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目的:结合平谷区自然环境与人口特点,对平谷区耐多药结核病的病人发现与治疗管理现状进行分析,为区县级单位耐多药结核病控制提供依据。方法:收集并整理2008-2015年平谷区耐药结核病患者的诊疗转归记录,计算出耐多药肺结核的检出率,分析患者耐药分布情况及治疗转归情况。结果:12008-2015年共计耐多药患者18人,其中初治11例,占比61.11%;复治7例,占比38.89%。22008-2015年确诊18例MDR-TB患者,除异烟肼和利福平外的其他药物中,出现链霉素耐药者居有15例,乙胺丁醇耐药者10例,左氧氟沙星耐药者7例,丙硫异烟胺3例,对氨基水杨酸耐药2例,阿米卡星耐药1例。3确诊MDR-TB的18例患者中,初治患者11例,纳入MDR-TB项目管理5例(治愈4例,治疗中1例);其余患者6例:一线方案延长治愈2例、北京市胸科医院治疗1例、回原籍1例、死亡1例、1例因患糖尿病肾病未能纳入该项目管理,而采用M微卡免费治疗半年。复治7例,纳入MDR-TB项目管理3例(治愈2例,治疗中1例);其余患者4例:死亡3例,等待1例。4药物不良反应发生情况。治疗的9例MDR-TB患者中,出现高尿酸血症1人,听力肾功能异常1人,停用PZA治疗。52008-2015年,接受规范治疗的MDR-TB患者治疗满6个月全部涂片培养阴性,且12月及18月痰检均阴性。结论:如何普及结核病防治知识,及早发现结核病患者,及时发现并确诊MDR-TB患者,及时确定合理的化疗方案,督促患者进行规范化治疗。在治疗过程中,密切观察不良反应等,是区县级结防单位治疗管理耐多药结核病的工作重点。
OBJECTIVE: To analyze the status quo of patient discovery and treatment and management of MDR-TB in Pinggu District by combining the characteristics of natural environment and population in Pinggu District, and to provide basis for the control of MDR-TB in district and county level. Methods: The records of diagnosis and treatment of drug-resistant TB patients in Pinggu District during 2008-2015 were collected and analyzed. The detection rate of multidrug-resistant pulmonary tuberculosis was calculated, and the distribution of drug resistance and the outcome of treatment were analyzed. Results: A total of 18 MDR patients were recruited from 12008 to 2015, of which 11 were newly diagnosed, accounting for 61.11%. Retreatment was performed in 7 cases, accounting for 38.89%. 22008 - In 2015, 18 patients with MDR-TB were diagnosed. Among the drugs except isoniazid and rifampicin, 15 were streptomycin-resistant, 10 were resistant to ethambutol, 10 were levofloxacin 7 cases of drug, 3 cases of propylthiouracil, 2 cases of resistance to aminosalicylic acid, 1 case of amikacin resistance. Among the 18 patients diagnosed with MDR-TB, 11 were newly diagnosed and included 5 cases of MDR-TB project management (4 cases were cured and 1 case was treated); the remaining 6 cases were cured by extension of first-line program and 2 cases were cured by Beijing First Hospital Thoracic hospital treatment in 1 case, back to the origin in 1 case, 1 case of death, 1 case of diabetic nephropathy failed to be included in the project management, and the use of M micro-card free treatment for six months. Retreatment in 7 cases, included in MDR-TB project management in 3 cases (cured 2 cases, 1 case of treatment); the remaining 4 patients: 3 died, waiting for 1 case. 4 adverse drug reactions occurred. Treatment of 9 patients with MDR-TB patients, one person with hyperuricemia, hearing loss of renal dysfunction, disable PZA treatment. 52008 - In 2015, MDR-TB patients receiving normative treatment were negative for all smears cultured for 6 months and sputum tests were negative for both December and 18 months. Conclusion: How to popularize knowledge of tuberculosis prevention and control, early detection of tuberculosis patients, timely detection and diagnosis of MDR-TB patients, promptly determine a reasonable chemotherapy regimen, and urge patients to standard treatment. In the course of treatment, close observation of adverse reactions, is the district and county units of tuberculosis prevention and treatment of multi-drug-resistant tuberculosis work priorities.