Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Respir Med. 2017 Oct;131:43-48. doi: 10.1016/j.rmed.2017.08.002. Epub 2017 Aug 4.
Rifampin (RIF) mono-resistant tuberculosis (RMR-TB) is a rare disease. Current guidelines recommend that RMR-TB be treated as multidrug-resistant TB (MDR-TB) but the evidence is scarce.
We conducted a retrospective cohort study on pulmonary TB patients to investigate the characteristics and outcomes of RMR-TB. The characteristics of RMR-TB were compared with those with adverse events to rifampin (RAE-TB).
Forty-four RMR-TB and 29 RAE-TB patients were enrolled. RMR-TB patients showed more alcohol use, prior history of TB, and radiologically severe disease, while RAE-TB patients were older and had more comorbidities and combined extrapulmonary TB. A fluoroquinolone (FQ) was the drug most commonly added (70.5%, RMR-TB; 82.8%, RAE-TB). Median treatment duration was 453 days in RMR-TB and 371 days in RAE-TB (p = 0.001) and treatment success rates were 87.2% (34/39) and 80.0% (20/25), respectively (p = 0.586). Subanalysis of the RMR-TB group by treatment regimen (standard regimen [n = 11], standard regimen + FQ [n = 12], MDR-TB regimen [n = 21]) revealed a higher rate of radiologically severe disease in the MDR-TB subgroup, with similar treatment success rates for the subgroups (85.7% [6/7]), 91.7% [11/12], and 85.0% [17/20], respectively) despite different durations of treatment (345, 405, and 528 days, respectively). Two recurrences (33.3% [2/6]) developed only in standard regimen subgroup, suggesting that standard regimen is not enough to treat RMR-TB patients.
The treatment outcome of RMR-TB with 1-line drugs + FQ was comparable to that of MDR-TB regimen. Shorter treatment duration may be considered for RMR-TB patients compared with MDR-TB patients.
利福平（RIF）单耐药结核病（RMR-TB）较为罕见。目前的指南建议将 RMR-TB 作为耐多药结核病（MDR-TB）进行治疗，但相关证据有限。
我们对肺结核患者进行了回顾性队列研究，以调查 RMR-TB 的特征和结局。将 RMR-TB 的特征与利福平不良反应（RAE-TB）的特征进行比较。
纳入 44 例 RMR-TB 和 29 例 RAE-TB 患者。RMR-TB 患者饮酒较多，既往有结核病病史，影像学上疾病严重程度更高，而 RAE-TB 患者年龄更大，合并症更多，合并肺外结核病。氟喹诺酮类药物（FQ）是最常添加的药物（RMR-TB 为 70.5%，RAE-TB 为 82.8%）。RMR-TB 患者的中位治疗时间为 453 天，RAE-TB 患者为 371 天（p=0.001），治疗成功率分别为 87.2%（34/39）和 80.0%（20/25）（p=0.586）。对 RMR-TB 组按治疗方案进行亚组分析（标准方案[11 例]、标准方案+FQ[12 例]、MDR-TB 方案[21 例]）显示，MDR-TB 亚组影像学严重疾病的发生率更高，但治疗成功率相似（分别为 85.7%[6/7]、91.7%[11/12]和 85.0%[17/20]），尽管治疗持续时间不同（分别为 345、405 和 528 天）。标准方案亚组仅发生 2 例复发（33.3%[2/6]），提示标准方案不足以治疗 RMR-TB 患者。
用 1 线药物+FQ 治疗 RMR-TB 的疗效与 MDR-TB 方案相当。与 MDR-TB 患者相比，RMR-TB 患者的治疗持续时间可能更短。
