He Xiao-Chun, Tao Ning-Ning, Liu Yao, Zhang Xian-Xin, Li Huai-Chen
Department of Respiratory Medicine, Baoji Central Hospital, Baoji, Shaanxi, China.
Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China.
BMC Infect Dis. 2017 Aug 9;17(1):555. doi: 10.1186/s12879-017-2652-x.
Extensively Drug-Resistant (XDR) Tuberculosis (TB) has posed a great threat to global health and finance systems, especially for developing countries with high TB and Multidrug-Resistant (MDR) TB burden.
We retrospectively analyzed HIV-uninfected TB case confirmed and treated in Shandong Provincial Chest Hospital (SPCH) between January 2008 and December 2015. Unique characteristics of XDR-TB were identified; its longitudinal changes and survival were analyzed.
Between January 2008 and December 2015, a total of 144 cases were confirmed to be XDR-TB (2.5% of 5663 culture-confirmed TB cases; 27.9% of 516 MDR-TB cases). The proportion of XDR TB cases among MDR-TB cases has increased from 26.5% in 2008 to 44.5% in 2014 (Chi-Square test for trends: P < 0.01). Among the 144 XDR-TB cases, 21 patients (14.6%) had treatment success, 123 (85.1%) had poor treatment outcomes. Mortality was higher among XDR-TB cases than among MDR TB cases (8.3% vs. 3.8%, P = 0.033) and drug-susceptible TB cases (8.3% vs. 2.1%, P < 0.01).
XDR-TB cases comprise a substantial and increasing fraction of MDR-TB cases, causing poor treatment outcomes and high mortalities. Early drug susceptibility testing, adequate TB treatment and efficient infection control must be in place in future TB control strategies.
广泛耐药结核病（XDR-TB）对全球卫生和金融系统构成了巨大威胁，尤其是对于结核病和耐多药结核病（MDR-TB）负担较高的发展中国家。
我们回顾性分析了2008年1月至2015年12月在山东省胸科医院确诊并接受治疗的未感染艾滋病毒的结核病病例。确定了广泛耐药结核病的独特特征；分析了其纵向变化和生存率。
2008年1月至2015年12月期间，共有144例确诊为广泛耐药结核病（占5663例培养确诊结核病病例的2.5%；占516例耐多药结核病病例的27.9%）。耐多药结核病病例中广泛耐药结核病病例的比例从2008年的26.5%上升至2014年的44.5%（趋势的卡方检验：P<0.01）。在144例广泛耐药结核病病例中，21例患者（14.6%）治疗成功，123例（85.1%）治疗效果不佳。广泛耐药结核病病例的死亡率高于耐多药结核病病例（8.3%对3.8%，P=0.033）和药物敏感结核病病例（8.3%对2.1%，P<0.01）。
广泛耐药结核病病例在耐多药结核病病例中占相当大且不断增加的比例，导致治疗效果不佳和高死亡率。未来的结核病控制策略必须进行早期药物敏感性检测、适当的结核病治疗和有效的感染控制。
