市级结核病定点医院耐多药肺结核病病人治疗和管理现况分析
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摘要
目的了解安徽省市级结核病定点医院收治的耐多药肺结核病(multi-drug resistant tuberculosis,MDR-TB)病例接受治疗和管理服务的现状。方法随机抽取合肥市、阜阳市、蚌埠市和马鞍山市作为调查点,每市抽取2015年1月1日—2017年6月30日期间在市级结核病定点医疗机构接受治疗的MDR-TB病人15人,开展问卷调查。结果最终共纳入MDR-TB病人60例,既往接受过1次以上抗结核治疗比例、既往治疗中断的比例分别达到88.3%和47.2%,就诊时有咳嗽咳痰症状和从出现症状到寻求救治时间间隔2 w以下的病人均占调查人数的三分之二,到过省级医院治疗和出现治疗中断的比例均为35.0%,治疗中断的主要原因为药物不良反应;71.7%的病人接受了直接督导下的化疗,接受上门或电话访视和定期复查的病人比例分别为80.0%和86.7%,病人自认为复查费用高是导致MDR-TB未定期复查的主要原因。结论安徽省MDR-TB病人既往抗结核治疗的经历复杂,多数病人临床表现较典型,寻求医疗服务的积极性高,治疗期间因药物不良反应引起的停药比例高;合理及时处理不良反应、加强病人管理、提高病人的治疗依从性、保证规范全程治疗、进一步减轻MDR-TB的医疗经济负担,是今后MDR-TB防治工作的重点。
Objective To understand the current status of treatment and management services for the patients with multidrug resistant pulmonary tuberculosis(MDR-TB) in the municipal TB hospitals in Anhui province. Methods There were four cities of Hefei, Fuyang, Bengbu and Ma'anshan randomly selected as the investigation points. From each point, 15 patients with MDR-TB treated in the designated TB hospitals at municipal level were sampled from January 1, 2015 to June 30, 2017 to develop questionnaire survey. Results Among total 60 MDR-TB patients, the proportion of receiving antituberculosis treatment more than 1 times in the past and discontinued therapy were 89.3% and 47.2%, respectively. The patients with cough, expectoration and time lag within 2 weeks from onset to visiting doctor were two-third of all the patients.The proportion of treatment in provincial hospital and therapy interruption was both 35.0%. The main reason for therapy interruption was adverse drug reaction. There was 71.7% of the patients received chemotherapy under direct supervision,80.0% and 86.7% of the patients received home or telephone interview and regular re-examination. High expense was the thought of the patients as the main reason for periodic review failure. Conclusions The previous experience of antituberculosis treatment is intricate among MDR-TB patients in Anhui province. Most patients have typical clinical manifestations and high positivity of seeking medical service. The proportion of drug withdrawal due to adverse drug reactions is high during the treatment. Reasonable and timely treatment of adverse reactions, strengthening patient management, improving therapy compliance, ensuring standardized treatment and further reducing the medical burden are the key to the future MDR-TB prevention and treatment.
Objective To understand the current status of treatment and management services for the patients with multidrug resistant pulmonary tuberculosis(MDR-TB) in the municipal TB hospitals in Anhui province. Methods There were four cities of Hefei, Fuyang, Bengbu and Ma'anshan randomly selected as the investigation points. From each point, 15 patients with MDR-TB treated in the designated TB hospitals at municipal level were sampled from January 1, 2015 to June 30, 2017 to develop questionnaire survey. Results Among total 60 MDR-TB patients, the proportion of receiving antituberculosis treatment more than 1 times in the past and discontinued therapy were 89.3% and 47.2%, respectively. The patients with cough, expectoration and time lag within 2 weeks from onset to visiting doctor were two-third of all the patients.The proportion of treatment in provincial hospital and therapy interruption was both 35.0%. The main reason for therapy interruption was adverse drug reaction. There was 71.7% of the patients received chemotherapy under direct supervision,80.0% and 86.7% of the patients received home or telephone interview and regular re-examination. High expense was the thought of the patients as the main reason for periodic review failure. Conclusions The previous experience of antituberculosis treatment is intricate among MDR-TB patients in Anhui province. Most patients have typical clinical manifestations and high positivity of seeking medical service. The proportion of drug withdrawal due to adverse drug reactions is high during the treatment. Reasonable and timely treatment of adverse reactions, strengthening patient management, improving therapy compliance, ensuring standardized treatment and further reducing the medical burden are the key to the future MDR-TB prevention and treatment.
