Dhingra V K, Rajpal S, Mittal Anshu, Hanif M
New Delhi Tuberculosis Centre, Jawaharlal Nehru Marg, New Delhi-110 002.
Indian J Tuberc. 2008 Jan;55(1):15-21.
To determine the clinical, radiological and drug resistance profile as well as the factors associated with treatment outcome of Multi-Drug Resistant Tuberculosis (MDR-TB).
All newly diagnosed patients with pulmonary MDR-TB from August 2002 to December 2004 enrolled at New Delhi Tuberculosis Centre, were included in the study. They were followed up clinically, radiologically and bacteriologically by sputum smear, culture and Drug Susceptibility Testing (DST) at regular intervals. According to their DST pattern and previous history of Anti-Tubercular Treatment (ATT), individualized treatment regimens were tailored for each patient.
Out of total 27 bacteriologically proven cases of MDR-TB included in this study, 19 were males (mean age and weight 38.5 years and 52.6 kgs, respectively) and eight females (mean age and weight 34.3 years and 40.7 kgs, respectively). A majority (18) were residents of Delhi and the rest hailed from different parts of North India. All of them had a history of previous treatment ranging from six to 34 months. Cavity on chest X-rays was seen in 81%, while 44% showed extensive involvement. The patients received at least four "second line drugs" during their treatment with a mean of 6.2 anti-tubercular drugs during their intensive phase. Of the 27 patients, 13 were cured, 10 defaulted, one died, one is still on treatment and two were referred for surgery. Radiological improvement was observed in two third of cases and chest X-ray of two patients showed a complete resolution. Six predictors were identified for successful outcome of MDR-TB. They include weight gain at six months, culture conversion, radiological improvement during treatment, disease with M. tuberculosis strains exhibiting resistance to less than or up to three anti-tubercular drugs, use of less than or up to three second line drugs in treatment and no change of regimen during treatment.
Default from treatment was observed to be a major challenge in the treatment of MDR-TB due to long duration and expense of ATT.
确定耐多药结核病（MDR-TB）的临床、放射学及耐药情况，以及与治疗结果相关的因素。
纳入2002年8月至2004年12月在新德里结核病中心新诊断的所有肺部MDR-TB患者。定期对他们进行临床、放射学及细菌学随访，包括痰涂片、培养及药敏试验（DST）。根据他们的DST模式及既往抗结核治疗（ATT）史，为每位患者制定个体化治疗方案。
本研究纳入的27例经细菌学证实的MDR-TB病例中，19例为男性（平均年龄和体重分别为38.5岁和52.6千克），8例为女性（平均年龄和体重分别为34.3岁和40.7千克）。大多数（18例）是德里居民，其余来自印度北部不同地区。他们都有6至34个月的既往治疗史。胸部X线显示81%有空洞，44%显示广泛受累。患者在治疗期间至少接受了四种“二线药物”，强化期平均使用6.2种抗结核药物。27例患者中，13例治愈，10例中断治疗，1例死亡，1例仍在治疗中，2例被转诊接受手术。三分之二的病例观察到放射学改善，2例患者的胸部X线显示完全吸收。确定了MDR-TB治疗成功的六个预测因素。包括六个月时体重增加、培养转阴率、治疗期间放射学改善、结核分枝杆菌菌株对少于三种或多达三种抗结核药物耐药的疾病、治疗中使用少于三种或多达三种二线药物以及治疗期间未更改治疗方案。
由于抗结核治疗疗程长且费用高，治疗中断被认为是耐多药结核病治疗中的一项重大挑战。
