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目的分析湖南省中国全球基金耐多药结核病项目患者治疗情况,为今后耐多药肺结核患者的治疗提供参考依据。方法分析2011年2月1日—2013年12月31日湖南省确诊的耐多药肺结核患者纳入治疗及治疗转归情况。共确诊377例耐多药肺结核患者,285例纳入项目进行标准化方案6Z-Km(Cm)-Lfx-Pto-PAS(Cs)/18Z-Lfx-Pto-PAS(Cs)治疗,纳入率75.6%。结果治疗成功率(治愈+完成治疗)60.7%(173/285);女性治疗成功率(治愈+完成治疗)为69.7%(53/76),死亡患者均为男性共12例,不同性别的治疗成功率间差异无统计学意义(P=0.060)。<20岁年龄组治疗成功率(治愈+完成治疗)最高为73.3%(11/15);≥60岁年龄组治疗成功率最低为44.4%(4/9),各年龄组治疗成功率间差异有统计学意义(Z=-3.007,P=0.003)。不同登记分类中,初治失败者治疗成功率最高为81.8%(18/22),复治失败者治疗成功率较低为53.9%(89/165),不同登记类别患者治疗成功率间差异有统计学意义(Fisher确切概率法P=0.018)。新患者治疗成功率为72.4%(21/29),既往使用过一线抗结核药患者治疗成功率为71.1%(108/152),既往使用过一线+二线抗结核药患者治疗成功率为42.3%(44/104),不同用药史患者治疗成功率差异间有统计学意义(P<0.001)。结论在目前实验室开展二线药敏试验能力和资源有限的条件下,对于同一类别的所有患者使用同一治疗方案的标准化治疗策略是可行的。
Objective To analyze the treatment of MDR-TB patients in China Global Fund for Hunan Province and provide reference for the future treatment of MDR-TB patients. Methods From January 1, 2011 to December 31, 2013, the diagnosis and treatment outcome of patients with MDR-TB confirmed in Hunan Province were analyzed. A total of 377 patients with MDR-TB were diagnosed, and 285 patients were enrolled in the project for standardization of 6Z-Km (Cm) -Lfx-Pto-PAS (Cs) / 18Z-Lfx-Pto-PAS (Cs) Results The success rate of treatment (cure + completion of treatment) was 60.7% (173/285). The success rate of treatment of women (cure + completion of treatment) was 69.7% (53/76). All the deaths were male The difference between the success rates was not statistically significant (P = 0.060). The highest success rate (cure + complete treatment) in the 20-year-old group was 73.3% (11/15), the lowest in the 60-year-old group was 44.4% (4/9), the difference between the success rates of each age group There was statistical significance (Z = -3.007, P = 0.003). Among the different registration categories, the successful treatment rate of the newly diagnosed losers was the highest (81.8%, 18/22), and the failure rate of the relapse-controlled patients was 53.9% (89/165). The difference in success rates among the different registered categories was Statistical significance (Fisher exact test P = 0.018). The successful treatment rate of new patients was 72.4% (21/29). The success rate of first-line anti-TB drugs was 71.1% (108/152). The successful rate of first-line and second-line anti-TB drugs was 42.3% (44/104). There was a statistically significant difference in the success rate of treatment between patients with different medication history (P <0.001). CONCLUSIONS Given the current laboratory’s ability and resources to conduct second-line susceptibility testing, standardized treatment strategies using the same regimen are feasible for all patients in the same category.