Balabanova Y, Drobniewski F, Fedorin I, Zakharova S, Nikolayevskyy V, Atun R, Coker R
HPA Mycobacterium Reference Unit, Clinical TB and HIV Group, St Bartholomew and Queen Mary School of Medicine, London E1 2AT, UK.
Respir Res. 2006 Mar 23;7(1):44. doi: 10.1186/1465-9921-7-44.
The World Health Organisation (WHO) defines Russia as one of the 22 highest-burden countries for tuberculosis (TB). The WHO Directly Observed Treatment Short Course (DOTS) strategy employing a standardised treatment for 6 months produces the highest cure rates for drug sensitive TB. The Russian TB service traditionally employed individualised treatment. The purpose of this study was to implement a DOTS programme in the civilian and prison sectors of Samara Region of Russia, describe the clinical features and outcomes of recruited patients, determine the proportion of individuals in the cohorts who were infected with drug resistant TB, the degree to which resistance was attributed to the Beijing TB strain family and establish risk factors for drug resistance.
Prospective study.
2,099 patients were recruited overall. Treatment outcomes were analysed for patients recruited up to the third quarter of 2003 (n = 920). 75.3% of patients were successfully treated. Unsuccessful outcomes occurred in 7.3% of cases; 3.6% of patients died during treatment, with a significantly higher proportion of smear-positive cases dying compared to smear-negative cases. 14.0% were lost and transferred out. A high proportion of new cases (948 sequential culture-proven TB cases) had tuberculosis that was resistant to first-line drugs; (24.9% isoniazid resistant; 20.3% rifampicin resistant; 17.3% multidrug resistant tuberculosis). Molecular epidemiological analysis demonstrated that half of all isolated strains (50.7%; 375/740) belonged to the Beijing family. Drug resistance including MDR TB was strongly associated with infection with the Beijing strain (for MDR TB, 35.2% in Beijing strains versus 9.5% in non-Beijing strains, OR-5.2. Risk factors for multidrug resistant tuberculosis were: being a prisoner (OR 4.4), having a relapse of tuberculosis (OR 3.5), being infected with a Beijing family TB strain (OR 6.5) and having an unsuccessful outcome from treatment (OR 5.0).
The implementation of DOTS in Samara, Russia, was feasible and successful. Drug resistant tuberculosis rates in new cases were high and challenge successful outcomes from a conventional DOTS programme alone.
世界卫生组织（WHO）将俄罗斯列为结核病负担最高的22个国家之一。WHO的直接观察治疗短程疗法（DOTS）采用标准化的6个月治疗方案，对药物敏感型结核病的治愈率最高。俄罗斯的结核病服务传统上采用个体化治疗。本研究的目的是在俄罗斯萨马拉地区的平民和监狱部门实施DOTS计划，描述招募患者的临床特征和治疗结果，确定队列中感染耐药结核病的个体比例、耐药性归因于北京结核菌株家族的程度，并确定耐药的危险因素。
前瞻性研究。
总共招募了2099名患者。对截至2003年第三季度招募的患者（n = 920）的治疗结果进行了分析。75.3%的患者得到成功治疗。7.3%的病例治疗结果不佳；3.6%的患者在治疗期间死亡，涂片阳性病例的死亡率明显高于涂片阴性病例。14.0%的患者失访或转出。很大一部分新病例（948例经连续培养证实的结核病病例）患有对一线药物耐药的结核病；（24.9%对异烟肼耐药；20.3%对利福平耐药；17.3%为耐多药结核病）。分子流行病学分析表明，所有分离菌株的一半（50.7%；375/740）属于北京家族。包括耐多药结核病在内的耐药性与感染北京菌株密切相关（对于耐多药结核病，北京菌株为35.2%，非北京菌株为9.5%，比值比为5.2）。耐多药结核病的危险因素包括：是囚犯（比值比4.4）、结核病复发（比值比3.5）、感染北京家族结核菌株（比值比6.5）以及治疗结果不佳（比值比5.0）。
在俄罗斯萨马拉实施DOTS是可行且成功的。新病例中耐药结核病的发生率很高，仅靠传统的DOTS计划难以取得成功的治疗结果。
