| Objective :To analyze and evaluate Dalian implementation in the field of global fund multidrug-resistant tuberculosis prevention and control,and provide the basis for further development of standardized and scientific MDR-TB prevention technology strategy.Methods: Using proportional method for testing nine kinds of drug resistance detection,such as INH,RFP,Am,Cm,Lfx,Mfx,PAS,office and EB.We screened MDR-TB cases and XDR-TB cases,and their treatments were included in the Global Fund MDR projects.We selected 118 MDR-TB cases which completed 12-month course as research subjects,and divided into MDR,pre-XDR and XDR three groups.Monthly review sputum smear,temperature,sputum culture,blood,ESR,CRP,PCT,liver function,renal function,electrolytes and weight.Every three months review chest radiography,timely review if any abnormal accurse like TSH,hearing,eyesight.SPSS19.0 statistical software was used for analysis,and chi-square to test sputum smear-negative rate,sputum culture conversion rate and the incidence of side effects.Excel software was used for changes in sputum conversion curve analysis.Results:After 12 months treatment,MDR group sputum smear-negative rate is not significant different to sputum culture,P< 0.05,sputum smear-negative rate was 82.6%(38/46)at the end of sixth month and 78.3%(36/46)at the last month separately.Meanwhile,there was no significant difference between sputum culture negative rate at the sixth month and last month,P>0.05,with 84.8%(39/46)and 73.9%(36/46)separately.Pre-XDR group sputum conversion rate at the end of sixth month and last month was 82.4%(42/51)and 66.7%(34/51)separately,the difference was significantly,X2 = 0.97,P < 0.01.Sputum smear negative conversion rate at the end of sixth month and last month of treatment were 82.4%(42/51)and 72.5%(37/51)separately,with no statistically significant,P>0.05.XDR group sputum smear-negative conversion rates in sixth month and last month of treatment were 81.0%(17/21)and 71.4%(15.21)separately,sputum culture negative rates were 76.2%(16/21)and 76.2%(16/21)respectively,all differences were not statistically significant,all P>0.05.MDR-TB group was divided to three groups according to initial treatment,retreatment and chronic infection.In comparison sputum smear and culture-negative rate of three groups of last month of treatment,initial treatment compared with retreatment and chronic infection was statistically significant,X2 value were 4.50,7.71,5.08 and 4.73,all P less than 0.05.In exploration of adverse drug reactions,electrolyte imbalance and gastrointestinal reactions of XDR group were 71.4%(15/21)and 66.7%(14/21),and were higher than MDR group which were 13.4%(13/97)and 44.3%(43/97),with significant differences,X 2 values were 31.84 and 3.42 respectively,all P less than 0.05.After 12 months anti-TB treatment,overall lung lesions significant absorption rate and improvement rate were 48.3%(57/118)and 24.6%(29/118)separately.Conclusion:Global Fund MDR-TB Project in Dalian is progressing well,the mid-efficacy sputum conversion rate has reached the expected results.It is an effective way to improve the cure rate that early drug detection and early treatment.We should pay attention to the treatment of Pre-XDR.It may be a risk that Pre-XDR is equivalent to MDR in chemotherapy regimen. |
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