结核病治疗结局的预测因素。

Predictors of tuberculosis treatment outcomes.

机构信息

Laboratório de Pesquisa Clínica em Micobacteriose, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.

出版信息

J Bras Pneumol. 2012 Jan-Feb;38(1):88-97. doi: 10.1590/s1806-37132012000100013.

DOI:10.1590/s1806-37132012000100013

PMID:22407045

Abstract

OBJECTIVE

To analyze tuberculosis treatment outcomes and their predictors.

METHODS

This was a retrospective longitudinal cohort study involving tuberculosis patients treated between 2004 and 2006 at the Instituto de Pesquisa Evandro Chagas, in the city of Rio de Janeiro. We estimated adjusted risk ratios (ARRs) for the predictors of treatment outcomes.

RESULTS

Among 311 patients evaluated, the rates of cure, treatment abandonment, treatment failure, and mortality were 72%, 19%, 2%, and 6%, respectively. Changes in the treatment regimen due to adverse events occurred in 8%. The factors found to reduce the probability of cure were alcoholism (ARR, 0.30), use of the streptomycin+ethambutol+ofloxacin (SEO) regimen (ARR, 0.32), HIV infection without the use of antiretroviral therapy (ART; ARR, 0.36), and use of the rifampin+isoniazid+pyrazinamide+ethambutol regimen (ARR, 0.58). Being younger and being alcoholic both increased the probability of abandonment (ARR, 3.84 and 1.76, respectively). It was impossible to determine the ARR for the remaining outcomes due to their low prevalence. However, using the relative risk (RR), we identified the following potential predictors of mortality: use of the SEO regimen (RR, 11.43); HIV infection without ART (RR, 9.64); disseminated tuberculosis (RR, 9.09); lack of bacteriological confirmation (RR, 4.00); diabetes mellitus (RR, 3.94); and homosexual/bisexual behavior (RR, 2.97). Low income was a potential predictor of treatment failure (RR, 11.70), whereas disseminated tuberculosis and HIV infection with ART were potential predictors of changes in the regimen due to adverse events (RR, 3.57 and 2.46, respectively).

CONCLUSIONS

The SEO regimen should not be used for extended periods. The data confirm the importance of ART and suggest the need to use it early.

摘要

目的

分析结核病治疗结局及其预测因素。

方法

这是一项回顾性纵向队列研究，涉及 2004 年至 2006 年期间在里约热内卢市埃文德罗·查加斯研究所接受治疗的结核病患者。我们估计了治疗结局预测因素的调整风险比（ARR）。

结果

在评估的 311 名患者中，治愈率、治疗中断率、治疗失败率和死亡率分别为 72%、19%、2%和 6%。因不良反应而改变治疗方案的发生率为 8%。发现降低治愈率的因素有酗酒（ARR，0.30）、使用链霉素+乙胺丁醇+氧氟沙星（SEO）方案（ARR，0.32）、未使用抗逆转录病毒治疗（ART）的 HIV 感染（ARR，0.36）和使用利福平+异烟肼+吡嗪酰胺+乙胺丁醇方案（ARR，0.58）。年龄较小和酗酒均增加了中断治疗的可能性（ARR，分别为 3.84 和 1.76）。由于这些结局的发生率较低，无法确定其余结局的 ARR。然而，使用相对风险（RR），我们确定了以下死亡的潜在预测因素：使用 SEO 方案（RR，11.43）；未接受 ART 的 HIV 感染（RR，9.64）；播散性结核病（RR，9.09）；缺乏细菌学确认（RR，4.00）；糖尿病（RR，3.94）；以及同性恋/双性恋行为（RR，2.97）。低收入是治疗失败的潜在预测因素（RR，11.70），而播散性结核病和接受 ART 的 HIV 感染是因不良反应改变方案的潜在预测因素（RR，分别为 3.57 和 2.46）。