Ogawara M, Sakatani M
Department of Internal Medicine, National Kinki-Central Hospital for Chest Diseases, Osaka, Japan.
Kekkaku. 1998 Nov;73(11):673-7.
We studied the clinical characteristics, treatment and prognosis of multidrug-resistant pulmonary tuberculosis patients retrospectively. In this study, multidrug-resistant is defined as both resistant to 0.1 microgram/ml of INH and 50 micrograms/ml of RFP at least. From 1990 to 1997, out of 1841 culture positive pulmonary tuberculosis patients, 76 patients (4%) proved to be multidrug-resistant (53 males, 23 females, age 18-84, 40 originally treated cases and 36 relapse cases). Most of cases revealed resistance to other drugs in addition to INH and RFP. The combination of anti-tuberculous drugs were complicated and changed repeatedly. The incidences of administration of drugs were as follows; TH 62%, EB 58%, PZA 58%, KM 33%, PAS 33%, SM 29%, CS 20%, EVM 14%, CPM 3%. New quinolones, for example OFLX/LVFX, CPFX and SPFX, were also used frequently (62%). Eight percent of patients were operated. Bacteriologically effective drugs that meant culture negative were TH (14%), PZA (12%), KM (12%), EB (12%), SM (5%), new quinolones (16%). 67% of originally treated cases and 43% of relapse cases became culture negative. Many cases were treated for a long period. 19% of originally treated cases and 33% of relapse cases were treated more than three years. 11% of patients were died of tuberculosis. Major prognostic factors were diabetes mellitus (17%), malignancies (10%), non-adherence (9%) and other complications. Because of no absolutely effective treatment, we have to choose a treatment according to each patient. Development of new treatment is crucial.
我们回顾性研究了耐多药肺结核患者的临床特征、治疗及预后。本研究中，耐多药定义为至少对0.1微克/毫升异烟肼和50微克/毫升利福平耐药。1990年至1997年，在1841例痰培养阳性的肺结核患者中，76例（4%）被证实为耐多药（男性53例，女性23例，年龄18 - 84岁，初治病例40例，复治病例36例）。大多数病例除对异烟肼和利福平耐药外，还对其他药物耐药。抗结核药物组合复杂且反复变化。药物使用发生率如下：硫胺（TH）62%，乙胺丁醇（EB）58%，吡嗪酰胺（PZA）58%，卡那霉素（KM）33%，对氨基水杨酸（PAS）33%，链霉素（SM）29%，卷曲霉素（CS）20%，乙硫异烟胺（EVM）14%，环丙沙星（CPM）3%。新型喹诺酮类药物，如氧氟沙星/左氧氟沙星（OFLX/LVFX）、环丙沙星（CPFX）和司帕沙星（SPFX），也经常使用（62%）。8%的患者接受了手术治疗。细菌学有效药物（即痰培养转阴）有硫胺（14%）、吡嗪酰胺（12%）、卡那霉素（12%）、乙胺丁醇（12%）、链霉素（5%）、新型喹诺酮类药物（16%）。67%的初治病例和43%的复治病例痰培养转阴。许多病例接受了长期治疗。19%的初治病例和33%的复治病例治疗时间超过三年。11%的患者死于结核病。主要预后因素为糖尿病（17%）、恶性肿瘤（10%）、不依从（9%）及其他并发症。由于没有绝对有效的治疗方法，我们必须根据每个患者的情况选择治疗方案。开发新的治疗方法至关重要。
