Sotgiu G, Ferrara G, Matteelli A, Richardson M D, Centis R, Ruesch-Gerdes S, Toungoussova O, Zellweger J-P, Spanevello A, Cirillo D, Lange C, Migliori G B
Hygiene and Preventive Medicine Institute, University of Sassari, Sassari, Italy.
Eur Respir J. 2009 Apr;33(4):871-81. doi: 10.1183/09031936.00168008. Epub 2009 Feb 27.
Extensively drug-resistant tuberculosis (XDR-TB) is present in all regions and poses serious challenges for public health and clinical management. Laboratory diagnosis is difficult and little evidence exists to guide clinicians in treating people with XDR-TB effectively. To summarise the available data on diagnosis and treatment, the current authors performed a systematic review on 13 recent studies of the epidemiology and clinical management of XDR-TB. Studies that met inclusion criteria were reviewed, in order to assess methodology, treatment regimens and treatment outcomes. Meta-analysis of currently available data is not possible because of inconsistent definitions and methodologies. Data show that XDR-TB can be successfully treated in up to 65% of patients, particularly those who are not co-infected with HIV. However, treatment duration is longer and outcomes are in general poorer than for non-XDR TB patients. To strengthen the evidence for extensively drug-resistant tuberculosis diagnosis, treatment and prevention, future studies should: 1) be prospective in design; 2) adopt standardised, internationally accepted definitions; 3) use quality-assured laboratory testing for all first- and second-line drugs; and 4) collect data on an agreed-upon set of standard variables, allowing for comparisons across studies. Early diagnosis and aggressive management of extensively drug-resistant tuberculosis provide the best chance of positive outcome, but prevention is still paramount.
广泛耐药结核病（XDR-TB）在所有地区均有出现，对公共卫生和临床管理构成严峻挑战。实验室诊断困难，且几乎没有证据可指导临床医生有效治疗XDR-TB患者。为总结有关诊断和治疗的现有数据，本文作者对最近13项关于XDR-TB流行病学和临床管理的研究进行了系统评价。对符合纳入标准的研究进行了审查，以评估方法、治疗方案和治疗结果。由于定义和方法不一致，目前无法对现有数据进行荟萃分析。数据显示，高达65%的患者的XDR-TB能够成功治愈，尤其是那些未合并感染艾滋病毒的患者。然而，与非XDR-TB患者相比，治疗时间更长，总体结果更差。为加强广泛耐药结核病诊断、治疗和预防的证据，未来研究应：1）设计前瞻性研究；2）采用标准化的、国际公认的定义；3）对所有一线和二线药物使用质量有保证的实验室检测；4）收集一套商定的标准变量的数据，以便进行跨研究比较。对广泛耐药结核病进行早期诊断和积极管理可提供获得阳性结果的最佳机会，但预防仍然至关重要。
