Tahaoğlu K, Törün T, Sevim T, Ataç G, Kir A, Karasulu L, Ozmen I, Kapakli N
Department of Pulmonary Disease, Sureyyapaşa Center for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.
N Engl J Med. 2001 Jul 19;345(3):170-4. doi: 10.1056/NEJM200107193450303.
We evaluated the results of treatment in 158 consecutive patients with multidrug-resistant tuberculosis who were treated at our center in Istanbul.
A total of 21 female patients and 137 male patients (age range, 15 to 68 years) received treatment for multidrug-resistant tuberculosis between March 1992 and October 1999. The patients had previously received a mean of 5.7 antituberculosis drugs and were infected with organisms that were resistant to a mean of 4.4 drugs. All patients were infected with organisms that were resistant to both isoniazid and rifampicin. The regimens we used were selected on the basis of previous treatment protocols and the results of susceptibility tests. All patients received at least three drugs thought to be active; the treatment was continued for at least 18 months after the conversion to a negative culture and for at least 24 months in the absence of first-line drugs.
The mean number of drugs given during the study was 5.5 (range, 3 to 9). Surgical resection was performed in 36 patients. Adverse effects led to discontinuation of one or more drugs in 62 patients (39 percent). Cultures became negative in 150 patients (95 percent) after a mean of 1.9 months (range, 1 to 9). The overall success rate of treatment was 77 percent, with cures in 78 patients (49 percent) and probable cures in 43 (27 percent). Treatment failed in 13 patients (8 percent). Seven patients died (4 percent). Seventeen patients (11 percent) did not complete the treatment regimen. The patients with unsuccessful outcomes were older than those with successful outcomes (mean age, 42 years vs. 36 years; P=0.008), had received a larger number of drugs previously (median, six vs. five; P=0.048), were more likely to have been treated previously with ofloxacin (57 percent vs. 30 percent, P=0.004), and were less likely to have received ofloxacin as part of the study protocol (65 percent vs. 84 percent, P=0.018). Thirty-eight percent of the patients with unsuccessful outcomes were infected with organisms that were resistant to more than five drugs. In a step-down logistic-regression analysis, a successful outcome was independently associated with a younger age (P=0.013) and the absence of previous treatment with ofloxacin (P=0.005).
Most patients with multidrug-resistant tuberculosis can be cured with the use of appropriate, intensive treatment regimens.
我们评估了在伊斯坦布尔我们中心接受治疗的158例连续性耐多药结核病患者的治疗结果。
1992年3月至1999年10月期间，共有21例女性患者和137例男性患者（年龄范围15至68岁）接受了耐多药结核病治疗。这些患者此前平均接受过5.7种抗结核药物治疗，感染的病菌平均对4.4种药物耐药。所有患者感染的病菌均对异烟肼和利福平耐药。我们使用的治疗方案是根据既往治疗方案和药敏试验结果选定的。所有患者至少接受三种据信有效的药物治疗；痰培养转阴后治疗至少持续18个月，若无一线药物则至少持续24个月。
研究期间给予的药物平均数量为5.5种（范围3至9种）。36例患者接受了手术切除。62例患者（39%）因不良反应停用了一种或多种药物。150例患者（95%）的痰培养平均在1.9个月（范围1至9个月）后转阴。治疗的总体成功率为77%，78例患者（49%）治愈，43例患者（27%）可能治愈。13例患者（8%）治疗失败。7例患者死亡（4%）。17例患者（11%）未完成治疗方案。治疗结果未成功的患者比成功的患者年龄更大（平均年龄42岁对36岁；P = 0.008），此前接受的药物数量更多（中位数分别为6种对5种；P = 0.048），更有可能曾接受过氧氟沙星治疗（57%对30%，P = 0.004），而作为研究方案一部分接受氧氟沙星治疗的可能性更小（65%对84%，P = 0.018）。治疗结果未成功的患者中38%感染的病菌对五种以上药物耐药。在逐步逻辑回归分析中，治疗成功与较年轻的年龄（P = 0.013）和既往未接受过氧氟沙星治疗（P = 0.005）独立相关。
大多数耐多药结核病患者通过使用适当的强化治疗方案可以治愈。
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