The value of end-of-treatment chest radiograph in predicting pulmonary tuberculosis relapse.
The value of end-of-treatment chest radiograph in predicting pulmonary tuberculosis relapse.
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发表时间：
2008-09
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通讯作者：
C. Hamilton;J. Stout;P. Goodman;A. Mosher;R. Menzies;N. Schluger;A. Khan;J. L. Johnson;A. Vernon
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作者：
C. Hamilton;J. Stout;P. Goodman;A. Mosher;R. Menzies;N. Schluger;A. Khan;J. L. Johnson;A. Vernon
背景：在基线胸片（CXR）上显示培养阳性的腔型肺结核（TB）患者在治疗8周后复发的风险很高。治疗结束（EOT） CXR在预测复发中的作用尚不清楚。目的确定EOT CXR是否能独立预测结核病复发。设计：我们对1004例经培养证实的人类免疫缺陷病毒血清阴性成人肺结核患者进行了一项随机试验，在结核病继续治疗阶段使用利福喷丁进行间歇性治疗。结果在EOT检查中，有持续空腔的患者复发的比例为17.3%，有空腔的患者复发的比例为7.6%，没有空腔的患者复发的比例为2.5% （P=0.002）。在多变量分析中，EOT CXR中持续腔的患者比基线或2个月CXR中无腔的患者更容易复发（风险比[HR] 4.22, 95%CI 2.00-8.91），比早期腔已通过EOT CXR消退的患者更容易复发（风险比[HR] 1.92, 95%CI 1.09-3.39）。结论在控制其他变量后，结核治疗6个月后出现持续空腔与疾病复发独立相关。EOT CXR可以帮助预测那些可能复发的人。
SETTING Patients with cavitary pulmonary tuberculosis (TB) on baseline chest radiograph (CXR) who remain culture-positive after 8 weeks of treatment are at high risk of relapse. The role of end-of-treatment (EOT) CXR in predicting relapse is unclear. OBJECTIVE To determine whether EOT CXR independently predicts TB relapse. DESIGN We conducted a secondary analysis of a randomized trial of intermittent treatment using rifapentine in the continuation phase of TB treatment among 1004 human immunodeficiency virus seronegative adults with culture-proven pulmonary TB. RESULTS Relapse occurred in 17.3% of subjects with persistent cavity on EOT CXR, in 7.6% of subjects with a cavity that resolved by EOT, and 2.5% (P=0.002 for trend) of subjects who never had a cavity. In multivariable analysis, patients with persistent cavity on EOT CXR were significantly more likely to relapse than patients with no cavity on baseline or 2-month CXR (hazard ratio [HR] 4.22, 95%CI 2.00-8.91), and were more likely to relapse than subjects whose early cavity had resolved by EOT CXR (HR 1.92, 95%CI 1.09-3.39). CONCLUSION A persistent cavity after 6 months of TB treatment was independently associated with disease relapse after controlling for other variables. EOT CXR may help predict those likely to relapse.