34例未纳入全球基金耐多药结核病项目治疗的耐多药肺结核患者分析

摘要

目的 分析耐多药结核病(MDR-TB)患者未纳入全球基金耐多药结核病项目(以下简称项目)治疗的原因,为未纳入该项目患者的干预提供依据.方法 2012年3月-2014年6月,以兰州地区770例MDR-TB可疑者中筛选的MDR-TB患者76例为研究对象,由专家小组根据患者一般情况、痰菌、实验室检查结果和既往用药史,决定患者是否纳入项目,据此将患者分为纳入组(42例)和未纳入组(34例).采用比例法进行药敏试验,包括异烟肼(INH,H)、利福平(RFP,R)、乙胺丁醇(EMB,E)、链霉素(SM,S)、氧氟沙星(OFLX,Ofx)、卡那霉素(KM,Km)、丁胺卡那霉素(AMK,Am)、卷曲霉素(CPM,Cm)等8种药物.结果 未纳入组患者青年6例,中年19例,老年9例.两组年龄分布、治疗史构成比较,差异有统计学意义(P<0.05).34例未纳入组患者共有9种不同形式的耐多药组合,17例患者仅对一线药物耐药,耐药谱组合顺位第1位是H+R+S(8例),其次是H+R(6例);17例患者对包含二线药物的组合耐药,耐药谱组合顺位第1位是H+R+S+Ofx(8例),其次为H+R+E+S+Ofx(5例).34例患者未纳入项目原因为,死亡6例,拒绝治疗4例,失访2例,维持原方案2例,排除1例,其他原因19例(包括羁押人员8例,年龄>65岁且有不同基础疾病5例,严重肝、肾损伤或其他合并症及并发症5例,药敏结果报告出来时项目已截止1例).结论 在未纳入项目的MDR-TB患者防治中,应重视二线抗结核药物,重点关注老年人、羁押人员等在内的脆弱人群.%Objective To analyze the reasons of the patients with multidrug-resistant tuberculosis (MDR-TB) excluded from the Tuberculosis Control Project supported by Global Fund,so as to provide evidences for the treatment of these patients.Methods The participants enrolled were 76 cases with MDR-TB selected from 770 suspicious cases in Lanzhou from March 2012 to June 2014.They were divided into included group(n=42) and non-included group(n=34) by the panel of experts based on the baseline characteristics,bacteria culture,results of auxiliary examination,and drug treatment history.The susceptibility to isoniazid(INH,H),rifampicin (RFP,R),ethambutol (EMB,E),streptomycin(SM,S),ofloxacin (OFLX,Ofx),kanamycin (KM,Km),amikacin (AMK,Am),capreomycin (CPM,Cm) was tested by the proportional method.Results Of the 34 patients in the non-included group,6 were young,19 were middle-aged,and 9 were aged.The age distribution and treatment history differed significantly between the two groups(P<0.05).The 34 patients in the non-included group had 9 kinds of antibiotic resistance combination;17 were only resistant to first-line anti-tuberculosis drugs,the first combination of antibiotic resistance spectrum was H+R+S(8 cases),and the second was H+R(6 cases);other 17 cases were resistant to both first-line and second-line anti-tuberculosis drugs,the first combination of antibiotic resistance spectrum was H+R+S+Ofx(8 cases),and the second was H+R+E+S+Ofx(5 cases).The 34 patients excluded from the Project was due to death(6 cases),refusing to receive that kind of treatment(4 cases),lost to follow up (2 cases),insisting on using the original treatment(2 cases),1 was excluded,detaining(8 cases),aged over 65 and with different chronic basic diseases(5 cases),severe liver or kidney injury or other comorbidities and complications(5 cases),the coming out time of results of antibiotic susceptibility was later than the included time of the Project(1 case).Conclusion It is necessary to pay great attention to using the second-line anti-tuberculosis drugs in the control and treatment of MDR-TB patients whose treatment was excluded from the Project.Besides,vulnerable population including elderly and detained patients should also be focused on.