Follow-up of patients with multidrug resistant tuberculosis four years after standardized first-line drug treatment.
Follow-up of patients with multidrug resistant tuberculosis four years after standardized first-line drug treatment.
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DOI：
10.1371/journal.pone.0010799
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发表时间：
2010-05-24
期刊：
影响因子：
3.7
通讯作者：
van den Hof S
中科院分区：
文献类型：
--
作者：
He GX;Xie YG;Wang LX;Borgdorff MW;van der Werf MJ;Fan JH;Yan XL;Li FB;Zhang XZ;Zhao YL;van den Hof S
2004年，在中国黑龙江省进行的一项抗结核（TB）药物耐药性调查中，纳入了1574名（79%）新患者和421名（21%）复治患者。在7.2%的新患者和30.4%的复治患者中检测到耐多药结核病。所有患者均接受标准化一线药物（FLD）方案治疗。我们报告了2004年队列的治疗结果，以及2008年下半年评估的长期结果。初治和复治耐多药结核病人的治愈率分别为83%（94/113）和66%（85/128）（P<0.001）。241名耐多药结核病患者中有10人在治疗期间死亡。在其余231起案件中，有129起（56%）可以追溯到2008年。新发和复治病例的总复发率分别为46%和66%（P = 0.03）。 新发和复治病例的总死亡率分别为25%和46%（P = 0.02）。 40%的追踪新发病例和24%的复治病例存活且无复发（P = 0.01）。 在2004年治疗失败或未能接受治疗的16名患者中，到2008年只有两名患者没有被重新诊断为结核病。在111例（86%）初始治疗成功的患者中，63例（57%）发生了复发性结核病，40例（36%）死亡，其中27例（24%）死于结核病。四年的随访期排除了对所有患者的随访。在一项高度保守的敏感性分析中，我们假设所有未纳入的患者均存活且无复发性TB，复发率和死亡率分别为33%和21%。基于传统涂片显微镜的治愈记录是长期结果的不良预测因素。中国黑龙江省的耐多药结核病患者在接受标准化FLD方案治疗后4年复发率和死亡率较高，这加强了对耐多药结核病早期诊断和治疗的需求，包括采用更敏感的实验室方法评估治疗结果。
In 2004, an anti-tuberculosis (TB) drug resistance survey in Heilongjiang province, China, enrolled 1574 (79%) new and 421 (21%) retreatment patients. Multi-drug resistant (MDR) TB was detected in 7.2% of new and 30.4% of retreatment patients. All received treatment with standardized first-line drug (FLD) regimens. We report treatment outcomes of the 2004 cohort, and long-term outcomes as assessed in the second half of 2008. The reported cure rate for MDR-TB patients was 83% (94/113) among new and 66% (85/128) among retreatment patients (P<0.001). Ten of the 241 MDR-TB patients died during treatment. Of the remaining 231, 129 (56%) could be traced in 2008. The overall recurrence rates among new and retreatment cases were 46% and 66%, respectively (P = 0.03). The overall death rates among new and retreatment cases were 25% and 46%, respectively (P = 0.02). Forty percent of the traced new cases and 24% of the retreatment cases were alive and without recurrent TB (P = 0.01). Of the 16 patients who failed or defaulted from treatment in 2004, only two patients were not re-diagnosed with TB by 2008. Of the 111 (86%) patients with an initial successful treatment outcome 63 (57%) had developed recurrent TB, 40 (36%) had died, 27 (24%) of them died of TB. The follow-up period of four years precluded follow-up of all patients. In a highly conservative sensitivity analysis in which we assumed that all non-included patients were alive and did not have recurrent TB, the recurrence and death rate were 33% and 21%. Documentation of cure based on conventional smear microscopy was a poor predictor of long term outcomes. MDR-TB patients in Heilongjiang province in China had high recurrence and death rates four years after treatment with standardized FLD regimens, reinforcing the need for early diagnosis and treatment of MDR-TB, including assessment of treatment outcomes with more sensitive laboratory methods.
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