Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Int J Tuberc Lung Dis. 2013 Jul;17(7):878-84. doi: 10.5588/ijtld.12.0732.
Mycobacterium tuberculosis comprises four principal genetic lineages: one evolutionarily ancestral (Indo-Oceanic) and three modern. Whether response to tuberculosis (TB) treatment differs among the lineages is unknown.
To examine the association between M. tuberculosis lineage and time to sputum culture conversion in response to standard first-line drug therapy.
We conducted an exploratory retrospective cohort analysis of time to sputum culture conversion among pulmonary tuberculosis (PTB) cases reported in the United States from 2004 to 2007.
The analysis included 13,170 PTB cases with no documented resistance to first-line drugs who received a standard four-drug treatment regimen. Among cases with baseline positive sputum smear results, relative to cases with Euro-American lineage, cases with Indo-Oceanic lineage had higher adjusted hazards of sputum culture conversion (aHR 1.32, 95%CI 1.20-1.45), whereas cases with East-African-Indian or East-Asian lineage did not differ (aHR 1.05, 95%CI 0.88-1.25 and aHR 0.99, 95%CI 0.91-1.07, respectively). Among cases with baseline negative sputum smear results, time to sputum culture conversion did not differ by lineage.
Although these results are exploratory, they suggest that the eradication of viable bacteria may occur sooner among cases with Indo-Oceanic lineage than among those with one of the three modern lineages. Prospective studies of time to sputum culture conversion by lineage are required.
结核分枝杆菌主要有四个遗传谱系：一个进化上的祖先谱系（印度洋）和三个现代谱系。目前尚不清楚不同谱系对结核病（TB）治疗的反应是否存在差异。
研究结核分枝杆菌谱系与标准一线药物治疗后痰培养转化时间之间的关系。
我们对 2004 年至 2007 年期间美国报告的肺结核（PTB）病例进行了一项探索性回顾性队列分析，以研究痰培养转化时间与结核分枝杆菌谱系之间的关系。
该分析包括 13170 例无一线药物耐药记录且接受标准四联药物治疗方案的 PTB 病例。在基线痰涂片阳性的病例中，与欧美谱系病例相比，印度-印度洋谱系病例痰培养转化的调整后危险比（aHR）更高（1.32，95%CI 1.20-1.45），而东非-印度或东亚谱系病例则无差异（aHR 分别为 1.05，95%CI 0.88-1.25 和 0.99，95%CI 0.91-1.07）。在基线痰涂片阴性的病例中，不同谱系之间痰培养转化时间无差异。
尽管这些结果是探索性的，但它们表明，在印度-印度洋谱系病例中，与三个现代谱系之一相比，活细菌的清除可能更早发生。需要对不同谱系的痰培养转化时间进行前瞻性研究。
