复治肺结核耐异烟肼患者和耐利福平患者治疗效果的分析

doi:10.3969/j.issn.1000-6621.2021.04.005

中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (4): 322-327.doi: 10.3969/j.issn.1000-6621.2021.04.005

复治肺结核耐异烟肼患者和耐利福平患者治疗效果的分析

舒薇, 戈启萍, 黄学锐, 马丽萍, 纪滨英, 陈瑜晖, 陈效友, 姜广路, 谢莉, 李波, 陈盛玉, 陈森林, 闫俊萍, 石莲, 陈玲, 黎友伦, 席秀娥, 刘倩颖, 闫兴录, 王飞, 王芙蓉, 吴湘, 张朋, 冷学艳, 曹文利, 张海晴, 崔洪哲, 杨澄清, 吴超, 李鹃, 李华, 孙玙贤, 张立杰, 谢仕恒, 宁宇佳, 田希忠, 杜建(), 李亮(), 高微微()

101149 首都医科大学附属北京胸科医院北京市结核病胸部肿瘤研究所中国疾病预防控制中心结核病防治临床中心(舒薇、戈启萍、黄学锐、姜广路、谢莉、孙玙贤、张立杰、谢仕恒、宁宇佳、田希忠、杜建、李亮、高微微);河南省疾病预防控制中心结核病预防控制所(马丽萍);哈尔滨市胸科医院(纪滨英);广东省结核病控制中心结核科(陈瑜晖);首都医科大学附属北京地坛医院(陈效友);北京结核病控制研究所门诊部(李波);天津市结核病控制中心结核科(陈盛玉);湖北省荆州市传染病医院结核科(陈森林);包头市第三医院结核科(闫俊萍);沈阳市胸科医院结核科(石莲);遵义医科大学附属医院(陈玲);重庆医科大学附属第一医院结核科(黎友伦);新乡医学院第一附属医院结核科(席秀娥);中国人民解放军总医院第八医学中心结核科(刘倩颖);黑龙江省疾病预防控制中心结核病预防控制所(闫兴录);浙江省疾病预防控制中心结核病防治所(王飞);内蒙古自治区第四医院结核科(王芙蓉);湖北省荆门市疾病预防控制中心结核病防治所(吴湘);河北省唐山市第四医院结核科(张朋);河北省秦皇岛市第三医院结核科(冷学艳);北京老年医院门诊部(曹文利);江苏省徐州市传染病医院结核科(张海晴);吉林省延边结核病防治所(崔洪哲);武汉市结核病防治所(杨澄清);江苏省镇江市第三人民医院(吴超);广西壮族自治区疾病预防控制中心(李鹃);山西省临汾市第三人民医院(李华)

收稿日期:2021-01-26 出版日期:2021-04-10 发布日期:2021-04-09
通信作者: 杜建,李亮,高微微 E-mail:jdusdu@163.com;liliang@tb123.org;gwwjys@sina.com
基金资助:
“十一五”国家科技重大专项(2008ZX10003-015);“十二五”国家科技重大专项(2013ZX10003009-001-006);“十二五”国家科技重大专项(2013ZX10003009-001-007);“十三五”国家科技重大专项(2018ZX10722302-003)

Analysis of treatment outcomes of retreated pulmonary tuberculosis patients with isoniazid-resistance and rifampin-resistance

Beijing Chest Hospital, Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute, Clinical Center on Tuberculosis, Chinese Center for Disease Control and Prevention, Beijing 101149, China

Received:2021-01-26 Online:2021-04-10 Published:2021-04-09
Contact: DU Jian,LI Liang,GAO Wei-wei E-mail:jdusdu@163.com;liliang@tb123.org;gwwjys@sina.com

