Department of Pulmonology, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey.
Department of Pulmonology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
Balkan Med J. 2013 Jun;30(2):204-10. doi: 10.5152/balkanmedj.2013.005. Epub 2013 Jun 1.
Tuberculosis is a public health problem and its transmission is a threat to the community.
The aim of this study was to determine the factors influencing the treatment outcomes and the effectiveness of the National Tuberculosis Program (NTP) in relation to the application of the directly observed treatment, short-course (DOTS) program in various sites in Istanbul, Turkey.
Case-Control Study.
A case-control study was used, where cases and controls were randomly selected from the Turkish Tuberculosis National Database, which includes complete data on treatment outcomes for patients recorded in the database from January 1, 2006 to December 31, 2009 and had one year follow-up.
The case group was composed of 464 patients with adverse outcome, while the control group was composed of 441 patients who had been cured of disease. Factors associated with adverse treatment outcome were >65 years of age (OR: 3.39 (1.99-5.76)) ; male gender (OR:2.11 (1.49-2.99)); born outside Turkey (OR: 5.48 (2.13-14.04)); co-morbidity (OR: 1.85 (1.29-2.65)); bilateral radiologic lesions (OR: 2.07 (1.41-3.00); previous treatment history (OR: 3.99 (2.78-5.74)); 3(rd) month positive microscopy (OR: 4.96 (3.04-8.09)) and any H&R +/- others multidrug resistant (MDR) resistance (OR: 22.64 (6.92-74.08)). There was no association between the adverse treatment outcome and the application site of direct observation treatment, short course (DOTS) delivery and the supervisors.
Our findings indicate similar quality in DOTS application and supervision among patients with or without adverse treatment outcomes. However, patients with certain characteristics should be carefully monitored and aggressively treated.
结核病是一个公共卫生问题，其传播对社区构成威胁。
本研究旨在确定影响治疗结果的因素，以及土耳其伊斯坦布尔各地点实施直接观察治疗短期疗程（DOTS）方案对国家结核病规划（NTP）的效果。
病例对照研究。
采用病例对照研究，病例和对照均随机选自土耳其结核病国家数据库，该数据库包含了 2006 年 1 月 1 日至 2009 年 12 月 31 日期间记录在数据库中的治疗结果完整数据，并进行了为期 1 年的随访。
病例组由 464 例不良结局患者组成，对照组由 441 例治愈的患者组成。与不良治疗结局相关的因素包括年龄>65 岁（OR：3.39（1.99-5.76））；男性（OR：2.11（1.49-2.99））；出生于土耳其境外（OR：5.48（2.13-14.04））；合并症（OR：1.85（1.29-2.65））；双侧放射学病变（OR：2.07（1.41-3.00））；既往治疗史（OR：3.99（2.78-5.74））；第 3 个月显微镜检查阳性（OR：4.96（3.04-8.09））和任何 H＆R +/-其他耐多药（MDR）耐药（OR：22.64（6.92-74.08））。不良治疗结局与直接观察治疗短期疗程（DOTS）实施地点以及督导员之间无相关性。
我们的研究结果表明，在具有或不具有不良治疗结局的患者中，DOTS 应用和监督质量相似。然而，具有某些特征的患者应密切监测并积极治疗。
