Migliori G B, Espinal M, Danilova I D, Punga V V, Grzemska M, Raviglione M C
WHO Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione Salvatore Maugeri, Care and Research Institute, Tradate, Italy.
Int J Tuberc Lung Dis. 2002 Oct;6(10):858-64.
Ivanovo Oblast, Russian Federation, 300 km north-east of Moscow, where a pilot DOTS TB control programme was implemented in October 1995.
To determine the frequency of TB recurrence among MDR (multidrug-resistant) patients who achieved treatment 'success' on standard short-course chemotherapy.
All patients with MDR tuberculosis, defined as resistance to at least isoniazid and rifampicin, who were declared 'cured' or 'treatment completed', were identified using the district register and traced whenever possible. Eligible patients underwent medical examination and, if necessary, chest radiography, sputum smear examination, culture and susceptibility testing. If the patient had died, the relatives were interviewed to try to determine the reasons for death.
Of 18 patients eligible for analysis, five (27.8%) were documented to have recurrence (two of seven patients resistant to HRSE, one of five patients resistant to HRS and two of six patients resistant to HR). Patients receiving the Category I regimen were more likely to relapse than those receiving the Category II regimen (40% vs. 12.5%). The median time to relapse was 8 months; 2.46 recurrences were observed in 100 person-months (3.17 in category I and 1.3 in Category II patients).
The frequency of TB recurrence among MDR-TB patients declared 'cured' after short-course chemotherapy is high. Improvements in treatment success, after removal of programme-related pitfalls in the treatment delivery process, must incorporate methods for early detection of MDR, along with adequate treatment regimens including second-line drugs. Culture-based bacteriological confirmation at the end of treatment is recommended.
俄罗斯联邦伊万诺沃州，位于莫斯科东北300公里处，1995年10月在此实施了结核病直接督导短程化疗试点项目。
确定在标准短程化疗中取得治疗“成功”的耐多药（MDR）患者中结核病复发的频率。
利用地区登记册识别所有耐多药结核病患者，即对至少异烟肼和利福平耐药且被宣布“治愈”或“完成治疗”的患者，并尽可能进行追踪。符合条件的患者接受医学检查，必要时进行胸部X光检查、痰涂片检查、培养和药敏试验。如果患者已死亡，则对其亲属进行访谈以试图确定死亡原因。
在18例符合分析条件的患者中，有5例（27.8%）被记录有复发（7例对HRSE耐药的患者中有2例，5例对HRS耐药的患者中有1例，6例对HR耐药的患者中有2例）。接受I类治疗方案的患者比接受II类治疗方案的患者更容易复发（40%对12.5%）。复发的中位时间为8个月；每100人月观察到2.46次复发（I类患者为3.17次，II类患者为1.3次）。
短程化疗后被宣布“治愈”的耐多药结核病患者中结核病复发的频率很高。在消除治疗实施过程中与项目相关的缺陷后，提高治疗成功率必须纳入早期检测耐多药的方法，以及包括二线药物在内的适当治疗方案。建议在治疗结束时进行基于培养的细菌学确认。
