影响初治菌阳肺结核病人强化期痰菌阴转因素研究

摘要/Abstract

摘要： 目的研究影响初治菌阳肺结核病人强化期痰菌阴转因素,探讨提高病人痰菌转阴率的有效方法。方法从患者初诊痰菌菌量、病变累及范围、空洞存在情况、有否合并糖尿病、强化期服药次数、痰菌复查时间以及耐药情况等方面,统计分析其对初治菌阳肺结核病人强化期末痰菌阴转情况的影响。结果当病人初诊痰菌菌量为3次涂阳、2次涂阳、1次涂阳和涂阴培阳组时,强化期末痰菌转阴率分别为66.7%、81.2%、92.5%和95.7%,3次涂阳组中当标本含菌量在4+、3+、2+、1+时,其痰菌转阴率分别只有51.0%、60.5%、66.2%和81.2%。单一耐药病例强化期痰菌转阴率为87.2%。耐2、3、4药病例的强化期痰菌转阴率分别为82.8%、74.3%和70.6%。耐多药病例强化期痰菌转阴率为73.3%。当病灶范围分布在16个肺野时,强化期末痰菌转阴率分别为93.6%、88.7%、77.9%、65.1%、62.4%和68.0%。无空洞病例强化期末痰菌转阴率可达87.6%,单空洞病例的痰菌转阴率也能达77.4%,而多空洞病例的痰菌转阴率则只有47.6%。单纯肺结核病患者强化期末痰菌转阴率为83.3%,而肺结核合并糖尿病患者强化期末痰菌转阴率则只是63.5%。对上述各影响因素进行多因素Logistic回归分析,结果显示患者初诊痰菌菌量、病变累及范围、有否合并糖尿病及耐药种数等4个因素变量的组间（阴转组与非阴转组）差异有统计学意义,是影响强化期末痰菌阴转的独立因素。结论患者细菌载荷量、病变累及范围、耐药种数及有否合并糖尿病等均为影响初治菌阳肺结核患者强化期末痰菌阴转的重要因素。而落实结核病人归口管理制度,提高病人配合治疗、查痰的依从性,正确确定强化期查痰时间也是提高初治菌阳肺结核病人强化期痰菌阴转的重要措施。

关键词: 结核, 肺/预防和控制

Abstract: Objective To study on the reason of affecting the smear negative result at the end of 2^nd month of treatment of new smear positive pulmonary tuberculosis patients of tuberculosis control,so as to improve the treatment for the new smear positive pulmonary tuberculosis patients.Methods Based on the patient’s phlegm bacterium volume,focus scope,with or without cavities in lungs and whether have other complication(e.g diabetes and drug resistance situation,analysis the influence factors on the smear negative result at the end of 2^nd month of treatment on the new smear positive pulmonary tuberculosis patients. Results When phlegm bacterium volume are in the level of 3 times smear positive,2 times smear positive;one time smear positive and smear negative pei+,the clearance rate are 66.7%、81.2%、92.5% and 95.7% at the end of 2^nd month treatment respectively.Within 3 time smear positive,when phlegm bacterium volume of the specimen are in the level of 4+、3+、2+、1+,the clearance rate are 51.0%、60.5%、66.2% and 81.2% respectively.Clearance rate at the 2^nd month treatment of single drug resistance is 87.2%.Clearance rate at the 2^nd month treatment of two drugs resistance,three drugs resistance and four drugs resistance are 82.8%,74.3% and 70.6% respectively.Clearance rate at the 2^nd month treatment of multi drug resistance is 73.3%.When focus scope within 16 pulmonary field,the clearance rate are 93.6%,88.7%,77.9% 65.1%, 62.4% and 68% respectively.Those cases without cavities the clearance rate at the end of 2^nd month of the treatment can reach 87.6%.Single cavities cases the clearance rate can reach 77.4%.The multi cavities cases the clearance rate is only 47.6%.In the case of pulmonary,the clearance rate is 83.3% at the end of 2^nd month of the treatment,while pulmonary combined with diabetes the clearance rate is only 63.5%.We perform regression analysis on the above mentioned affecting factors,there is statistic meaning on the difference（smear negative and non-smear negative group） of variables of the patient’s phlegm bacterium volume,drug resistance situation,with or without cavities in lungs and whether have other complication（e.g diabetes）.The above mentioned 4 factors are independent reasons of affecting smear negative result at the end of 2^nd month.Conclusions Patient’s phlegm bacterium volume,drug resistance situation,with or without cavities in lungs and whether have other complication（e.g diabetes） are all the factors to affect the clearance result at the end of 2^nd month of treatment on the new smear positive pulmonary tuberculosis patients.It is also important to improve the register control on the new smear positive pulmonary tuberculosis patients,the health education need to be enhanced on the tuberculosis control,define the correct timing for the phlegm checking s also a important measure to improve the clearance rate at the end of 2^nd month of the treatment.

Key words: Pulmonary tuberculosis/prevention and control

冼翠平,陈小华,许卓卫,谭家活,刘玉美,温文沛,. 影响初治菌阳肺结核病人强化期痰菌阴转因素研究[J]. 中国防痨杂志, 2008, 30(1): 7-10.

Xian Cuiping,Chen Xiaohua,Xu Zhuowei,et al.. Study on the reason of affecting the smear negative result at the end of 2^nd month of treatment of new smear positive pulmonary tuberculosis patients[J]. Chinese Journal of Antituberculosis, 2008, 30(1): 7-10.

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