Banu Rekha V V, Balasubramanian Rani, Swaminathan Soumya, Ramachandran Rajeswari, Rahman Fathima, Sundaram V, Thyagarajan K, Selvakumar N, Adhilakshmi A R, Iliayas Sheik, Narayanan P R
Tuberculosis Research Centre (ICMR), Chennai, India.
Indian J Med Res. 2007 Nov;126(5):452-8.
BACKGROUND & OBJECTIVE: New smear-positive pulmonary tuberculosis (PTB) patients in the Revised National Tuberculosis Control Programme (RNTCP) are treated with a 6-month short-course chemotherapy (SCC) regimen irrespective of co-morbid conditions. We undertook this retrospective analysis to compare sputum conversion rates (smear, culture) at the end of intensive phase (IP) of Category-1 regimen among patients admitted to concurrent controlled clinical trials: pulmonary tuberculosis alone (PTB) or with type 2 diabetes mellitus (DM-TB) or HIV infection (HIV-TB), and to identify the risk factors influencing sputum conversion.
In this retrospective analysis sputum conversion rates at the end of intensive phase (IP) in three concurrent studies undertaken among PTB, DM-TB and HIV-TB patients, during 1998 - 2002 at the Tuberculosis Research Centre (TRC), Chennai, were compared. Sputum smears were examined by fluorescent microscopy. HIV infected patients did not receive anti-retroviral treatment (ART). Patients with DM were treated with oral hypoglycaemic drugs or insulin (sc).
The study population included 98, 92 and 88 patients in the PTB, DM-TB and HIV-TB studies. At the end of IP the smear conversion (58, 61, and 62%) and culture conversion (86, 88 and 92%) rates were similar in the three groups respectively. The variables associated with lack of sputum smear or culture conversion were age >45 yr, higher pre-treatment smear and culture grading, and extent of the radiographic involvement.
INTERPRETATION & CONCLUSION: Our findings confirm that the current policy of the control programme to treat all pulmonary TB patients with or with out co-morbid conditions with Category-I regimen appears to be appropriate.
在修订后的国家结核病控制规划（RNTCP）中，新发现的涂片阳性肺结核（PTB）患者无论有无合并症，均采用6个月短程化疗（SCC）方案进行治疗。我们进行了这项回顾性分析，以比较在同时进行的对照临床试验中入院的患者（单纯肺结核（PTB）、合并2型糖尿病（DM-TB）或HIV感染（HIV-TB））在1类方案强化期（IP）结束时的痰菌转阴率（涂片、培养），并确定影响痰菌转阴的危险因素。
在这项回顾性分析中，比较了1998年至2002年在金奈结核病研究中心（TRC）对PTB、DM-TB和HIV-TB患者进行的三项同期研究中强化期（IP）结束时的痰菌转阴率。痰涂片采用荧光显微镜检查。HIV感染患者未接受抗逆转录病毒治疗（ART）。糖尿病患者采用口服降糖药或胰岛素（皮下注射）治疗。
PTB、DM-TB和HIV-TB研究中的研究人群分别包括98、92和88例患者。在强化期结束时，三组的涂片转阴率（分别为58%、61%和62%）和培养转阴率（分别为86%、88%和92%）相似。与痰涂片或培养未转阴相关的变量包括年龄>45岁、治疗前涂片和培养分级较高以及影像学受累程度。
我们的研究结果证实，目前控制规划中对所有有无合并症的肺结核患者采用I类方案治疗的政策似乎是合适的。
