Drobniewski F, Eltringham I, Graham C, Magee J G, Smith E G, Watt B
PHLS Mycobacterium Reference Unit, Dulwich Public Health Laboratory and Guy's, King's and St Thomas' Medical School, King's College, Dulwich Hospital, London SE22 8QF, UK.
Thorax. 2002 Sep;57(9):810-6. doi: 10.1136/thorax.57.9.810.
This study aimed to describe the clinical, microbiological, molecular epidemiology and treatment of multidrug resistant tuberculosis (MDRTB) cases in the UK and to determine factors associated with survival.
Ninety MDRTB cases were identified from 1 January 1996 to 30 June 1997; 69 were DNA fingerprinted. Date of diagnosis was determined and data were collated on key demographic factors, clinical, radiological and treatment details. Variables associated with survival were included in a Cox proportional hazards model.
Most of the patients (72.4%) were male, born outside the UK (57.1%), were sputum smear positive (82.2%), and had entered the UK more than 5 years previously (61.9%). Thirty eight of 78 cases (48.7%) had prior TB. Sufficient data on 82 patients were available for survival analysis; 20/27 (74.1%) known to be dead at the end of the observation period had died of tuberculosis. Median survival time overall was 1379 days (95% CI 1336 to 2515) or 3.78 (95% CI 3.66 to 6.89) years (858 days (95% CI 530 to 2515) in immunocompromised individuals (n=32) and 1554 (95% CI 1336 to 2066) days in immunocompetent cases (n=48)). Median survival in patients treated with three drugs to which the bacterium was susceptible on in vitro testing (n=62) was 2066 days (95% CI 1336 to 2515) or 5.66 years, whereas in those not so treated (n=13) survival was 599 days (95% CI 190 to 969) or 1.64 years.
Immunocompromised status, failure to culture the bacterium in 30 days or to apply appropriate three drug treatment, and age were significant factors in mortality. An immunocompromised patient was nearly nine times more likely to die, while application of appropriate treatment reduced the risk (risk ratio 0.06). Increasing age was associated with increasing risk of death (risk ratio 2.079; 95% CI 1.269 to 3.402)-that is, for every 10 year increase in age the risk almost doubled. Overall survival was lower than that reported in previous studies.
本研究旨在描述英国耐多药结核病（MDRTB）病例的临床、微生物学、分子流行病学及治疗情况，并确定与生存相关的因素。
1996年1月1日至1997年6月30日期间共识别出90例MDRTB病例；其中69例进行了DNA指纹分析。确定诊断日期，并整理关键人口统计学因素、临床、放射学及治疗细节的数据。将与生存相关的变量纳入Cox比例风险模型。
大多数患者（72.4%）为男性，出生于英国境外（57.1%），痰涂片阳性（82.2%），且5年多以前就已进入英国（61.9%）。78例患者中有38例（48.7%）既往有结核病。有82例患者的足够数据可用于生存分析；在观察期结束时已知死亡的20/27例（74.1%）死于结核病。总体中位生存时间为1379天（95%置信区间1336至2515）或3.78年（95%置信区间3.66至6.89）（免疫功能低下个体（n = 32）为858天（95%置信区间530至2515），免疫功能正常病例（n = 48）为1554天（95%置信区间1336至2066））。对体外试验中细菌敏感的三种药物进行治疗的患者（n = 62）的中位生存时间为2066天（95%置信区间1336至2515）或5.66年，而未接受这种治疗的患者（n = 13）的生存时间为599天（95%置信区间190至969）或1.64年。
免疫功能低下状态、30天内未培养出细菌或未采用适当的三联药物治疗以及年龄是死亡的重要因素。免疫功能低下的患者死亡可能性几乎高9倍，而采用适当治疗可降低风险（风险比0.06）。年龄增加与死亡风险增加相关（风险比2.079；95%置信区间1.269至3.402）——即每增加10岁，风险几乎翻倍。总体生存率低于先前研究报告的生存率。
