García-García Maria De Lourdes, Ponce-De-León Alfredo, García-Sancho Maria Cecilia, Ferreyra-Reyes Leticia, Palacios-Martínez Manuel, Fuentes Javier, Kato-Maeda Midori, Bobadilla Miriam, Small Peter, Sifuentes-Osornio José
Instituto Nacional de Salud Pública, Cuernavaca, México.
Emerg Infect Dis. 2002 Nov;8(11):1327-33. doi: 10.3201/eid0811.020021.
To describe the molecular epidemiology of tuberculosis (TB)-related deaths in a well-managed program in a low-HIV area, we analyzed data from a cohort of 454 pulmonary TB patients recruited between March 1995 and October 2000 in southern Mexico. Patients who were sputum acid-fast bacillus smear positive underwent clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) and received treatment from the local directly observed treatment strategy (DOTS) program. After an average of 2.3 years of follow-up, death was higher for clustered cases (28.6 vs. 7%, p=0.01). Cox analysis revealed that TB-related mortality hazard ratios included treatment default (8.9), multidrug resistance (5.7), recently transmitted TB (4.1), weight loss (3.9), and having less than 6 years of formal education (2). In this community, TB is associated with high mortality rates.
为描述在低艾滋病毒感染地区一个管理良好的项目中与结核病（TB）相关死亡的分子流行病学情况，我们分析了1995年3月至2000年10月在墨西哥南部招募的454例肺结核患者队列的数据。痰涂片抗酸杆菌阳性的患者接受了临床和分枝杆菌学评估（分离、鉴定、药敏试验以及基于IS6110的基因分型和间隔寡核苷酸分型），并接受当地直接观察治疗策略（DOTS）项目的治疗。平均随访2.3年后，聚集性病例的死亡率更高（28.6%对7%，p = 0.01）。Cox分析显示，与结核病相关的死亡风险比包括治疗中断（8.9）、耐多药（5.7）、近期传播的结核病（4.1）、体重减轻（3.9）以及正规教育年限少于6年（2）。在这个社区，结核病与高死亡率相关。