摘要/Abstract

摘要：

目的分析耐异烟肼、耐利福平和敏感的复治肺结核患者的治疗结局,探讨耐异烟肼患者的预后。方法采取回顾性调查的方法,选择2009年7月至2019年7月首都医科大学附属北京胸科医院联合国内20余家结核病防治机构共同合作纳入的资料完整并有治疗转归结果的922例复治菌阳肺结核患者,排除219例耐多药及广泛耐药肺结核患者,排除非利福平和非异烟肼耐药的100例患者,共入选复治菌阳肺结核患者603例。复治肺结核敏感患者的治疗方案采用复治标准化方案,耐异烟肼或耐利福平治疗方案采用个体化方案,对其中药物敏感的485例患者(简称“敏感组”)、耐异烟肼(包含异烟肼单耐药和多耐药)的73例患者(简称“耐异烟肼组”)和耐利福平(包含利福平单耐药和多耐药)的45例患者(简称“耐利福平组”)的治疗转归进行对比分析。结果在治疗2个月末时,耐异烟肼组痰涂片阴转率(63.6%,42/66)和痰培养阴转率(63.6%,35/55)均分别低于耐利福平组[84.6%(33/39)和70.6%(24/34)]和敏感组[84.2%(388/461)和80.0%(343/429)],差异均有统计学意义(χ²=16.567,P<0.001;χ²=8.500,P=0.014);在治疗6个月末时,耐异烟肼组痰涂片阴转率(79.7%,47/59)和痰培养阴转率(76.5%,39/51)均分别低于耐利福平组[89.2%(33/37)和93.5%(29/31)]和敏感组[91.5%(398/435)和90.8%(367/404)],差异均有统计学意义(χ²=8.127,P=0.017;χ²=10.533,P=0.005)。耐异烟肼组治愈率(53.4%,39/73)低于耐利福平组(60.0%,27/45)和敏感组(69.5%,337/485),差异有统计学意义(χ²=8.407,P=0.015);耐异烟肼组治疗成功率(64.4%,47/73)低于耐利福平组(75.6%,34/45)和敏感组(82.1%,398/485),差异有统计学意义(χ²=12.587,P=0.002)。结论复治肺结核患者中,耐异烟肼患者痰菌阴转率和治疗成功率均低于耐利福平患者和敏感患者;应重视每一种药品的耐药情况,特别是临床应用时间较长的药品。

关键词: 结核,肺, 复治, 结核,抗多种药物性, 异烟肼, 利福平

Abstract:

Objective To analyze the treatment outcomes of retreated pulmonary tuberculosis patients (PTB) with isoniazid resistance, rifampicin resistance, and drug sensitive PTB patients, and explore the prognosis of patients with isoniazid resistance. Methods From July 2009 to July 2019, a retrospective investigation was adopted to select 922 retreated bacteriologically positive PTB patients with complete data and treatment outcomes from Beijing Chest Hospital of Capital Medical University and other more than 20 domestic tuberculosis prevention and control institutions. Two hundred and nineteen MDR or XDR cases, and 100 non-rifampicin and non-isoniazid resistance cases were excluded, a total of 603 retreated bacteriologically positive PTB patients were enrolled in this study. The standard retreatment regimen was used for the sensitive and not drug-resistant group while an individualized treatment regimen was used for the isoniazid-resistant or rifampicin-resistant group. The treatment outcomes were compared among 485 patients in “drug-sensitive group”, 73 patients in “isoniazid-resistant group” (including isoniazid mono-drug resistance and poly-drug resistance), and 45 patients in “rifampicin-resistant group” (including rifampicin mono-drug resistance and poly-drug resistance). Results At the end of 2nd month’s treatment, the sputum smear negative conversion rate (63.6%, 42/66) and sputum culture negative conversion rate (63.6%, 35/55) in isoniazid-resistant group were lower than those in rifampicin-resistant group (84.6%, 33/39; 70.6%, 24/34) and drug-sensitive group (84.2%, 388/461; 80.0%, 343429) (χ²=16.567, 8.500; P<0.001, 0.014), respectively. At the end of 6th month’s treatment, the sputum smear negative conversion rate (79.7%, 47/59) and sputum culture negative conversion rate (76.5%, 39/51) in isoniazid-resistant group were lower than those in rifampicin-resistant group (89.2%, 33/37 and 93.5%, 29/31) and drug-sensitive group (91.5%, 398/435 and 90.8%, 367/404) (χ²=8.127, 10.533; P=0.017, 0.005), respectively. The cure rate of isoniazid-resistant group (53.4%, 39/73) was lower than that of rifampicin-resistant group (60.0%, 27/45) and drug-sensitive group (69.5%, 337/485) (χ²=8.407, P=0.015); the treatment success rate of isoniazid-resistant group (64.4%, 47/73) was lower than that of rifampicin-resistant group (75.6%, 34/45) and drug-sensitive group (82.1%, 398/485) (χ²=12.587, P=0.002). Conclusion The negative conversion rates and success rates of treatment in retreated PTB patients with isoniazid resistance were lower than that of rifampicin-resistant group and drug-sensitive group. It is suggested that attention should be paid to the drug resistance of every bactericide, especially for those medicines clinically used for a long period.

