Baghaei P, Marjani M, Tabarsi P, Moniri A, Rashidfarrokhi F, Ahmadi F, Nassiri A-A, Masjedi M-R, Velayati A A, Cattamanchi A
Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Nephrology and Haemodialysis, Masih Daneshvari Hospital, Tehran, Iran.
Int J Tuberc Lung Dis. 2014 Mar;18(3):352-6. doi: 10.5588/ijtld.13.0726.
National Referral Centre for Tuberculosis (TB), Tehran, Iran.
To determine the impact of chronic renal failure (CRF) on TB treatment outcomes.
A retrospective study was conducted among adult TB patients with CRF and age- and sex-matched TB controls without CRF treated at the National Research Institute of Tuberculosis and Lung Disease from 2004 to 2011. Multivariate analysis was performed to determine the impact of CRF on drug-induced hepatitis (DIH), treatment failure and all-cause mortality.
A total of 55 TB cases with CRF and 165 TB cases without CRF were included in the study. Baseline demographic and clinical characteristics were similar, except that TB cases with CRF were more likely to be of Iranian nationality (94.5% vs. 83%, P = 0.04). During anti-tuberculosis treatment, 40 (18.2%) patients developed DIH, none failed treatment and 15 (6.8%) died. Patients with CRF were more likely to develop DIH (27.3% vs. 15.2%, P = 0.04) and to die during treatment (16.4% vs. 3.6%, P = 0.001). CRF remained significantly associated with all-cause mortality (HR 4.87, 95%CI 1.73-13.65) in multivariate analysis, whereas the relationship with DIH was not.
TB patients with CRF are at increased risk of death. More intensive monitoring of patients with CRF should be considered by the National TB Programme.
伊朗德黑兰国家结核病转诊中心。
确定慢性肾衰竭（CRF）对结核病治疗结果的影响。
对2004年至2011年在国家结核病和肺部疾病研究所接受治疗的成年CRF结核病患者以及年龄和性别匹配的无CRF结核病对照患者进行回顾性研究。进行多变量分析以确定CRF对药物性肝炎（DIH）、治疗失败和全因死亡率的影响。
本研究共纳入55例CRF结核病病例和165例无CRF结核病病例。基线人口统计学和临床特征相似，但CRF结核病病例更可能为伊朗国籍（94.5%对83%，P = 0.04）。在抗结核治疗期间，40例（18.2%）患者发生DIH，无治疗失败病例，15例（6.8%）死亡。CRF患者更易发生DIH（27.3%对15.2%，P = 0.04）且在治疗期间死亡（16.4%对3.6%，P = 0.001）。多变量分析中，CRF仍与全因死亡率显著相关（HR 4.87，95%CI 1.73 - 13.65），而与DIH的关系不显著。
CRF结核病患者死亡风险增加。国家结核病规划应考虑对CRF患者进行更密切的监测。
