Sputum smear conversion during directly observed treatment for tuberculosis
Sputum smear conversion during directly observed treatment for tuberculosis
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DOI：
10.1016/s0962-8479(96)90026-x
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发表时间：
1996-04-01
期刊：
影响因子：
--
通讯作者：
Rieder, HL
中科院分区：
文献类型：
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作者：
Rieder, HL
设定：泰国难民营的结核病治疗项目。目的：确定治疗月直接显微镜检查痰涂片的累积转化率，并确定预测转化失败的因素。方法：三种痰涂片检查方法的转阳分析（每月进行一次）在一组痰涂片阳性结核病患者中进行，这些患者接受直接观察的每日方案治疗，整个过程中含有利福平。巢式病例对照研究的患者未能在4个月内明确转换相比，控制谁没有convert.Results：痰转换后的2个月的密集阶段为75.0%，范围从61.7%到90.9%的患者最初的强阳性和弱阳性涂片，分别。治疗4个月内无明确转换的最强预测因素是2个月强化治疗期结束时痰涂片阳性（调整后相对优势4.2，95%置信区间1.5-11.4）。在那些没有转换的患者中，阳性涂片是15例的孤立现象，4例在治疗延长后明确转换的患者中反复出现，2例需要重新治疗方案的患者中持续阳性。如果进行严格的痰涂片检查程序，则判定痰涂片转化比常规程序条件下慢，但在病程后期的阳性结果通常是一种孤立的现象，可能意义不大。两个月时的痰涂片结果强烈预测治疗三个月后的细菌学结果，从而确定可能从强化期延长中获益的病例。
Setting: Treatment program for tuberculosis in a refugee camp in Thailand.Objectives: To determine the cumulative frequency of conversion of sputum smears examined by direct microscopy by month of treatment and to identify factors predicting failure to convert.Methods: Analysis of conversion based on three sputum smear examinations (performed monthly) in a cohort of patients with sputum smear-positive tuberculosis treated with a directly observed daily regimen containing rifampicin throughout. Nested case-control study of patients failing to convert definitively within four months compared to controls who did convert.Results: Sputum conversion after the 2-month intensive phase was 75.0%, with a range from 61.7% to 90.9% in patients with initially strongly- and weakly-positive smears, respectively. The strongest predictor identified for no definitive conversion within four months of treatment was a positive sputum smear result at the end of the 2-month intensive phase (adjusted relative odds 4.2, 95% confidence interval 1.5-11.4). Of those patients who did not convert, positive smears were an isolated phenomenon in 15, repeatedly in four who definitely converted with a prolongation of treatment, and persistently positive in two requiring a re-treatment regimen.Conclusions: Definitive sputum smear conversion is judged to be slower if a strict program of sputum smear examination is undertaken than under routine program conditions, but positive results late in the course are commonly an isolated phenomenon and possibly of little significance. Sputum smear results at two months strongly predict bacteriologic results beyond three months of treatment, and thus identify cases who might benefit from a prolongation of the intensive phase.