Huerga H, Bastard M, Kamene M, Wanjala S, Arnold A, Oucho N, Chikwanha I, Varaine F
Epicentre, Paris, France.
National Leprosy and Tuberculosis Control Programme, Nairobi.
Int J Tuberc Lung Dis. 2017 Mar 1;21(3):314-319. doi: 10.5588/ijtld.16.0661.
In March 2006, the first multidrug-resistant tuberculosis (MDR-TB) treatment programme was implemented in Kenya.
To describe patients' treatment outcomes and adverse events.
A retrospective case note review of patients started on MDR-TB treatment at two Médecins Sans Frontières-supported sites and the national referral hospital of Kenya was undertaken. Sites operated an ambulatory model of care. Patients were treated for a minimum of 24 months with at least 4-5 drugs for the intensive phase of treatment, including an injectable agent.
Of 169 patients, 25.6% were human immunodeficiency virus (HIV) positive and 89.3% were culture-positive at baseline. Adverse events occurred in 67.4% of patients: 45.9% had nausea/vomiting, 43.9% electrolyte disturbance, 41.8% dyspepsia and 31.6% hypothyroidism. The median time to culture conversion was 2 months. Treatment outcomes were as follows: 76.6% success, 14.5% deaths, 8.3% lost to follow-up and 0.7% treatment failure. HIV-positive individuals (adjusted odds ratio [aOR] 3.51, 95% confidence interval [CI] 1.12-11.03) and women (aOR 2.73, 95%CI 1.01-7.39) had a higher risk of unfavourable outcomes, while the risk was lower in those with culture conversion at 6 months (aOR 0.11, 95%CI 0.04-0.32).
In Kenya, where an ambulatory model of care is used for MDR-TB treatment, treatment success was high, despite high rates of HIV. Almost half of the patients experienced electrolyte disturbance and one third had hypothyroidism; this supports the view that systematic regular biochemical monitoring is needed in Kenya.
2006年3月，肯尼亚实施了首个耐多药结核病（MDR-TB）治疗项目。
描述患者的治疗结果和不良事件。
对在无国界医生组织支持的两个地点以及肯尼亚国家转诊医院开始接受耐多药结核病治疗的患者进行回顾性病例记录审查。这些地点采用门诊护理模式。患者接受至少24个月的治疗，强化期至少使用4-5种药物，包括一种注射剂。
169名患者中，25.6%为人类免疫缺陷病毒（HIV）阳性，89.3%在基线时培养阳性。67.4%的患者发生不良事件：45.9%有恶心/呕吐，43.9%有电解质紊乱，41.8%有消化不良，31.6%有甲状腺功能减退。培养转阴的中位时间为2个月。治疗结果如下：76.6%成功，14.5%死亡，8.3%失访，0.7%治疗失败。HIV阳性个体（调整后的优势比[aOR]3.51，95%置信区间[CI]1.12-11.03）和女性（aOR 2.73，95%CI 1.01-7.39）出现不良结局的风险较高，而6个月时培养转阴的患者风险较低（aOR 0.11，95%CI 0.04-0.32）。
在肯尼亚，耐多药结核病治疗采用门诊护理模式，尽管HIV感染率很高，但治疗成功率较高。几乎一半的患者出现电解质紊乱，三分之一有甲状腺功能减退；这支持了在肯尼亚需要进行系统定期生化监测的观点。
