Masuyama H, Takase A, Aoki M, Shimao T
Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan.
Kekkaku. 1998 Dec;73(12):697-703.
The Tuberculosis Control Project, Lumbini, Rupandehi (TCPLR) is a bilateral cooperative venture between two NGO's, the Nepal Anti-Tuberculosis Association (NATA) and the Japan Anti-Tuberculosis Association (JATA), which consists of planning and implementing pilot tuberculosis control activities in Lumbini, Rupandehi district in Nepal, aiming at achieving high cure rate of newly detected smear-positive pulmonary tuberculosis patients before introducing DOTS strategies. Between December 1993 and July 1996, 349 tuberculosis (TB) cases were enrolled in the TCPLR. The categories of cases were as follows: 138 cases (40%) of new smear-positive pulmonary TB [new Sm(+) PTB], and 54 cases (15%) of smear positive pulmonary TB other than new Sm(+) PTB [other Sm(+) PTB] including such cases as continued treatment and relapse, 106 cases (30%) of new smear-negative TB [new Sm(-) TB], and 51 cases (15%) of other smear-negative TB other than New Sm(-) PTB [other Sm(-) TB]. The number and proportion of new Sm(+) PTB cases enrolled in the project have been increasing [6 cases (23%) for the first year, 102 cases (54%) for the third year] although the proportion is still low (40% overall). The regimens of chemotherapy in the initial intensive and the continuation phases of treatment according to the categories of TB were as follows: New Sm(+) PTB; 2HRZE(S)/6HE, other Sm(+) PTB; 2HRZES/1HRZE/5HRE, and Sm(-) TB; 2HRZ/6HE. The proportion of cases treated by the appropriate regimen of chemotherapy has increased. The cohort analysis of the treatment outcome of the cases enrolled in the project showed the following. The proportion of cured cases plus smear-unconfirmed cases completing treatment among new Sm(+) PTB was 74% overall, however, the proportion of defaulters increased in the third year. The proportion of cured cases plus smear-unconfirmed cases completing treatment among other Sm(+) PTB cases was 66% overall, which is slightly lower than that of new Sm(+) PTB cases, however, the difference was not so marked. The proportion of treatment completed cases among smear-negative pulmonary TB cases was 77% overall, however, proportion of defaulters increased in the third year. The treatment outcome in this report was obtained before the adoption of DOTS strategies: However, it showed that cure and treatment completion rates were comparable to those obtained in the SEARO countries which adopt DOTS strategies. The treatment outcome could be improved after the introduction of DOTS strategies in 1997.
蓝毗尼鲁潘德希结核病控制项目（TCPLR）是尼泊尔抗结核协会（NATA）和日本抗结核协会（JATA）这两个非政府组织之间的双边合作项目，其内容包括在尼泊尔鲁潘德希县蓝毗尼规划和实施结核病控制试点活动，目标是在引入直接观察短程治疗（DOTS）策略之前，使新发现的涂片阳性肺结核患者获得高治愈率。1993年12月至1996年7月期间，349例结核病患者被纳入TCPLR项目。病例分类如下：138例（40%）新涂片阳性肺结核[新Sm(+) PTB]，54例（15%）除新Sm(+) PTB之外的涂片阳性肺结核[其他Sm(+) PTB]，包括复治和复发等病例，106例（30%）新涂片阴性肺结核[新Sm(-) TB]，以及51例（15%）除新Sm(-) PTB之外的其他涂片阴性肺结核[其他Sm(-) TB]。尽管该项目中登记的新Sm(+) PTB病例比例总体仍较低（40%），但其数量和比例一直在增加[第一年6例（23%），第三年102例（54%）]。根据结核病类别，治疗初始强化期和继续期的化疗方案如下：新Sm(+) PTB；2HRZE(S)/6HE，其他Sm(+) PTB；2HRZES/1HRZE/5HRE，以及Sm(-) TB；2HRZ/6HE。接受适当化疗方案治疗的病例比例有所增加。对该项目登记病例的治疗结果进行队列分析显示如下情况。新Sm(+) PTB中治愈病例加完成治疗的涂片未确诊病例的总体比例为74%，然而，第三年失访者比例有所增加。其他Sm(+) PTB病例中治愈病例加完成治疗的涂片未确诊病例的总体比例为66%，略低于新Sm(+) PTB病例，但差异并不显著。涂片阴性肺结核病例中完成治疗病例的总体比例为77%，然而，第三年失访者比例有所增加。本报告中的治疗结果是在采用DOTS策略之前获得的：然而，结果显示治愈率和治疗完成率与采用DOTS策略的东南亚区域办事处国家所取得的结果相当。1997年引入DOTS策略后，治疗结果可能会得到改善。