Key words: Tuberculosis, pulmonary, Retreatment, Tuberculosis, multidrug-resistant, Isoniazid, Rifampin

舒薇, 戈启萍, 黄学锐, 马丽萍, 纪滨英, 陈瑜晖, 陈效友, 姜广路, 谢莉, 李波, 陈盛玉, 陈森林, 闫俊萍, 石莲, 陈玲, 黎友伦, 席秀娥, 刘倩颖, 闫兴录, 王飞, 王芙蓉, 吴湘, 张朋, 冷学艳, 曹文利, 张海晴, 崔洪哲, 杨澄清, 吴超, 李鹃, 李华, 孙玙贤, 张立杰, 谢仕恒, 宁宇佳, 田希忠, 杜建, 李亮, 高微微. 复治肺结核耐异烟肼患者和耐利福平患者治疗效果的分析[J]. 中国防痨杂志, 2021, 43(4): 322-327. doi: 10.3969/j.issn.1000-6621.2021.04.005

SHU Wei, GE Qi-ping, HUANG Xue-rui, MA Li-ping, JI Bin-ying, CHEN Yu-hui, CHEN Xiao-you, JIANG Guang-lu, XIE Li, LI Bo, CHEN Sheng-yu, CHEN Sen-lin, YAN Jun-ping, SHI Lian, CHEN Ling, LI You-lun, XI Xiu-e, LIU Qian-ying, YAN Xing-lu, WANG Fei, WANG Fu-rong, WU Xiang, ZHANG Peng, LENG Xue-yan, CAO Wen-li, ZHANG Hai-qing, CUI Hong-zhe, YANG Cheng-qing, WU Chao, LI Juan, LI Hua, SUN Yu-xian, ZHANG Li-jie, XIE Shi-heng, NING Yu-jia, TIAN Xi-zhong, DU Jian, LI Liang, GAO Wei-wei. Analysis of treatment outcomes of retreated pulmonary tuberculosis patients with isoniazid-resistance and rifampin-resistance[J]. Chinese Journal of Antituberculosis, 2021, 43(4): 322-327. doi: 10.3969/j.issn.1000-6621.2021.04.005

图/表 2

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参考文献 22

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分类	敏感组(485例)		耐异烟肼组(73例)		耐利福平组(45例)		χ²值	P值
分类	例数	构成比(%)	例数	构成比(%)	例数	构成比(%)	χ²值	P值
年龄组(岁)							3.660	0.454
18~39	179	36.9	33	45.2	17	37.8
40~59	238	49.1	35	47.9	22	48.9
60~65	68	14.0	5	6.9	6	13.3
性别							1.337	0.512
女	100	20.6	19	26.0	11	24.4
男	385	79.4	54	74.0	34	75.6
体质量指数^a							2.229	0.328
≥18.5	324	66.9	49	67.1	35	77.8
<18.5	160	33.1	24	32.9	10	22.2
复治类型							5.181	0.269
复发	302	62.3	42	57.5	34	75.6
初治失败	68	14.0	9	12.3	5	11.1
其他^b	115	23.7	22	30.2	6	13.3

观察指标	敏感组 (485例)		耐异烟肼组 (73例)		耐利福平组 (45例)		χ²值	P值	敏感组与耐异烟肼组		敏感组与耐利福平组		耐异烟肼组与耐利福平组
观察指标	例数	构成比 (%)	例数	构成比 (%)	例数	构成比 (%)	χ²值	P值	χ²值	P值	χ²值	P值	χ²值	P值
2个月末痰涂片^a							16.567	<0.01	16.201	<0.01	0.005	0.941	5.287	0.021
阴性	388	84.2	42	63.6	33	84.6
阳性	73	15.8	24	36.4	6	15.4
2个月末痰培养^b							8.500	0.014	7.588	0.006	1.681	0.195	0.454	0.500
阴性	343	80.0	35	63.6	24	70.6
阳性	86	20.0	20	36.4	10	29.4
6个月末痰涂片^c							8.127	0.017	8.142	0.004	0.030	0.862	1.486	0.223
阴性	398	91.5	47	79.7	33	89.2
阳性	37	8.5	12	20.3	4	10.8
6个月末痰培养^d							10.533	0.005	9.732	0.002	0.033	0.855	3.972	0.046
阴性	367	90.8	39	76.5	29	93.5
阳性	37	9.2	12	23.5	2	6.5
治疗转归							12.587	0.002	12.278	<0.01	1.157	0.282	1.614	0.204
治疗成功	398	82.1	47	64.4	34	75.6
治疗未成功	87	17.9	26	35.6	11	24.4
胸部X线变化^e							-	0.202
吸收	397	86.3	54	77.1	38	90.5
不变	53	11.5	14	20.0	3	7.1
恶化	10	2.2	2	2.9	1	2.4

复治肺结核耐异烟肼患者和耐利福平患者治疗效果的分析

Analysis of treatment outcomes of retreated pulmonary tuberculosis patients with isoniazid-resistance and rifampin-resistance

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