荷兰门诊环境中结核病长期治疗的预测因素

Predictors of Prolonged TB Treatment in a Dutch Outpatient Setting.

作者信息

Van't Boveneind-Vrubleuskaya Natasha, Daskapan Alper, Kosterink Jos G W, van der Werf Tjip S, van den Hof Susan, Alffenaar Jan-Willem C

机构信息

Department of Public Health TB Control, Metropolitan Public Health Service, The Hague, The Netherlands.

University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.

出版信息

PLoS One. 2016 Nov 10;11(11):e0166030. doi: 10.1371/journal.pone.0166030. eCollection 2016.

DOI:10.1371/journal.pone.0166030

PMID:27832142

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5104463/

Abstract

INTRODUCTION

Standard treatment duration for drug-susceptible tuberculosis (TB) treatment is 6 months. Treatment duration is often extended-and for various different reasons. The aim of this study was to determine the prevalence and to assess risk factors associated with extended TB treatment.

METHODS

A cross-sectional study was conducted. Data including demographic, clinical, radiological and microbiological information from the Netherlands TB Register (NTR) of 90 patients with smear and culture positive pulmonary TB of the region Haaglanden, The Netherlands, was eligible for analysis.

RESULTS

Treatment was extended to ≥ 200 days by 46 (51%) patients. Extended TB treatment was associated with a higher frequency of symptoms, presumed to be due to adverse drug reactions (ADR; OR 2.39 95% CI: 1.01-5.69), drug-induced liver injury (DILI) (OR: 13.51; 95% CI: 1.66-109.82) and longer than 2 month smear and culture conversion rate (OR: 11.00; 95% CI: 1.24-97.96 and OR: 8.56; 95% CI: 1.53-47.96). In the multivariable logistic analysis, development of DILI emerged as the single statistically strong risk factor necessitating extension of TB treatment.

CONCLUSION

This finding will need further confirmation in a prospective study, exploring the possible mutual role of pharmacokinetic and pharmacogenetic determinants of DILI among TB patients.

摘要

引言

药物敏感型肺结核治疗的标准疗程为6个月。但疗程常常因各种不同原因而延长。本研究的目的是确定延长疗程的肺结核患者的患病率，并评估与之相关的危险因素。

方法

开展了一项横断面研究。从荷兰海牙地区肺结核登记处（NTR）获取了90例痰涂片和培养均呈阳性的肺结核患者的人口统计学、临床、放射学和微生物学信息数据，这些数据符合分析要求。

结果

46例（51%）患者的治疗疗程延长至≥200天。延长疗程与较高的症状发生率相关，推测这是由药物不良反应（ADR；比值比[OR]2.39，95%置信区间[CI]：1.01 - 5.69）、药物性肝损伤（DILI）（OR：13.51；95%CI：1.66 - 109.82）以及痰涂片和培养转阴时间超过2个月（OR：11.00；95%CI：1.24 - 97.96和OR：8.56；95%CI：1.53 - 47.96）所致。在多变量逻辑分析中，DILI的发生成为唯一具有统计学意义的、导致肺结核治疗疗程延长的强危险因素。