Recurrence after Successful Treatment of Multidrug-Resistant Tuberculosis in Taiwan.
Recurrence after Successful Treatment of Multidrug-Resistant Tuberculosis in Taiwan.
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成功治疗台湾多药耐药性结核病后的复发。
DOI：
10.1371/journal.pone.0170980
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Chan PC
中科院分区：
文献类型：
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作者：
Chen MY;Lo YC;Chen WC;Wang KF;Chan PC
耐多药结核病(MDR-TB)成功治疗后复发具有挑战性，因为再治疗选择有限。这项研究旨在确定在台湾成功治疗后耐多药结核病复发率和预测因素。对国家队列中295万名DR-TB患者的复发率进行了分析。多药耐药结核病复发的相关因素通过多变量COX回归分析进行分析。10名(3%)患者在中位数4.8年的随访期内出现耐多药结核病复发。总复发率为0.6例/1000人月。胸片上的空洞是复发的独立预测因素(调整后的风险比[AHR]=6.3；95%可信区间为1.2-34)。当分析限于215例(73%)二线药物敏感性检测的患者时，空洞(AHR=10.2；95%CI，1.2-)和广泛耐药结核病(XDR-TB)或广泛耐药前结核病的耐药模式(AHR=7.3；95%CI，1.2-44)与多药耐药结核病复发的风险增加相关。在台湾，具有空洞性病变和耐药模式的耐多药结核病患者复发风险最高。这些对旨在优化治疗后随访和早期发现复发耐多药结核病的耐多药结核病项目具有重要意义。
Recurrence after successful treatment for multidrug-resistant tuberculosis (MDR-TB) is challenging because of limited retreatment options. This study aimed to determine rates and predictors of MDR-TB recurrence after successful treatment in Taiwan. Recurrence rates were analyzed by time from treatment completion in 295 M DR-TB patients in a national cohort. Factors associated with MDR-TB recurrence were examined using a multivariate Cox regression analysis. Ten (3%) patients experienced MDR-TB recurrence during a median follow-up of 4.8 years. The overall recurrence rate was 0.6 cases per 1000 person-months. Cavitation on chest radiography was an independent predictor of recurrence (adjusted hazard ratio [aHR] = 6.3; 95% CI, 1.2–34). When the analysis was restricted to 215 patients (73%) tested for second-line drug susceptibility, cavitation (aHR = 10.2; 95% CI, 1.2–89) and resistance patterns of extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (aHR = 7.3; 95% CI, 1.2–44) were associated with increased risk of MDR-TB recurrence. In Taiwan, MDR-TB patients with cavitary lesions and resistance patterns of XDR-TB or pre-XDR-TB are at the highest risk of recurrence. These have important implications for MDR-TB programs aiming to optimize post-treatment follow-up and early detection of recurrent MDR-TB.