中国耐多药结核病患者治疗成功的预后因素。

Prognostic factors for treatment success in patients with multidrug-resistant tuberculosis in China.

机构信息

Department of Internal Medicine, Zhejiang University Hospital, Hangzhou.

The National Education Base for Basic Medical Sciences, School of Medicine, Zhejiang University, Hangzhou.

出版信息

Int J Tuberc Lung Dis. 2018 Mar 1;22(3):300-305. doi: 10.5588/ijtld.17.0183.

DOI:10.5588/ijtld.17.0183

PMID:29471908

Abstract

OBJECTIVE

To examine the clinical outcomes and associated prognostic factors among patients with multidrug-resistant tuberculosis (MDR-TB) in China.

METHODS

This retrospective study involved 243 patients with MDR-TB. All patients received standard regimens containing para-amino salicylic acid (PAS) and/or cycloserine (CS). The demographic, social and clinical characteristics of patients were recorded and the patients were followed up for 24 months.

RESULTS

Treatment success was closely associated with young age, non-farming occupations, shorter history or smoking, normal urine results, initial MDR-TB treatment regimen, increased haemoglobin, direct bilirubin, uric acid and thyroid stimulating hormone (TSH) levels, and lower white blood cell, neutrophil and blood platelet counts (all P < 0.05). On multivariable analysis, increased haemoglobin (hazard ratio [HR] 1.019, 95%CI 1.007-1.032, P = 0.002) and TSH levels (HR 1.002, 95%CI 1.006-1.039, P = 0.008), normal urine results (HR 1.541, 95%CI 1.008-2.358, P = 0.046) and initial MDR-TB treatment regimen (HR 2.238, 95%CI 1.090-4.597, P = 0.028) were prognostic factors for treatment success in MDR-TB.

CONCLUSIONS

Higher haemoglobin and TSH levels, normal urine results and initial MDR-TB treatment regimen might predict successful treatment of MDR-TB.

摘要

目的

研究中国耐多药结核病（MDR-TB）患者的临床结局及其相关预后因素。

方法

本回顾性研究纳入了 243 例 MDR-TB 患者。所有患者均接受了包含对氨基水杨酸（PAS）和/或环丝氨酸（CS）的标准方案治疗。记录了患者的人口统计学、社会和临床特征，并对其进行了 24 个月的随访。

结果

治疗成功与年龄较小、非务农职业、较短的病史或吸烟史、正常的尿液结果、初始 MDR-TB 治疗方案、血红蛋白、直接胆红素、尿酸和促甲状腺激素（TSH）水平升高以及白细胞、中性粒细胞和血小板计数降低有关（均 P < 0.05）。多变量分析显示，血红蛋白升高（风险比 [HR] 1.019，95%CI 1.007-1.032，P = 0.002）和 TSH 水平升高（HR 1.002，95%CI 1.006-1.039，P = 0.008）、尿液正常（HR 1.541，95%CI 1.008-2.358，P = 0.046）和初始 MDR-TB 治疗方案（HR 2.238，95%CI 1.090-4.597，P = 0.028）是 MDR-TB 治疗成功的预后因素。