Tang Shenjie, Tan Shouyong, Yao Lan, Li Fujian, Li Li, Guo Xinzhi, Liu Yidian, Hao Xiaohui, Li Yanqiong, Ding Xiuxiu, Zhang Zhanjun, Tong Li, Huang Jianan
Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China ; Tuberculosis Center for Diagnosis and Treatment, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Tuberculosis, Guangzhou Chest Hospital, State Key Laboratory of Respiratory Disease, Guangzhou, China.
PLoS One. 2013 Dec 5;8(12):e82943. doi: 10.1371/journal.pone.0082943. eCollection 2013.
The treatment of patients with MDR- and XDR-TB is usually more complex, toxic and costly and less effective than treatment of other forms of TB. However, there is little information available on risk factors for poor outcomes in patients with MDR- and XDR-TB in China.
METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively analyzed the clinical records of HIV-negative TB Patients with culture-proven MDR- or XDR-TB who were registered from July 2006 to June 2011 at five large-scale Tuberculosis Specialized Hospitals in China. Among 1662 HIV-seronegative TB cases which were culture-positive for M. tuberculosis complex and had positive sputum-smear microscopy results, 965 cases (58.1%) were DR-TB, and 586 cases (35.3%) were classified as having MDR-TB, accounting for 60.7% of DR-TB. 169 cases (10.2%) were XDR-TB, accounting for 17.5% of DR-TB, 28.8% of MDR-TB. The MDR-TB patients were divided into XDR-TB group (n=169) and other MDR-TB group (non-XDR MDR-TB) (n=417). In total, 240 patients (40.95%) had treatment success, and 346 (59.05%) had poor treatment outcomes. The treatment success rate in other MDR-TB group was 52.2%, significantly higher than that in the XDR-TB group (13%, P<0.001). In multivariate logistic regression analysis, poor outcomes were associated with duration of previous anti-TB treatment of more than one year (OR, 0.077; 95% CI, 0.011-0.499, P<0.001), a BMI less than 18.5 kg/m(2) (OR, 2.185; 95% CI, 1.372-3.478, P<0.001), XDR (OR, 13.368; 95% CI, 6.745-26.497, P<0.001), retreatment (OR, 0.171; 95% CI, 0.093-0.314, P<0.001), diabetes (OR, 0.305; 95% CI, 0.140-0.663, P=0.003), tumor (OR, 0.095; 95% CI, 0.011-0.795, P=0.03), decreased albumin (OR, 0.181; 95% CI, 0.118-0.295, P<0.001), cavitation (OR, 0.175; 95% CI, 0.108-0.286, P<0.001).
CONCLUSIONS/SIGNIFICANCE: The patients with MDR-TB and XDR-TB have poor treatment outcomes in China.The presence of extensive drug resistance, low BMI, hypoalbuminemia, comorbidity, cavitary disease and previous anti-TB treatment are independent prognostic factors for poor outcome in patients with MDR-TB.
耐多药结核病（MDR-TB）和广泛耐药结核病（XDR-TB）患者的治疗通常比其他形式的结核病治疗更复杂、毒性更大、成本更高且效果更差。然而，关于中国MDR-TB和XDR-TB患者治疗效果不佳的危险因素的信息很少。
方法/主要发现：我们回顾性分析了2006年7月至2011年6月在中国五家大型结核病专科医院登记的经培养证实为MDR-TB或XDR-TB的HIV阴性结核病患者的临床记录。在1662例结核分枝杆菌复合群培养阳性且痰涂片显微镜检查结果为阳性的HIV血清阴性结核病病例中，965例（58.1%）为耐多药结核病（DR-TB），586例（35.3%）被归类为耐多药结核病（MDR-TB），占DR-TB的60.7%。169例（10.2%）为广泛耐药结核病（XDR-TB），占DR-TB的17.5%，MDR-TB的28.8%。MDR-TB患者分为XDR-TB组（n = 169）和其他MDR-TB组（非XDR MDR-TB）（n = 417）。总共有240例患者（40.95%）治疗成功，346例（59.05%）治疗效果不佳。其他MDR-TB组的治疗成功率为52.2%，显著高于XDR-TB组（13%，P < 0.001）。在多因素逻辑回归分析中，治疗效果不佳与既往抗结核治疗时间超过一年（OR，0.077；95%CI，0.011 - 0.499，P < 0.001）、体重指数（BMI）小于18.5 kg/m²（OR，2.185；95%CI，1.372 - 3.478，P < 0.001）、XDR（OR，13.368；95%CI，6.745 - 26.497，P < 0.001）、复治（OR，0.171；95%CI，0.093 - 0.314，P < 0.001）、糖尿病（OR，0.305；95%CI，0.140 - 0.663，P = 0.003）、肿瘤（OR，0.095；95%CI，0.011 - 0.795，P = 0.03）、白蛋白降低（OR，0.181；95%CI，0.118 - 0.295，P < 0.001）、空洞形成（OR，0.175；95%CI，0.108 - 0.286，P < 0.001）有关。
结论/意义：在中国，MDR-TB和XDR-TB患者的治疗效果不佳。广泛耐药、低BMI、低白蛋白血症、合并症、空洞性疾病以及既往抗结核治疗是MDR-TB患者治疗效果不佳的独立预后因素。
