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目的掌握深圳市耐多药结核病(multi-drug resistant tuberculosis,MDR-TB)治疗转归情况,分析治疗未成功的主要原因,为进一步完善深圳市耐多药结核病防控措施提供科学依据。方法以2006年10月—2013年10月期间确诊的MDR-TB患者为研究对象,患者治疗前经专家组评估后,实施个体化治疗和全程督导服药管理。患者治疗转归由专家组根据判定标准讨论确定。对患者治疗转归情况和治疗未成功的原因进行描述性分析和单因素分析。结果纳入项目治疗的MDR-TB患者165例,治愈99例(60.0%),完成治疗10例(6.1%),治疗未成功56例(33.9%),治疗成功率为66.1%。治疗未成功的主要原因是因药物不良反应和患者主观因素(丢失、拒治、拒绝复查、迁出、自杀死亡)导致的停止继续治疗,分别占到25.0%(14/56)和62.5%(35/56)。结论药物不良反应和患者主观因素是导致深圳市MDR-TB患者治疗未成功的主要原因,应针对性制定和实施相应的防治措施,可取得更好的治疗效果。
Objective To understand the outcome of treatment of multi-drug resistant tuberculosis (MDR-TB) in Shenzhen and to analyze the main reasons for the failure of treatment and provide a scientific basis for further prevention and control of MDR-TB in Shenzhen. Methods The patients diagnosed as MDR-TB from October 2006 to October 2013 were selected as the research objects. Before the treatment, the patients were evaluated by the expert group, and individualized treatment and medication administration were conducted throughout the whole process. The patient’s treatment outcome is decided by the expert group based on the criteria. Descriptive analysis and univariate analysis were performed on the outcome of patients’ treatment and the reason of unsuccessful treatment. Results A total of 165 patients with MDR-TB were enrolled in this study. Among them, 99 (60.0%) were cured, 10 (6.1%) completed the treatment, and 56 (33.9%) failed to complete the treatment. The success rate was 66.1%. The main reasons for the unsuccessful treatment were discontinuation of treatment due to adverse drug reactions and subjective factors (loss, rejection, refusal, relocation, suicide), accounting for 25.0% (14/56) and 62.5% (respectively) 35/56). Conclusion Adverse drug reactions and patient subjective factors are the main reasons leading to the failure of MDR-TB patients in Shenzhen. Corresponding prevention and treatment measures should be formulated and implemented to achieve better therapeutic effects.