引文
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[12]伍小英,钟小燕,谭守勇,等.广州市海珠区肺结核患者就诊延误影响因素的研究[J].中华疾病控制杂志,2016,20(6):564-567.
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[14]毕洪波,刘继文.2011-2015年新疆喀什地区肺结核病流行特征分析[J].疾病预防控制通报,2017,32(6):5-8.
[15]刘芳,满世军,刘兴荣.甘肃省河西地区抗结核药品不良反应现状及其影响因素[J].疾病预防控制通报,2017,32(3):52-54.
[16]彭颖,陈松华,陈彬,等.耐多药肺结核患者中断治疗的影响因素分析[J].预防医学,2016,28(10):977-980.
[17]闫赟.中国5城市耐多药肺结核患者诊治及管理现状研究[D].济南:山东大学,2010.
[18]程新征,朱宁,李卫彬,等.耐多药肺结核患者疾病经济负担调查分析[J].医药前沿,2014(4):20-21.
[2]杨成风,叶建君,张玉,等.湖北省耐多药与广泛耐药肺结核病人治疗效果及转归分析[J].中国防痨杂志,2016,38(7):582-587.
[3]丁晓艳,许卫国,竺丽梅,等.175例耐多药肺结核患者治疗转归情况分析[J].中国防痨杂志,2014,36(4):238-243.
[4]吕德良,杨应周,谭卫国,等.深圳市耐多药结核病治疗转归分析[J].中国热带医学,2016,16(7):649-652,665.
[5]李玲,姚嵩,邹铮,等.全球基金结核病项目安徽省试点耐多药结核病综合防治效果分析[J].中国防痨杂志,2017,39(7):728-731.
[6]王宇.耐多药肺结核防治管理工作方案[M].北京:军事医学科学出版社,2012:16-17.
[7]WMA.Continuous medical education course on treatment of multidrug-resistant tuberculosis[R].Geneva:World Medical Association,2008.
[8]CHEN S,HUAI P,WANG X,et al.Risk factors for multidrug resistance among previously treated patients with tuberculosis in eastern China:A case-control study[J].Int JInfect Dis,2013,17(12):e1116-e1120.
[9]余述凤,梅晓冬,阚晓宏,等.安徽省耐多药肺结核危险因素病例对照研究[J].中华疾病控制杂志,2016,20(10):1026-1028.
[10]刘泓,刘金宝,芮宝玲,等.乌鲁木齐市耐多药肺结核病患者危险因素分析[J].疾病预防控制通报,2015,30(2):20-22.
[11]张玉,侯双翼,杨成凤,等.耐多药结核病危险因素logistic回归分析[J].中国卫生统计,2013,30(2):190-191,195.
[12]伍小英,钟小燕,谭守勇,等.广州市海珠区肺结核患者就诊延误影响因素的研究[J].中华疾病控制杂志,2016,20(6):564-567.
[13]边学峰.中国耐多药结核病防治体系现状、问题与对策研究[D].济南:山东大学,2011.
[14]毕洪波,刘继文.2011-2015年新疆喀什地区肺结核病流行特征分析[J].疾病预防控制通报,2017,32(6):5-8.
[15]刘芳,满世军,刘兴荣.甘肃省河西地区抗结核药品不良反应现状及其影响因素[J].疾病预防控制通报,2017,32(3):52-54.
[16]彭颖,陈松华,陈彬,等.耐多药肺结核患者中断治疗的影响因素分析[J].预防医学,2016,28(10):977-980.
[17]闫赟.中国5城市耐多药肺结核患者诊治及管理现状研究[D].济南:山东大学,2010.
[18]程新征,朱宁,李卫彬,等.耐多药肺结核患者疾病经济负担调查分析[J].医药前沿,2014(4):20-21.