High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up
High mortality rates in tuberculosis patients in Zomba Hospital, Malawi, during 32 months of follow-up
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DOI：
10.1016/s0035-9203(00)90335-3
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发表时间：
2000-05-01
影响因子：
2.2
通讯作者：
Nunn, P
中科院分区：
文献类型：
--
作者：
Kang'ombe, C;Harries, AD;Nunn, P
在撒哈拉以南非洲，在常规方案条件下接受治疗的涂片阴性肺结核(PTB)或肺外肺结核(EPTB)患者的长期随访资料很少。1995年7月1日至12月31日，在马拉维Zomba医院登记的827名成年结核病住院患者中，进行了一项前瞻性研究，以确定从开始治疗起32个月的结果。到32个月时，已有351名患者(42%)死亡。386例涂阳肺结核患者死亡率为30%(95%可信区间[95%CI]25-35%)，211例涂阳肺结核患者死亡率为60%(95%可信区间53-67%)，230例肺结核患者死亡率为47%(95%可信区间40-54%)。在符合艾滋病毒检测结果的793名患者中，612名(77%)艾滋病毒血清阳性：47%的艾滋病毒阳性患者在32个月后死亡，而艾滋病毒阴性患者的死亡率为27%(调整后的危险比[HR]2.395%可信区间1.73.1，P<；0.001)。在32个月的随访中，涂阳肺结核患者的死亡率最高(与涂阳患者相比，HR2.7；95%CI2.1-3.5，P<；0.001)，其次是肺结核患者(HR1.9；95%CI1.5-2.5，与涂阳患者相比，P<；0.001)。当分析局限于治疗期结束后(即12-32个月)时，艾滋病毒血清状态和结核病类型的死亡率差异保持不变。在撒哈拉以南非洲，降低艾滋病毒阳性结核病患者死亡率的低成本、易于实施的战略(例如使用甲氧苄氨嘧啶-磺胺甲恶唑预防)需要在方案环境中紧急进行测试。
There is little information about long-term follow-up in patients with smear-negative pulmonary tuberculosis (PTB) or extrapulmonary tuberculosis (EPTB) who have been treated under routine programme conditions in sub-Saharan Africa. A prospective study was carried out to determine outcome 32 months from start of treatment in an unselected cohort of 827 adult TB inpatients registered at Zomba Hospital, Malawi, in 1 July-31 December 1995. By 32 months, 351 (42%) patients had died. Death rates were 30% (95% confidence interval [95% CI] 25-35%) in 386 patients with smear-positive PTB, 60% (95% CI 53-67%) in 211 patients with smear-negative PTB and 47% (95% CI 40-54%) in 230 patients with EPTB. Of the 793 patients with concordant HIV test results 612 (77%) were HIV seropositive: 47% HIV-positive patients were dead by 32 months compared with 27% HIV-negative patients (adjusted hazard ratio [HR] 2.3; 95% CI 1.7-3.1, P < 0.001). Smear-negative PTB patients had the highest death rates during the 32-month follow-up (HR 2.7; 95% CI 2.1-3.5, P < 0.001 compared to smear-positive patients), followed by EPTB patients (HR 1.9; 95% CI 1.5-2.5, P < 0.001 compared to smear-positive patients). When analysis was restricted to after the treatment period had finished (i.e., months 12-32), the differences in mortality were maintained for HIV-serostatus and for types of TB. Low-cost, easy to implement strategies for reducing mortality in HIV-positive TB patients in sub-Saharan Africa (such as the use of trimethoprim-sulphamethoxazole prophylaxis) need to be tested urgently in programme settings.