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目的探讨耐多药肺结核临床特点,为武汉市耐多药肺结核防治提供依据。方法采取回顾性分析,对2015年武汉市肺科医院耐多药结核病病区确诊的所有耐多药肺结核患者临床资料及耐药情况等进行分析。结果耐多药结核病(multi-drug resistance tuberculosis,MDR-TB)仍然以获得性耐药为主,占72.88%;早期广泛耐药结核(pre-extensively drug-resistant tuberculosis,pre-XDR-TB)占33.90%,其中以耐氟喹诺酮类为主,占pre-XDR-TB中85.71%;广泛耐药结核(extensively drug-resistant tuberculosis,XDR-TB)占4.24%。MDR-TB治疗过程中药物不良反应发生率非常高,其中以关节肿痛最常见(81.36%)。MDR-TB治疗满12月总的痰菌培养阴转率为68.87%,其中MDR-TB(不含pre-XDR-TB及XDR-TB)、pre-XDR-TB、XDR-TB疗程满12月痰菌培养阴转率分别为81.25%、54.05%、20.00%;MDR-TB与pre-XDR-TB之间痰菌培养阴转差异有统计学意义(P<0.01),MDR-TB与XDR-TB之间痰菌培养阴转差异有统计学意义(P<0.05),pre-XDR-TB与XDR-TB之间痰菌阴转差异无统计学意义(P>0.05)。结论武汉市耐多药肺结核中氟喹诺酮类耐药率较高,pre-XDR-TB治疗痰菌阴转率低于MDR-TB,常规开展二线抗结核药物敏感试验非常必要。
Objective To investigate the clinical features of multidrug-resistant pulmonary tuberculosis and provide evidence for the prevention and treatment of multidrug-resistant tuberculosis in Wuhan. Methods A retrospective analysis was conducted to analyze the clinical data and drug resistance of all MDR-TB patients diagnosed in 2015 in Wuhan Pulmonary Hospital, MDR-TB. Results MDR-TB still accounted for 72.88%. The proportion of pre-extensively drug-resistant tuberculosis (pre-XDR-TB) 33.90% of which were resistant to fluoroquinolones, accounting for 85.71% of pre-XDR-TB and 4.24% of extensively drug-resistant tuberculosis (XDR-TB). The incidence of adverse drug reactions during MDR-TB treatment is very high, of which joint pain is the most common (81.36%). The total negative sputum culture negative conversion rate was 68.87% after MDR-TB treatment for 12 months, of which MDR-TB (without pre-XDR-TB and XDR-TB), pre-XDR-TB and XDR- The negative conversion rate of sputum culture was 81.25%, 54.05% and 20.00%, respectively. The difference of sputum culture between MDR-TB and pre-XDR-TB was statistically significant (P <0.01) (P <0.05). The difference of sputum negative conversion between pre-XDR-TB and XDR-TB was not statistically significant (P> 0.05). Conclusions Fluoroquinolones resistant rate is higher in MDR-TB patients in Wuhan, and the negative conversion rate of sputum in pre-XDR-TB is lower than that in MDR-TB. It is very necessary to carry out second-line anti-tuberculosis drug sensitivity test.