摘要
目的分析由6种药物组成、疗程为18个月的化疗方案对耐多药肺结核患者的治疗效果,为缩短耐多药肺结核患者的化疗疗程提供依据。方法纳入2009年7月至2015年12月在首都医科大学附属北京胸科医院等20家结核病专科医院确诊为耐多药肺结核的681例患者,按照所采用的化疗方案将患者分为观察组(18个月方案组,515例)和对照组(24个月方案组,166例)。收集治疗中结核分枝杆菌培养、血常规、肝肾功能、心电图检查等结果,观察药物不良反应,评估两组患者的治疗转归(治疗成功、失败、死亡、丢失等)。采用SPSS 22.0软件进行数据的统计学分析,计量资料采用t检验或χ^2检验,计数资料采用χ^2检验;两组患者治疗前有差异的临床指标与治疗成功率间的关系采用logistic回归分析,以P<0.05为差异有统计学意义。结果观察组的治疗成功率(64.66%,333/515)高于对照组(54.22%,90/166)(χ^2=5.818,P=0.002),病死率(2.33%,12/515)低于对照组(5.42%,9/166)(χ^2=4.015,P=0.045)。而两组的失败率(17.06%,92/515;23.49%,39/166)、丢失率(11.46%,59/515;11.45%,19/166)、药物不良反应的总发生率(24.85%,128/515;25.90%,43/166)差异均无统计学意义(χ^2=2.561,P=0.109;χ^2=0.000,P=0.997;χ^2=0.095,P=0.757)。logistic回归分析显示年龄≥50岁[β=0.549,Sx=0.204,Wold χ^2=7.262,P=0.007,OR(95%CI)=1.731(1.161~2.579)]和使用乙胺丁醇[β=0.485,Sx=0.190,Wold χ^2=6.516,P=0.011,OR(95%CI)=1.625(1.114~2.359)]是影响治疗成功率的风险因素。结论采用6种药物组成、疗程为18个月的化疗方案能够达到24个月化还歹案的疗效,并获得较好的治疗成功率,且未增加药物不良反应发生率,具有临床可行性。
Objective We observed and analyzed the effect of 18 months regimen containing 6 drugs in the treatment of multidrug-resistant pulmonary tuberculosis(MDR-PTB)with the purpose to provide evidence for shortening the treatment course of MDR-TB.Methods Six hundred and eighty-one confirmed MDR-TB patients were enrolled from 20 TB specialized hospitals in China from July,2009 to December,2015 among which 515 were treated with the 18 months regimen containing 6 drugs(observation group)and 166 were treated with 24 months regimen containing 5 drugs(control group).Results of TB bacilli culture,complete blood count,hepatic and renal function,electrocardiograph,etc were collected throughout the treatment.The treatment outcome(success,death,failure and lost to follow-up)and adverse effect were assessed at the end of treatment.Data were analyzed using SPSS 22.0 software.Measurement data were analyzed by t test or z test.Enumeration data were analyzed by Chi-square test.The clinical indicator with significant difference before treatment were further analyzed by logistic regression to identify the risk factors associated with treatment success rate.P<0.05 was considered significant difference statistically.Results The treatment success rate(64.66%,333/515)in the observation group was higher than that of the control group(54.22%,90/166)(χ^2=5.818,P=0.002)and the death rate in the observation group(2.33%,12/515)was lower than that of the control group(5.42%,9/166)(χ^2=4.015,P=O.045).The rate of failure(17.86%(92/515)vs 23.49%(39/166))(χ^2=2.561,P=0.109)and lost to follow-up((11.46%,59/515)vs 11.45%(19/166)(χ^2=0.000,P=0.991))were similar between the two groups.The total incidence of adverse reactions in the observation group(24.85%,128/515)was close to that of the control group(25.90%,43/166)(χ^2=0.095,P=0.757).Analysis using logistic regression showed that>50 age(β=0.549,sx=0.204,Wald χ^2=7.262,P=0.007,OR(95%CI)=1.731(1.161-2.579)and selection of ethambutol.(β=0.485,sx=0.190,Wald χ^2=6.516,P=0.011,OR(95%CI)=1.625(1.119-2.
作者
李琦
姜晓颖
高孟秋
刘宇红
杨坤云
阚晓红
梁建琴
田明
刘锦程
崔文玉
刘文
余德美
谭守勇
唐神结
刘玉琴
梁煊
邱丽华
邵世峰
高飞
接力
蔡宝云
卜建玲
马丽萍
刘智
徐麟
杜娟
操敏
高静韬
舒薇
李亮
Li Qi;Jiang Xiaoying;Gao Mengqiu;Liu Yuhong;Yang Kunyun;Kan Xiaohong;Liang Jianqin;Tian Ming;Liu Jincheng;Cui Wenyu;Liu Wen;Yu Demei;Tan Shouyong;Tang Shenjie;Liu Yuqin;Liang Xuan;Qiu Lihua;Shao Shifeng;Gao Fei;Jie Li;Cai Baoyun;Bu Jianling;Ma Liping;Liu Zhi;Xu Lin;Du Juan;Cao Min;Gao Jingtao;Shu Wei;Li Liang(Clinical Center on Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)
出处
《结核病与胸部肿瘤》
2019年第3期173-180,共8页
Tuberculosis and Thoracic Tumor
关键词
结核
抗多种药物性
药物疗法
联合
方案评价
疗效比较研究
Tuberculosis
multidrug-resistant
Drug combined therapy
Regimen evaluation
Efficacy Comparative study
