Siemion-Szcześniak Izabela, Kuś Jan
I Klinika Chorób Płuc, Instytut Gruźlicy i Chorób Płuc, ul. Płocka 26, 01–138 Warszawa.
Pneumonol Alergol Pol. 2012;80(5):412-21.
The aim of the study was to evaluate the impact of social risk factors on treatment outcome among culturepositive patients treated for active pulmonary tuberculosis in three separate districts - Warsaw, Gdansk and Siedlce - in years 1995 and 2000.
We retrospectively reviewed medical records of patients who were notified in 1995 and 2000 and were treated in hospitals and dispensaries. Alcohol abuse and homelessness were recognized as risk factors associated with tuberculosis and nonadherence to treatment. Treatment outcome was evaluated using treatment indicators defined by the World Health Organisation: cured, treatment completed, treatment defaulted, treatment failure and other results of treatment.
Seven hundred and eight patients with culture positive pulmonary tuberculosis were included (373 in 1995 and 335 in 2000). There were 85 patients with risk factors in 1995 and 101 patients in 2000. 80 of participants in 1995 and 69 in 2000 abused alcohol, 5 and 32 were classified as homeless, respectively. Among alcohol abusers treatment success rates according to the WHO definition (either bacteriologic cured or treatment completed) were 45.1% in 1995 and 53.6% in 2000. Among patients not abusing alcohol treatment success rates were 63.8% and 54.1%, respectively. The differences were statistically significant (p = 0.005 in 1995 and p = 0.0186 in 2000). In 1995 forty percent of homeless patients had succeeded treatment, while the rate of treatment success among non-homeless was 60%. Because of small number included in homeless group the difference was not statistically significant (p = 0.6532). In 2000 treatment success rate among homeless participants was 25% and among non-homeless - 57.1%, which was highly statistically significant (p = 0.001).
Alcohol abuse and homelessness were associated with bad treatment outcome among patients with pulmonary tuberculosis. Interventions to improve treatment adherence in patients considered to be at risk for default are necessary.
本研究的目的是评估1995年和2000年在华沙、格但斯克和 Siedlce 这三个不同地区接受活动性肺结核治疗的培养阳性患者中社会风险因素对治疗结果的影响。
我们回顾性地查阅了1995年和2000年报告并在医院和诊疗所接受治疗的患者的病历。酗酒和无家可归被视为与结核病及治疗不依从相关的风险因素。使用世界卫生组织定义的治疗指标评估治疗结果：治愈、完成治疗、治疗中断、治疗失败及其他治疗结果。
纳入了708例培养阳性的肺结核患者（1995年373例，2000年335例）。1995年有85例有风险因素的患者，2000年有101例。1995年80名参与者和2000年69名参与者酗酒，1995年5名和2000年32名被归类为无家可归者。根据世界卫生组织的定义（细菌学治愈或完成治疗），酗酒者的治疗成功率在1995年为45.1%，2000年为53.6%。非酗酒患者的治疗成功率分别为63.8%和54.1%。差异具有统计学意义（1995年p = 0.005，2000年p = 0.0186）。1995年40%的无家可归患者治疗成功，而无家可归者的治疗成功率为60%。由于无家可归组纳入人数较少，差异无统计学意义（p = 0.6532）。2000年，无家可归参与者的治疗成功率为25%，无家可归者为57.1%，差异具有高度统计学意义（p = 0.001）。
酗酒和无家可归与肺结核患者的不良治疗结果相关。有必要采取干预措施提高被认为有治疗中断风险患者的治疗依从性。
