修订后的国家结核病控制规划下直接督导下的短程化疗老年患者概况

Profile of geriatric patients under DOTS in Revised National Tuberculosis Control Programme.

作者信息

Arora V K, Singla Neeta, Sarin R

机构信息

LRS Institute of Tuberculosis and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, India.

出版信息

Indian J Chest Dis Allied Sci. 2003 Oct-Dec;45(4):231-5.

PMID:12962456

Abstract

BACKGROUND

With an increase in life expectancy and the resultant elderly population, there has been an increase in the number of tuberculosis (TB) cases including those in geriatric age as well. However using Directly Observed Treatment-Short Course (DOTS), all categories of TB patients have been sucessfully treated within the country. A need was felt to study the profile of geriatric TB patients under the Revised National Tuberculosis Control Programme (RNTCP).

METHODS

A retrospective study of 7439 patients enrolled under DOTS from January 1996 to March 2001 was carried out in a tertiary care referral institute in Delhi and the profile was analysed in terms of the gender, type of TB and ratio of sputum smear-positive to negative patients for both the younger and geriatric age groups. Further, treatment outcomes of the two age groups were analysed and compared for the 2655 new sputum smear patients.

RESULTS

The male : female ratio of 315 geriatric TB patients enrolled under DOTS was observed to be 3 : 1 as against the 1.4 : 1 in younger TB patients. The occurrence of pulmonary TB was significantly higher than extra-pulmonary TB in geriatric age group (16:1) as compared to the younger age group (4:1). The ratio of new smear-positive to smear-negative patients was almost similar in the two age groups. Further, the treatment outcomes of new smear-positive geriatric TB patients in comparison to younger TB patients showed significantly lower sputum conversion (75.3% vs 85.7% respectively) and cure rates (69.2% vs 80.7% respectively), significantly higher exclusion rates from DOTS (2.3% vs 0.15% respectively) and relatively higher default and treatment failure rates.

CONCLUSIONS

The present study has identified certain issues in the Indian TB patients of geriatric age. These include a lower reported prevalence amongst females, poor sputum conversion as well as cure rates and higher exclusion as well as default rates. Further studies are needed to address the issues under operational conditions of Indian RNTCP.

摘要

背景

随着预期寿命的延长以及老年人口的增加，包括老年结核病病例在内的结核病病例数量也有所上升。然而，通过直接观察短程治疗（DOTS），该国所有类型的结核病患者均已成功治愈。人们感到有必要在修订后的国家结核病控制规划（RNTCP）下研究老年结核病患者的情况。

方法

在德里的一家三级医疗转诊机构对1996年1月至2001年3月期间登记接受DOTS治疗的7439例患者进行了回顾性研究，并根据性别、结核病类型以及青年和老年年龄组痰涂片阳性与阴性患者的比例分析了患者情况。此外，对2655例新的痰涂片患者分析并比较了两个年龄组的治疗结果。

结果

在接受DOTS治疗的315例老年结核病患者中，男女比例为3:1，而青年结核病患者的男女比例为1.4:1。与青年年龄组（4:1）相比，老年年龄组肺结核的发生率显著高于肺外结核（16:1）。两个年龄组中新涂片阳性与涂片阴性患者的比例几乎相似。此外，与青年结核病患者相比，新涂片阳性老年结核病患者的治疗结果显示痰菌转阴率（分别为75.3%和85.7%）和治愈率（分别为69.2%和80.7%）显著较低，DOTS排除率显著较高（分别为2.3%和0.15%），以及相对较高的违约率和治疗失败率。