Tan Shouyong, Ding Xiuxiu, Tan Yaoju, Cai Xingshan, Li Yanqiong
Guangzhou Chest Hospital, State Key Laboratory of Respiratory Diseases, Guangzhou 510095, China. Email:
Zhonghua Jie He He Hu Xi Za Zhi. 2014 Dec;37(12):915-8.
To study regimens containing isoniazid and rifampicin for the treatment of pulmonary tuberculosis with isoniazid or rifampicin resistance.
Eighty patients with isoniazid or rifampicin resistance, and whose sputum were still positive at the end of 2-month therapy with isoniazid (H), rifampicin (R), pyrazineamide (Z) and ethambutol (E), were retrospectively analyzed from Jan.2009 to Dec.2012 in Guangzhou Chest Hospital. According to the Mycobacterium drug sensitive test (DST) before the treatment with isoniazid and rifampicin, the patients were divided into the sensitive group (either H or R sensitive), the multidrug-resistance group (both H and R resistance) and the single-resistance group (H or R resistance). There were 80 patients (57 females, 23 males) whose sputum was still positive at the end of 2 month treatment. Their ages ranged from 16-80 (average 45) years. Among them, 29 received the first-treatment, while 51 received retreatment. There were 37 cases in the sensitive group, with 18 first-treatment patients and 19 retreatment patients. There were 15 cases in the single-resistance group, with 3 first-treatment patients and 12 retreatment patients. There were 28 cases in the multidrug-resistance group, with 8 first-treatment patients and 20 retreatment patients.
After treatment, mycobacterial conversion to MDR-TB occurred in 2 patients in the sensitive group, and in 6 patients in the single-resistance group. The rate of conversion to MDR-TB was higher in the single-resistance group than that in the sensitive group (χ² = 12.849, P = 0.000).Six patients with single H resistance converted to MDR-TB and 2 patients with single R resistance converted to MDR-TB (P < 0.05, RR = 18.0).
Single H or R drug-resistance was more common in retreated patients with pulmonary tuberculosis.If regimens containing isoniazid and rifampicin was used to treat patients with single H or R drug-resistance, resistant enlarging effect may appear and lead to MDR-TB. The retreated patients should be monitored as soon as possible for detection of Mycobacterium resistance to H and R, and regimens for H or R-resistance should be used to prevent resistant enlarging effect.
研究含异烟肼和利福平的方案治疗对异烟肼或利福平耐药的肺结核。
回顾性分析2009年1月至2012年12月在广州市胸科医院就诊的80例对异烟肼或利福平耐药且在使用异烟肼（H）、利福平（R）、吡嗪酰胺（Z）和乙胺丁醇（E）进行2个月治疗后痰菌仍阳性的患者。根据使用异烟肼和利福平治疗前的结核分枝杆菌药敏试验（DST），将患者分为敏感组（对H或R敏感）、耐多药组（对H和R均耐药）和单耐药组（对H或R耐药）。有80例患者（女性57例，男性23例）在2个月治疗结束时痰菌仍阳性。他们的年龄在16至80岁之间（平均45岁）。其中，29例为初治患者，51例为复治患者。敏感组有37例，其中初治患者18例，复治患者19例。单耐药组有15例，其中初治患者3例，复治患者12例。耐多药组有28例，其中初治患者8例，复治患者20例。
治疗后，敏感组有2例患者结核菌转变为耐多药结核，单耐药组有6例患者结核菌转变为耐多药结核。单耐药组结核菌转变为耐多药结核的发生率高于敏感组（χ² = 12.849，P = 0.000）。6例单耐H患者结核菌转变为耐多药结核，2例单耐R患者结核菌转变为耐多药结核（P < 0.05，RR = 18.0）。
肺结核复治患者中单一H或R耐药更为常见。如果使用含异烟肼和利福平的方案治疗单一H或R耐药患者，可能会出现耐药扩大效应并导致耐多药结核。应尽快对复治患者进行监测以检测结核菌对H和R的耐药情况，并使用针对H或R耐药的方案以防止耐药扩大效应。
