的发生率分别为21.28％ (10/47)、27.66％(13/47)和17.02％ (8/47),明显高于中青年组的8.86％ (7/79)、12.67％ (10/79)和3.80％ (3/79),两组比较差异有统计学意义(x2值分别为3.892、4.444和4.911,均P＜0.05).老年组对左氧氟沙星耐药的患者(68.09％,32/47)显著高于中青年组患者(34.18％,27/79),其他耐药情况差异无统计学意义.结论 老年耐多药肺结核患者临床特征不典型,肺部病灶常伴有多发空洞,合并症较多,不良反应发生概率高,耐药程度高,临床疗效欠佳.
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