Picon Pedro Dornelles, Bassanesi Sergio Luiz, Caramori Maria Luiza Avancini, Ferreira Roberto Luiz Targa, Jarczewski Carla Adriane, Vieira Patrícia Rodrigues de Borba
Universidade Federal do Rio Grande do Sul - UFRGS, Federal University of Rio Grande do Sul - Porto Alegre (RS) Brazil.
J Bras Pneumol. 2007 Sep-Oct;33(5):572-8. doi: 10.1590/s1806-37132007000500013.
To identify risk factors for recurrence of tuberculosis.
We studied a cohort of 610 patients with active pulmonary tuberculosis who were enrolled for treatment between 1989 and 1994 and cured using a three-drug treatment regimen of rifampin, isoniazid and pyrazinamide (RHZ). The risk factors studied were age, gender, race, duration of symptoms, lesion cavitation, extent of disease, diabetes mellitus, alcoholism, HIV infection, delayed negative sputum conversion, treatment compliance, and medication doses. In order to detect recurrence, the patients were monitored through the Rio Grande do Sul State Healt Department Information System for 7.7 +/- 2.0 years after cure. Data were analyzed using the Student's t-test, the chi-square test or Fisher's exact test, and Cox regression models.
There were 26 cases of recurrence (4.3%), which corresponds to 0.55/100 patients-year. The recurrence rate was 5.95 and 0.48/100 patients-year in HIV-positive and HIV-negative patients, respectively (p < 0.0001). In the multivariate analysis, HIV infection [RR = 8.04 (95% CI: 2.35-27.50); p = 0.001] and noncompliance [RR = 6.43 (95% CI: 2.02-20.44); p = 0.002] proved to be independently associated with recurrence of tuberculosis.
Recurrence of tuberculosis was more common in HIV-positive patients and in patients who did not comply with the self-administered treatment (RHZ regimen). Patients presenting at least one of these risk factors can benefit from the implementation of a post-treatment surveillance system for early detection of recurrence. An alternative to prevent noncompliance with tuberculosis treatment would be the use of supervised treatment.
确定结核病复发的危险因素。
我们研究了一组610例活动性肺结核患者，这些患者于1989年至1994年间登记接受治疗，并采用利福平、异烟肼和吡嗪酰胺三联治疗方案（RHZ）治愈。所研究的危险因素包括年龄、性别、种族、症状持续时间、病变空洞形成、疾病范围、糖尿病、酗酒、HIV感染、痰菌转阴延迟、治疗依从性和药物剂量。为了检测复发情况，在治愈后通过南里奥格兰德州卫生部门信息系统对患者进行了7.7±2.0年的监测。使用学生t检验、卡方检验或Fisher精确检验以及Cox回归模型对数据进行分析。
有26例复发（4.3%），相当于0.55/100患者年。HIV阳性和HIV阴性患者的复发率分别为5.95和0.48/100患者年（p<0.0001）。在多变量分析中，HIV感染[相对危险度（RR）=8.04（95%可信区间：2.35 - 27.50）；p = 0.001]和不依从[RR = 6.43（95%可信区间：2.02 - 20.44）；p = 0.002]被证明与结核病复发独立相关。
结核病复发在HIV阳性患者和不依从自我给药治疗（RHZ方案）的患者中更为常见。存在至少一种这些危险因素的患者可受益于实施治疗后监测系统以早期发现复发。防止不依从结核病治疗的一种替代方法是采用监督治疗。
