Gopi P G, Chandrasekaran V, Subramani R, Santha T, Thomas A, Selvakumar N, Narayanan P R
Tuberculosis Research Centre (ICMR), Chennai, India.
Indian J Med Res. 2006 Jun;123(6):807-14.
BACKGROUND & OBJECTIVES: Early diagnosis of tuberculosis (TB) is important for initiating treatment to gain cure. The present investigation was undertaken to study the association of conversion and cure with initial smear grading among pulmonary tuberculosis (TB) patients registered in a directly observed treatment - short course (DOTS) programme in Tiruvallur district, south India.
All new smear positive cases registered from May, 1999 to December, 2002 were analysed for conversion and cure related to initial smear grading.
Of the 1463 patients, 1206(82.4%) were converted at the end of the intensive phase and 1109 (75.8%) were declared 'cured' after the completion of treatment. The cure rate decreased as the initial smear grading increased and the decrease in trend was statistically significant (P=0.01). Similarly, a significant decrease in conversion rate was also observed with increase in initial smear grading (P<0.001). In multivariate analysis, lower cure rate was significantly associated with patient's age (AOR=1.5, 95% CI=1.1-2.1), alcoholism (AOR=1.7, 95% CI 1.2- 2.4) and conversion at the end of intensive phase (AOR=3.5, 95% CI= 2.6-4.8).
INTERPRETATION & CONCLUSION: Cure and conversion rates were linearly associated with initial smear grading. High default and death rates were responsible for low cure and conversion. The proportion of patients who required extension of treatment and those who had an unfavourable treatment outcome were significantly higher among patients with a 3+ initial smear grading. This reiterates the need to pay more attention in motivating these patients to return to regular treatment and sustained commitment in the control of tuberculosis. There is a need to extend the treatment for one more month in the intensive phase of treatment.
结核病的早期诊断对于启动治疗以实现治愈至关重要。本研究旨在探讨印度南部蒂鲁瓦勒尔地区直接观察短程治疗（DOTS）项目登记的肺结核患者中，痰涂片转阴及治愈情况与初始涂片分级之间的关联。
对1999年5月至2002年12月登记的所有新涂阳病例进行分析，以了解与初始涂片分级相关的转阴及治愈情况。
1463例患者中，1206例（82.4%）在强化期末转阴，1109例（75.8%）在完成治疗后被宣布“治愈”。治愈率随初始涂片分级的增加而降低，且这种下降趋势具有统计学意义（P = 0.01）。同样，随着初始涂片分级的增加，转阴率也显著下降（P < 0.001）。多因素分析显示，较低的治愈率与患者年龄（比值比[AOR]=1.5，95%可信区间[CI]=1.1 - 2.1）、酗酒（AOR = 1.7，95%CI 1.2 - 2.4）以及强化期末转阴情况（AOR = 3.5，95%CI = 2.6 - 4.8）显著相关。
治愈率和转阴率与初始涂片分级呈线性相关。高失访率和死亡率导致了低治愈率和低转阴率。初始涂片分级为3+的患者中，需要延长治疗的患者比例以及治疗结果不佳的患者比例显著更高。这再次强调了需要更加关注激励这些患者回归正规治疗，并持续致力于结核病的控制。在治疗的强化期有必要将治疗再延长一个月。
