Predictors of short-term and long-term outcome after a diagnosis of tuberculosis

结核病诊断后短期和长期结果的预测因素

• 批准号: 7541526
• 负责人: David J. Horne
• 金额: $ 5.89万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-08 至 2010-07-07
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7541526
• 关键词: Affect; Age; Area; Cause of Death; Clinical; Complex; Demographic Factors; Development; Diagnosis; Diagnostic tests; Disease; Extreme drug resistant tuberculosis; Gender; Genotype; Health; Integration Host Factors; Intervention; Investigation; Investments; Lead; Molecular; Multi-Drug Resistance; Multidrug-Resistant Tuberculosis; Mycobacterium tuberculosis; Natural History; Outcome; Patients; Personal Satisfaction; Phylogenetic Analysis; Population; Prevalence; Race; Rate; Resources; Risk; Risk Factors; Severity of illness; Standards of Weights and Measures; Technology; Therapeutic; Tuberculosis; Variant; Washington; Work; base; cohort; disease transmission; fight against; follow-up; inattention; mortality; population genetic structure

DESCRIPTION (provided by applicant): Patients with tuberculosis (TB) are not usually followed after they have completed treatment and long-term outcomes in these patients have not been well evaluated. Several studies suggest that long-term survival may be reduced in this population. Population-based studies to assess risk factors that are associated with poor outcomes have not been performed. Characterization of factors that impact long-term survival could lead to the identification of patients at risk for increased mortality and allow for interventions. In addition to host factors, strain specific differences of Mycobacterium tuberculosis complex (MTB) may impact clinical outcome. Molecular genotyping of MTB has been an important advancement in the field of TB over the last two decades. A more recent application of this technology has been in the area of MTB phylogenetics, or the study of evolutionary relatedness. There is growing evidence that different strains of MTB may differ in disease severity and transmissibility. The aims of this proposal are to: 1) document survival of patients diagnosed with TB in a large population based cohort over a long follow-up period and determine cause of death, 2) identify clinical and demographic factors associated with outcome after a diagnosis of TB, 3) describe the genetic population structure of MTB in Washington State and identify associations between specific strains of TB and clinical outcome, 4) identify associations between phylogenetic lineage of MTB and recent disease transmission as demonstrated by the presence of non-unique genotype isolates. TB remains a leading cause of death world-wide; in the U.S. there were almost 14,000 cases of TB in 2006. Past inattention to TB in resulted in a dramatic increase in national rates and the increasing prevalence of multi-drug resistant (MDR) and extremely drug resistant TB have further demonstrated the need for continued investment of resources in the investigation, treatment, and control of TB. A better understanding of the natural history of TB, differences in outcomes and variations in transmissibility would have direct impacts on publich health. Further elucidation of the importance of MTB strain variability could be important in the development of diagnostic tests and therapeutics in the fight against TB.

描述（由申请人提供）：结核病患者（结核病）通常不会在他们完成治疗后不接受，并且这些患者的长期结局尚未得到很好的评估。几项研究表明，该人群可能会降低长期生存。尚未进行基于人群的研究以评估与结果不佳有关的危险因素。影响长期生存的因素的表征可能会导致鉴定出有增加死亡率并允许干预措施的患者。除宿主因素外，结核分枝杆菌复合物（MTB）的菌株特异性差异可能会影响临床结果。在过去的二十年中，MTB的分子基因分型在结核病领域一直是重要的进步。该技术的最新应用是在MTB系统发育学领域或 进化相关性的研究。越来越多的证据表明，MTB的不同菌株在疾病的严重程度和可传染性上可能有所不同。该提案的目的是：1）在长期随访期间，在大种群中诊断为TB的患者的存活情况并确定死亡原因，2）确定与结核病诊断后与结果相关的临床和人口统计学因素，3）3）描述华盛顿州的遗传种群在华盛顿州的遗传种群结构，并确定了TB的特定疾病与临床疾病之间的关联，4）差异，4）通过非唯一基因型分离株的存在所证明的传播。结核病仍然是全球死亡的主要原因。在美国，2006年有近14,000例结核病病例。过去对结核病的注意力不集中导致全国率急剧上升，多药抗药性（MDR）的患病率提高，并且非常耐药的结核病进一步证明了在调查，治疗和控制结核病的调查，治疗和控制中需要继续投资资源。更好地了解结核病的自然史，结果的差异和透气性的差异将对Publich Health产生直接影响。进一步阐明MTB菌株变异性的重要性对于在与结核病作斗争中的诊断测试和治疗剂的开发中可能很重要。