Liew S M, Khoo E M, Ho B K, Lee Y K, Mimi O, Fazlina M Y, Asmah R, Lee W K, Harmy M Y, Chinna K, Jiloris F D
University of Malaya, Kuala Lumpur, Malaysia.
Ministry of Health Malaysia, Putrajaya, Malaysia.
Int J Tuberc Lung Dis. 2015 Jul;19(7):764-71. doi: 10.5588/ijtld.14.0767.
To determine treatment outcomes and associated predictors of all patients registered in 2012 with the Malaysian National Tuberculosis (TB) Surveillance Registry.
Sociodemographic and clinical data were analysed. Unfavourable outcomes included treatment failure, transferred out and lost to follow-up, treatment defaulters, those not evaluated and all-cause mortality.
In total, 21 582 patients were registered. The mean age was 42.36 ± 17.77 years, and 14.2% were non-Malaysians. The majority were new cases (93.6%). One fifth (21.5%) had unfavourable outcomes; of these, 46% died, 49% transferred out or defaulted and 1% failed treatment. Predictors of unfavourable outcomes were older age, male sex, foreign citizenship, lower education, no bacille Calmette-Guérin (BCG) vaccination scar, treatment in tertiary settings, smoking, previous anti-tuberculosis treatment, human immunodeficiency virus infection, not receiving directly observed treatment, advanced chest radiography findings, multidrug-resistant TB (MDR-TB) and extra-pulmonary TB. For all-cause mortality, predictors were similar except for rural dwelling and nationality (higher mortality among locals). Absence of BCG scar, previous treatment for TB and MDR-TB were not found to be predictors of all-cause mortality. Indigenous populations in East Malaysia had lower rates of unfavourable treatment outcomes.
One fifth of TB patients had unfavourable outcomes. Intervention strategies should target those at increased risk of unfavourable outcomes and all-cause mortality.
确定2012年在马来西亚国家结核病监测登记处登记的所有患者的治疗结果及相关预测因素。
对社会人口统计学和临床数据进行分析。不良结局包括治疗失败、转出和失访、治疗中断者、未评估者以及全因死亡率。
总共登记了21582例患者。平均年龄为42.36±17.77岁，14.2%为非马来西亚人。大多数为新发病例（93.6%）。五分之一（21.5%）的患者有不良结局；其中，46%死亡，49%转出或中断治疗，1%治疗失败。不良结局的预测因素包括年龄较大、男性、外国公民身份、教育程度较低、无卡介苗（BCG）接种疤痕、在三级医疗机构接受治疗、吸烟、既往抗结核治疗史、人类免疫缺陷病毒感染、未接受直接观察治疗、胸部X线检查结果严重、耐多药结核病（MDR-TB）和肺外结核。对于全因死亡率，预测因素相似，但农村居住情况和国籍除外（当地人死亡率较高）。未发现无BCG疤痕、既往结核治疗史和MDR-TB是全因死亡率的预测因素。东马来西亚的土著居民不良治疗结局发生率较低。
五分之一的结核病患者有不良结局。干预策略应针对不良结局和全因死亡率风险增加的人群。
