Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
PLoS One. 2013 Jul 29;8(7):e69514. doi: 10.1371/journal.pone.0069514. Print 2013.
Pulmonary tuberculosis (TB) persists an important contributor to the burden of diseases in developing countries. TB control success is based on the patient's compliance to the treatment. Depressive disorders have been negatively associated with compliance of therapeutic schemes for chronic diseases. This study aimed to estimate the significance and magnitude of major depressive episode as a hazard factor for negative outcomes (NO), including abandon or death in patients receiving TB treatment.
METHODOLOGY/PRINCIPAL FINDINGS: A longitudinal study was conducted to evaluate the association of major depressive episode (MDE), as measured by a 5-item version of the Center for Epidemiological Studies Depression Scale (CES-D) with NO to TB treatment. Patients with confirmed TB were enrolled before the start of TB treatment. Baseline measurements included socio-demographic variables as well as the CES-D, which was also applied every month until the end of the treatment. Death and treatment default were assessed monthly. Survivor function (SF) for NO according to MDE status (CES-D≥6) at baseline (MDEb) was estimated. Cox's Regression was performed for bivariate analyses as well as for the multivariate model. A total of 325 patients accepted to participate in the study, of which 34 where excluded for diagnosis of MDR-TB. NO was observed in 24 patients (8.2%); 109 (37%) presented MDEb. Statistically significant difference was found on the SF of patients with and without MDEb (0.85 vs. 0.96, p-value = 0.002). The hazard ratio for NO, controlled for age, sex, marital status and instruction level was 3.54 (95%CI 1.43-8.75; p-value = 0.006).
The presence of MDE at baseline is associated to NO of TB treatment. Targeting detection and treatment of MDE may improve TB treatment outcomes.
肺结核（TB）仍然是发展中国家疾病负担的重要因素。结核病控制的成功基于患者对治疗的依从性。抑郁障碍与慢性疾病治疗方案的依从性呈负相关。本研究旨在评估重度抑郁发作（MDE）作为危险因素对治疗结果的影响，包括接受结核病治疗的患者放弃或死亡。
方法/主要发现：本研究采用前瞻性队列研究评估了使用流行病学研究中心抑郁量表（CES-D）5 项版本评估的 MDE 与结核病治疗结果（NO）的关系。在开始结核病治疗前，对确诊结核病的患者进行登记。基线测量包括社会人口统计学变量以及 CES-D，直至治疗结束前每月应用一次。每月评估死亡和治疗失败。根据基线时 MDE 状态（CES-D≥6）（MDEb）估计 NO 的生存函数（SF）。进行 Cox 回归进行双变量分析和多变量模型分析。共 325 名患者接受了研究，其中 34 名患者因耐多药结核病而被排除。有 24 名患者（8.2%）发生了 NO；109 名患者（37%）存在 MDEb。有和无 MDEb 的患者 SF 存在统计学显著差异（0.85 与 0.96，p 值=0.002）。控制年龄、性别、婚姻状况和教育程度后，NO 的危险比为 3.54（95%CI 1.43-8.75；p 值=0.006）。
基线时存在 MDE 与结核病治疗结果的 NO 相关。针对 MDE 的检测和治疗可能改善结核病治疗结果。
