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背景:本研究在菲律宾、马尼拉、菲律宾大学—菲律宾总医院(UP-PGH)进行。目的:确定肺结核病人耐药特征和多种药物耐药结核病的临床预测指标。设计:前瞻性分析描述。方法:对结核分支杆菌培养阳性的病人进行会面,了解有关抗结核治疗既往史,卡介苗接种史,胸部X线检查及家庭接触情况,从299名病人中分离的结核杆菌应用浸没纸片比例法,进行了利福平、异烟肼(INH),乙胺丁醇和链霉素的敏感性测定。用标准实验室粉剂在7H10培养基中测定吡嗪酰胺(PZA)的敏感性。结果:在299名分离的结核杆菌中17％对五种主要药物全敏感,54％对二种或二种以上药物耐药(多种药物耐药结核病,MDR-TB)。初始耐药率乙胺丁醇(39％)和INH(17％)是高的,MDR-TB明显地与既往抗结核治疗史相关(优势比[OR]2.44,95％可信限)。不正规抗结核治疗超过三个月增加MDR-TB的可能性(OR4.6,P<0.0001)。结论:高的MDR-TB率与既往抗结核治疗情况有关,当不正规的先期抗结核治疗超过三个月时发生MDR-TB的机会明显增加。
Background: This study was conducted at the University of the Philippines - Manila, Philippines - General Hospital of the Philippines (UP-PGH). Objective: To determine the drug resistance of patients with tuberculosis and the clinical predictors of drug-resistant tuberculosis. Design: Prospective analysis description. Methods: The patients with positive cultures of Mycobacterium tuberculosis were interviewed for the past history of antituberculosis treatment, the history of BCG vaccination, chest X-ray examination and family contacts. The Mycobacterium tuberculosis isolated from 299 patients was treated with the method of immersion paper, Rifampicin, isoniazid (INH), ethambutol and streptomycin susceptibility assays were performed. Pyrazinamide (PZA) sensitivity was determined in standard 7H10 media using standard laboratory dust. RESULTS: Seven out of 299 Mycobacterium tuberculosis isolates were fully susceptible to five major drugs and 54% were resistant to two or more drugs (MDR-TB). The initial resistance to ethambutol (39%) and INH (17%) were high, and MDR-TB was significantly associated with previous anti-TB treatment history (odds ratio [OR] 2.44, 95% confidence limit). The odds of increasing MDR-TB for more than three months (OR4.6, P <0.0001) for nonstandard anti-TB treatment. CONCLUSIONS: High MDR-TB rates are associated with prior anti-tuberculosis treatment, with a marked increase in the chance of developing MDR-TB when unnormalized prior anti-TB therapy exceeds three months.