Masjedi M R, Tabarsi P, Chitsaz E, Baghaei P, Mirsaeidi M, Amiri M V, Farnia P, Javanmard P, Mansouri D, Velayati A A
Mycobacteriology Research Centre, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Tuberc Lung Dis. 2008 Jul;12(7):750-5.
Multidrug-resistant tuberculosis (MDR-TB) imposes a formidable burden on national health systems. There is still no consensus on the subject, with controversies regarding treatment protocols, treatment outcomes and the various treatment regimens.
The present study describes Iran's second national cohort for treatment of MDR-TB. The study comprised all documented MDR-TB cases in Iran referred to our centre during the period 2002-2006. All patients received a standardised second-line regimen consisting of ofloxacin, cycloserine, prothionamide and amikacin. Based on drug susceptibility testing results, ethambutol and pyrazinamide were added to the regimen.
Forty-three patients diagnosed with MDR-TB, with a mean age of 44.38 +/- 19.05 years, received treatment; of these, 27 (62.8%) were male. Twenty-three were (53.5%) Iranians and the remainder were Afghans. All patients were acquired MDR-TB cases. Of the 43 cases, 25 (58.1%) experienced severe clinically significant adverse effects; 29 (67.5%) had a successful outcome and 14 (32.5%) had a poor outcome (treatment failure in six [14%] and death in eight [18.6%]). Mortality was higher in Iranians (P = 0.039) and in patients whose initial regimen was changed due to adverse drug reactions (P = 0.01).
Compared with previous studies, our study was able to obtain more favourable outcomes of MDR-TB treatment using a standardised regimen.
耐多药结核病（MDR-TB）给各国卫生系统带来了巨大负担。关于该主题仍未达成共识，在治疗方案、治疗结果及各种治疗方案方面存在争议。
本研究描述了伊朗治疗耐多药结核病的第二个全国性队列。该研究纳入了2002年至2006年期间转诊至我们中心的伊朗所有记录在案的耐多药结核病病例。所有患者均接受由氧氟沙星、环丝氨酸、丙硫异烟胺和阿米卡星组成的标准化二线治疗方案。根据药敏试验结果，将乙胺丁醇和吡嗪酰胺添加到治疗方案中。
43例被诊断为耐多药结核病的患者接受了治疗，平均年龄为44.38±19.05岁，其中27例（62.8%）为男性。23例（53.5%）为伊朗人，其余为阿富汗人。所有患者均为获得性耐多药结核病病例。43例患者中，25例（58.1%）出现严重的具有临床意义的不良反应；29例（67.5%）治疗成功，14例（32.5%）治疗效果不佳（6例[14%]治疗失败，8例[18.6%]死亡）。伊朗人的死亡率较高（P = 0.039），因药物不良反应而改变初始治疗方案的患者死亡率也较高（P = 0.01）。
与以往研究相比，我们的研究使用标准化治疗方案能够获得更有利的耐多药结核病治疗结果。
