Bukhary Zakeya A, Alrajhi Abdulrahman A
Department of Medicine, Taibah University, Madinah, Saudi Arabia.
Ann Saudi Med. 2007 May-Jun;27(3):171-4. doi: 10.5144/0256-4947.2007.171.
The outcome of chemotherapy for pulmonary, extrapulmonary, and disseminated tuberculosis is not well documented, especially in developing countries. This study assessed tuberculosis treatment outcome, cure-to-treatment ratio and mortality among all types of tuberculosis patients in a tertiary care setting in Saudi Arabia.
All cases diagnosed and treated for active Mycobacterium tuberculosis infection between 1991 and 2000 were included retrospectively. Data collected included type of tuberculosis involvement, treatment outcome, relapse, and colmorbidities.
Over a ten-year period, 535 cases of tuberculosis were diagnosed and treated. Isolated pulmonary tuberculosis was identified in 141 cases (26.4%), extrapulmonary tuberculosis in 339 cases (63.3%), and combined pulmonary and extrapulmonary disseminated involvements in 55 cases (10.3%). Colmorbidities were noted in 277 (52%) patients. Immunosuppression was found in 181 (34%) patients. The cure rate was 82%. The cure-to-treatment ratio was 86% in extrapulmonary tuberculosis and 78% in pulmonary tuberculosis, and 65% in disseminated tuberculosis. Overall mortality was 18%. Disseminated tuberculosis had the highest mortality (34.9%), followed by pulmonary (21.8%), then extrapulmonary tuberculosis (13.6%). Forty-seven percent of all mortalities were directly related to tuberculosis. Relapse was documented in 14 out of 349 patients (4%) who had 24 months of follow up.
Despite tertiary care support, complicated tuberculosis carries a high mortality. Earlier diagnosis and complete appropriate chemotherapy are essential for improved outcome.
对于肺结核、肺外结核及播散性结核的化疗效果，目前尚无充分的文献记载，尤其是在发展中国家。本研究评估了沙特阿拉伯一家三级医疗机构中各类结核病患者的治疗结果、治愈率与治疗比例以及死亡率。
回顾性纳入1991年至2000年间所有诊断并治疗活动性结核分枝杆菌感染的病例。收集的数据包括结核病受累类型、治疗结果、复发情况及合并症。
在十年期间，共诊断并治疗了535例结核病患者。其中，单纯肺结核141例（26.4%），肺外结核339例（63.3%），合并肺及肺外播散性受累55例（10.3%）。277例（52%）患者存在合并症。181例（34%）患者存在免疫抑制。治愈率为82%。肺外结核的治愈率与治疗比例为86%，肺结核为78%，播散性结核为65%。总体死亡率为18%。播散性结核的死亡率最高（34.9%），其次是肺结核（21.8%），然后是肺外结核（13.6%）。所有死亡病例中有47%与结核病直接相关。在349例接受24个月随访的患者中，有14例（4%）记录到复发。
尽管有三级医疗支持，但复杂型结核病的死亡率仍然很高。早期诊断和完整恰当的化疗对于改善治疗结果至关重要。
