Zhang Qing, Wu Zheyuan, Zhang Zurong, Sha Wei, Shen Xin, Xiao Heping
Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China.
Shanghai Center for Disease Control and Prevention, Shanghai 200065, P.R. China.
Exp Ther Med. 2016 Mar;11(3):777-782. doi: 10.3892/etm.2015.2966. Epub 2015 Dec 29.
Multidrug-resistant tuberculosis (MDR-TB) is a serious public health and social issue. It pertains to the type of tuberculosis that is resistant simultaneously to isoniazid and rifampicin. MDR-TB has a high mortality and is expensive to treat. The aim of the present study was to examine the therapeutic effects of individualized free treatment and the relevant influencing factors on the treatment outcome for MDR-TB. A prospective study module was used to analyze the therapeutic outcome of MDR-TB with individualized free treatment for 160 patients between 2011 and 2014. Statistical analysis was performed using the Chi-square or Fisher's exact test, and the odds ratio was calculated using a logistic regression analysis model. In total, 160 patients were enrolled in the study for treatment of MDR-TB. From these, 88 cases completed the course of treatment, and 70 cases were successfully treated. Of the remaining 72 cases, 37 cases exhibited treatment failure, 18 cases were suspended during treatment and 17 patients succumbed to the disease. The results showed that the confounding factors were: i) retreatment (p<0.05); ii) occurrence of diabetes (p<0.001); iii) lesion without improvement in radiography during treatment (p=0.001); iv) positive sputum culture for Mycobacterium tuberculosis after 3-month treatment (p<0.05); and v) termination of treatment due to adverse reaction (p<0.05). These factors were associated with poor treatment outcomes by logistic regression analysis. Adverse drug reaction was observed in 33 cases and treatment was terminated or changed permanently in 29 of these cases. The most common adverse reaction was liver function damage caused by pyrazinamide and leucopenia caused by rifabutin. One patient suffered from serious liver failure. In conclusion, the success rate of long treatment course for MDR-TB is not high due to many adverse reactions. Occurrence of diabetes is the main factor that caused poor efficacy.
耐多药结核病（MDR-TB）是一个严重的公共卫生和社会问题。它属于同时对异烟肼和利福平耐药的结核病类型。耐多药结核病死亡率高且治疗费用昂贵。本研究的目的是探讨个体化免费治疗对耐多药结核病的治疗效果以及影响治疗结局的相关因素。采用前瞻性研究模式分析2011年至2014年期间160例耐多药结核病患者接受个体化免费治疗的疗效。使用卡方检验或Fisher精确检验进行统计分析，并使用逻辑回归分析模型计算比值比。共有160例患者纳入本研究进行耐多药结核病治疗。其中，88例完成治疗疗程，70例治疗成功。其余72例中，37例治疗失败，18例在治疗期间中断治疗，17例患者死亡。结果显示，混杂因素为：i）复治（p<0.05）；ii）糖尿病的发生（p<0.001）；iii）治疗期间影像学检查病变无改善（p=0.001）；iv）治疗3个月后痰结核分枝杆菌培养阳性（p<0.05）；v）因不良反应终止治疗（p<0.05）。通过逻辑回归分析，这些因素与不良治疗结局相关。观察到33例药物不良反应，其中29例治疗终止或永久改变治疗方案。最常见的不良反应是吡嗪酰胺引起的肝功能损害和利福布汀引起的白细胞减少。1例患者发生严重肝衰竭。总之，由于许多不良反应，耐多药结核病长疗程治疗的成功率不高。糖尿病的发生是导致疗效不佳的主要因素。
