Leimane Vaira, Riekstina Vija, Holtz Timothy H, Zarovska Evija, Skripconoka Vija, Thorpe Lorna E, Laserson Kayla F, Wells Charles D
State Centre of Tuberculosis and Lung Diseases, Riga, Latvia.
Lancet. 2005;365(9456):318-26. doi: 10.1016/S0140-6736(05)17786-1.
Latvia has one of the highest rates of multidrug-resistant tuberculosis (MDRTB). Our aim was to assess treatment outcomes for the first full cohort of MDRTB patients treated under Latvia's DOTS-Plus strategy following WHO guidelines.
We retrospectively reviewed all civilian patients who began treatment with individualised treatment regimens for pulmonary MDRTB in Latvia between Jan 1, and Dec 31, 2000. We applied treatment outcome definitions for MDRTB, developed by an international expert consensus group, and assessed treatment effectiveness and risk factors associated with poor outcome.
Of the 204 patients assessed, 55 (27%) had been newly diagnosed with MDRTB, and 149 (73%) had earlier been treated with first-line or second-line drugs for this disease. Assessment of treatment outcomes showed that 135 (66%) patients were cured or completed therapy, 14 (7%) died, 26 (13%) defaulted, and treatment failed in 29 (14%). Of the 178 adherent patients, 135 (76%) achieved cure or treatment completion. In a multivariate Cox proportional-hazards model of these patients, independent predictors of poor outcome (death and treatment failure) included having previously received treatment for MDRTB (hazard ratio 5.7, 95% CI 1.9-16.6), the use of five or fewer drugs for 3 months or more (3.2, 1.1-9.6), resistance to ofloxacin (2.6, 1.2-5.4), and body-mass index less than 18.5 at start of treatment (2.3, 1.1-4.9).
The DOTS-Plus strategy of identifying and treating patients with MDRTB can be effectively implemented on a nationwide scale in a setting of limited resources.
拉脱维亚是耐多药结核病（MDRTB）发病率最高的国家之一。我们的目的是评估按照世界卫生组织指南，在拉脱维亚的“强化直接观察治疗策略（DOTS-Plus）”下接受治疗的首批耐多药结核病患者队列的治疗结果。
我们回顾性分析了2000年1月1日至12月31日期间在拉脱维亚开始接受个体化治疗方案治疗肺部耐多药结核病的所有平民患者。我们采用了由一个国际专家共识小组制定的耐多药结核病治疗结果定义，并评估了治疗效果以及与不良结果相关的危险因素。
在评估的204例患者中，55例（27%）为新诊断的耐多药结核病患者，149例（73%）此前曾接受过一线或二线药物治疗。治疗结果评估显示，135例（66%）患者治愈或完成治疗，14例（7%）死亡，26例（13%）失访，29例（14%）治疗失败。在178例依从性好的患者中，135例（76%）实现治愈或完成治疗。在这些患者的多变量Cox比例风险模型中，不良结果（死亡和治疗失败）的独立预测因素包括既往接受过耐多药结核病治疗（风险比5.7，95%置信区间1.9 - 16.6）、使用五种或更少药物达3个月或更长时间（3.2，1.1 - 9.6）、对氧氟沙星耐药（2.6，1.2 - 5.4）以及治疗开始时体重指数低于18.5（2.3，1.1 - 4.9）。
在资源有限的情况下，识别和治疗耐多药结核病患者的“强化直接观察治疗策略（DOTS-Plus）”能够在全国范围内有效实施。
