Rodrigues Alex Miranda, Hueb Márcia, Santos Thiago Adler Ralho Rodrigues dos, Fontes Cor Jésus Fernandes
Faculdade de Ciências Médicas, Universidade Federal de Mato Grosso, Cuiabá, MT.
Rev Soc Bras Med Trop. 2006 Mar-Apr;39(2):139-45. doi: 10.1590/s0037-86822006000200001. Epub 2006 May 5.
We investigated factors associated with treatment failure in the treatment of cutaneous leishmaniasis with meglumine antimony in a reference service in Mato Grosso State. A retrospective cohort of 151 patients with cutaneous leishmaniasis was built using medical records. The incidence of therapeutic failure was 47% (IC95%=39.2%-55%). Antimoniate doses below 10 mg/kg/day (RR=1.8; IC95: 1.1-3.0), previous leishmaniasis treatment (RR=1.7; IC95: 1.3-2.4), 3 or more skin lesions (RR=1.9; IC95: 1.4-2.5), incomplete treatment (RR=1.9; IC95: 1.3-2.6) and body weight above 68 kg (RR=1.7; IC95: 1.1-2.5) were associated with therapeutic failure. After adjustment, therapeutic failure was associated with having 3 or more cutaneous lesions (OR=4.6; IC95%=1.2-17.4), reports of previous leishmaniasis treatment (OR=4.5; IC95%=1.1-17.5), body weight above 68 kg (OR=4.3; IC95=1.5-11.9) and incomplete treatment schedule (OR=12.5; IC95%=2.1-75.4), although body weight is possibly associated with treatment failure due to the limitation of the maximum daily dose. These results help to identify patients at risk of treatment failure of cutaneous leishmaniasis with antimony therapy.
我们在马托格罗索州的一家参考医疗机构，对葡萄糖酸锑治疗皮肤利什曼病治疗失败的相关因素进行了调查。利用病历建立了一个151例皮肤利什曼病患者的回顾性队列。治疗失败的发生率为47%（95%置信区间=39.2%-55%）。低于10mg/kg/天的锑剂剂量（相对危险度=1.8；95%置信区间：1.1-3.0）、既往利什曼病治疗史（相对危险度=1.7；95%置信区间：1.3-2.4）、3个或更多皮肤病变（相对危险度=1.9；95%置信区间：1.4-2.5）、治疗不完整（相对危险度=1.9；95%置信区间：1.3-2.6）以及体重超过68kg（相对危险度=1.7；95%置信区间：1.1-2.5）均与治疗失败相关。调整后，治疗失败与有3个或更多皮肤病变（比值比=4.6；95%置信区间=1.2-17.4）、既往利什曼病治疗报告（比值比=4.5；95%置信区间=1.1-17.5）、体重超过68kg（比值比=4.3；95%置信区间=1.5-11.9）以及治疗方案不完整（比值比=12.5；95%置信区间=2.1-75.4）相关，尽管由于最大日剂量的限制，体重可能与治疗失败有关。这些结果有助于识别接受锑剂治疗的皮肤利什曼病治疗失败风险患者。
