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目的:评价痰菌阳性肺结核患者早期个性化抗结核治疗对预防难治性肺结核的疗效。方法:选取2014年1月—2015年12月间收治的痰涂片抗酸杆菌阳性病例314例和非结核分枝杆菌肺病患者12例(共326例);将研究分为3个研究6组,即60岁以上患者180例分为2组;肺部病变范围比较广泛的患者75例分为2组;有并发症的肺结核患者58例分为2组;上述3个研究中的对照组患者149例与病灶范围肺叶数≤2和年龄<60岁、无并发症的患者83例对照;对治疗2周痰菌减少不明显的、治疗4周痰菌仍然阳性的或治疗4周CT检查结果示肺部病变吸收不明显的患者,在原来治疗方案的基础上及早加用新的抗结核药物;治疗2月时痰涂片抗酸杆菌阳性患者视为难治性肺结核。结果:早期个性化治疗组患者治疗2月时痰涂片抗酸杆菌阳性患者明显少于对照组(P<0.05)。结论:对具有难治性肺结核高危因素的痰菌阳性患者采取早期个性化治疗,可预防其转变成难治性肺结核。
Objective: To evaluate the curative effect of early individualized antituberculosis therapy on the prevention of refractory pulmonary tuberculosis in sputum positive pulmonary tuberculosis patients. Methods: A total of 314 sputum smear-positive sputum smears and 12 non-tuberculous mycobacterium tuberculosis patients (326 cases) were selected from January 2014 to December 2015. The study was divided into three groups of 6 , That is, 60 patients over the age of 180 were divided into two groups; lung lesions in a wide range of patients divided into two groups of 75; 58 cases of tuberculosis with complications were divided into two groups; the three study patients in the control group 149 cases and the lesion range of lung leaf count ≤ 2 and age <60 years, 83 cases of patients without complications; no significant reduction of sputum for 2 weeks after treatment, 4 weeks of sputum is still positive or 4 weeks after the CT examination results Indications for lung lesions were not obvious in patients with the original treatment based on the early application of new anti-TB drugs; treatment February sputum smear positive acid-fast bacilli in patients with tuberculosis as refractory. Results: Patients in the early personalized therapy group were significantly less sputum smear positive for acid-fast bacillus than those in the control group at 2 months (P <0.05). Conclusion: Early personalized treatment of sputum positive patients who have high risk factors for refractory pulmonary tuberculosis may prevent their conversion to refractory pulmonary tuberculosis.