北京市63例耐多药肺结核患者特征及治疗情况分析

为了发现现行诊疗方案中可能影响MDR-TB患者治疗依从性及成功率的因素，对2016年3月-2019年11月北京市结核病控制研究所收治的90例DR-TB患者耐药结果、病人特征、治疗选择及临床转归进行统计分析。结果显示：90例DR-TB患者中，63例为MDR-TB，3例为XDR-TB;复治患者多于初治患者（5.3:1）；除INH,RFP外，以对SM耐药率最高（85.71%），组合耐药以耐INH+RFP+SM病人占比最多（36.51%）；65.08%的MDR-TB患者接受了进一步的抗结核治疗；接受抗结核治疗的患者，50%痊愈；不同性别，年龄，登记类型及抗结核用药史的患者接受进一步抗结核治疗率及治疗完成率之间未发现显著差异；MDR-TB患者抗结核治疗治愈平均时间为739.76天；MDR-TB患者中复治患者比例较高；除耐INH、RFP外，多合并其他药物耐药；患者进一步治疗的比例不高，治疗完成率不高，治疗周期较长。针对MDR-TB患者的治疗，有必要强调治疗前进行药物敏感性检测，根据药敏结果及患者类型制定个性化治疗方案；按照新药分组选药，提高患着治疗依从性及成功率。

Analysis on the Characteristics and treatment of 63 MDR-TB Patients

Objective: In order to study the factors that may affect the treatment compliance and success rate of MDR-TB patients in the current diagnosis and treatment program, 90 DR-TB patients admitted to the Beijing Institute of Tuberculosis Control between March 2016 to November 2019 were collected and their drug resistance results, patients'' characteristics, treatment options and clinical outcomes were statistical analyzed. The results showed that 63 of 90 DR-TB patients were MDR-TB and 3 were XDR-TB; retreated patients were more than newly treated patients (5.3:1); except for INH and RFP, SM has the highest resistance rate (85.71%), patients resistant to INH + RFP + SM accounted for the largest proportion in combined resistance (36.51%); 65.08% of MDR-TB patients received further anti-TB treatment; after receiving anti-TB treatment, 50% of the patients were cured; no significant difference was found in the rate of receiving further anti-TB treatment and completing treatment among patients of different gender, age, registration type and anti-tuberculosis medication history; the average time of anti-tuberculosis treatment for MDR-TB patients was 739.76 days; the retreated patients has a higher proportion in MDR-TB patients; in addition to resistance to INH and RFP, MDR-TB is often complicated with other resistances; those patients receiving further anti-TB treatment and completing treatment made up lower proportion than expectations, and the treatment cycle was longer. Clearly, it is necessary for the treatment of MDR-TB patients to emphasize DST before treatment, develop personalized treatment program based on drug sensitivity results and patient types, and select drugs according to the new drugs in groups to improve treatment compliance and success rate.