Programa Integrado de Investigación en Tuberculosis (PII TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Spain.
Respir Res. 2009 Dec 1;10(1):121. doi: 10.1186/1465-9921-10-121.
The adherence to long tuberculosis (TB) treatment is a key factor in TB control programs. Always some patients abandon the treatment or die. The objective of this study is to identify factors associated with defaulting from or dying during antituberculosis treatment.
Prospective study of a large cohort of TB cases diagnosed during 2006-2007 by 61 members of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). Predictive factors of completion outcome (cured plus completed treatment vs. defaulters plus lost to follow-up) and fatality (died vs. the rest of patients) were based on logistic regression, calculating odds ratios (OR) and 95% confidence intervals (CI).
Of the 1490 patients included, 29.7% were foreign-born. The treatment outcomes were: cured 792 (53.2%), completed treatment 540 (36.2%), failure 2 (0.1%), transfer-out 33 (2.2%), default 27 (1.8%), death 27 (1.8%), lost to follow-up 65 (4.4%), other 4 (0.3%). Completion outcome reached 93.5% and poor adherence was associated with: being an immigrant (OR = 2.03; CI:1.06-3.88), living alone (OR = 2.35; CI:1.05-5.26), residents of confined institutions (OR = 4.79; CI:1.74-13.14), previous treatment (OR = 2.93; CI:1.44-5.98), being an injecting drug user (IDU) (OR = 9.51; CI:2.70-33.47) and treatment comprehension difficulties (OR = 2.93; CI:1.44-5.98). Case fatality was 1.8% and it was associated with the following variables: age 50 or over (OR = 10.88; CI:1.12-105.01), retired (OR = 12.26;CI:1.74-86.04), HIV-infected (OR = 9.93; CI:1.48-66.34), comprehension difficulties (OR = 4.07; CI:1.24-13.29), IDU (OR = 23.59; CI:2.46-225.99) and Directly Observed Therapy (DOT) (OR = 3.54; CI:1.07-11.77).
Immigrants, those living alone, residents of confined institutions, patients treated previously, those with treatment comprehension difficulties, and IDU patients have poor adherence and should be targeted for DOT. To reduce fatality rates, stricter monitoring is required for patients who are retired, HIV-infected, IDU, and those with treatment comprehension difficulties.
结核病（TB）治疗的依从性是结核病控制项目的关键因素。总有一些患者会放弃治疗或死亡。本研究的目的是确定与抗结核治疗期间停药或死亡相关的因素。
对 2006-2007 年由西班牙呼吸病学和胸外科学会（SEPAR）的 61 名成员诊断的大量结核病病例进行前瞻性研究。完成治疗结局（治愈加完成治疗 vs. 停药加失访）和病死率（死亡 vs. 其余患者）的预测因素基于逻辑回归，计算比值比（OR）和 95%置信区间（CI）。
在纳入的 1490 例患者中，29.7%为移民。治疗结局为：治愈 792 例（53.2%），完成治疗 540 例（36.2%），失败 2 例（0.1%），转归 33 例（2.2%），停药 27 例（1.8%），死亡 27 例（1.8%），失访 65 例（4.4%），其他 4 例（0.3%）。完成治疗结局达到 93.5%，较差的依从性与以下因素相关：移民（OR=2.03；CI：1.06-3.88），独居（OR=2.35；CI：1.05-5.26），居住在封闭机构（OR=4.79；CI：1.74-13.14），既往治疗（OR=2.93；CI：1.44-5.98），注射吸毒者（IDU）（OR=9.51；CI：2.70-33.47）和治疗理解困难（OR=2.93；CI：1.44-5.98）。病死率为 1.8%，与以下变量相关：年龄 50 岁或以上（OR=10.88；CI：1.12-105.01），退休（OR=12.26；CI：1.74-86.04），感染艾滋病毒（OR=9.93；CI：1.48-66.34），治疗理解困难（OR=4.07；CI：1.24-13.29），IDU（OR=23.59；CI：2.46-225.99）和直接观察治疗（DOT）（OR=3.54；CI：1.07-11.77）。
移民、独居者、居住在封闭机构者、既往治疗者、治疗理解困难者和 IDU 患者依从性较差，应作为 DOT 的目标人群。为降低病死率，需要对退休、感染艾滋病毒、IDU 和治疗理解困难的患者进行更严格的监测。
