孟买一家耐药结核病中心的肺外耐药结核病：我们的经验——绝望中的希望！
Extrapulmonary drug-resistant tuberculosis at a drug-resistant tuberculosis center, Mumbai: Our experience - Hope in the midst of despair!
作者信息
Desai Unnati, Joshi Jyotsna M
机构信息
Department of Pulmonary Medicine, T. N. Medical College, B. Y. L. Nair Hospital, Mumbai, Maharashtra, India.
出版信息
Lung India. 2019 Jan-Feb;36(1):3-7. doi: 10.4103/lungindia.lungindia_192_18.
BACKGROUND
Drug-resistant tuberculosis (DR-TB) is a global problem with only 52% reported cure rate. Extrapulmonary (EP) DR-TB poses a formidable diagnostic, therapeutic challenge. We aimed to study their clinical profile and treatment outcomes under the programmatic setting.
MATERIALS AND METHODS
This retrospective observational study included the database of consecutive EPDR-TB cases enrolled at the DR-TB center from 2012 to 2014. The demographic, clinical details, drug susceptibility tests (DSTs), follow-up, therapy, adverse events (AEs), and outcome were reviewed. Statistical analysis was done using percentages and mean.
RESULTS
Of total 1743 DR-TB patients, 76 (4.4%) EPDR-TB cases were included. These consisted of 53 (69.7%) adults and 23 (30.3%) children, with female preponderance. The mean age in adults and children was 27.96 (9.63) and 12.56 (3.83), respectively. EP sites involved were lymph nodes in 39 (51.3%), spine in 15 (19.7%), other bones in 6 (7.9%), pleural effusion in 9 (11.9%), central nervous system in 2 (2.6%), and disseminated EP disease in 5 (6.6%). Forty-one (53.9%) had multi-DR-TB (MDR-TB), 29 (38.2%) MDR-TB with fluoroquinolone resistance {preextensively DR-TB (Pre-XDR-TB (FQ)), 1 (1.3%) MDR-TB with aminoglycoside resistance (Pre-XDR-TB (AM)), and 5 (6.6%) extensively DR-TB (XDR-TB) on DST. Thirteen (17.11%) had comorbidities. None had HIV. Two (2.63%) had DM. Patients were treated as per the revised TB control program - programmatic management of DR-TB guidelines. Duration of intensive (IP) was 6.55 (1.22) months. Ten (13.2%) received shorter regimens, wherein therapy was stopped at 12-18 months due to severe adverse drug reactions and treatment response. Sixty-two (81.6%) completed treatment, 8 (10.5%) defaulted, 3 (4%) died, 2 (2.6%) failed, and 1 (1.3%) was transferred out. Two-third of patients reported AE.
CONCLUSION
The prevalence of EP cases in DR-TB was 4.4%. Treatment completion rate was very high (81.6%). Shorter regimens were efficacious.
背景
耐多药结核病（DR-TB）是一个全球性问题，报告的治愈率仅为52%。肺外（EP）耐多药结核病带来了巨大的诊断和治疗挑战。我们旨在研究在规划环境下它们的临床特征和治疗结果。
材料与方法
这项回顾性观察性研究纳入了2012年至2014年在耐多药结核病中心登记的连续性肺外耐多药结核病病例数据库。回顾了人口统计学、临床细节、药物敏感性试验（DST）、随访、治疗、不良事件（AE）和结果。使用百分比和均值进行统计分析。
结果
在总共1743例耐多药结核病患者中，纳入了76例（4.4%）肺外耐多药结核病病例。其中包括53例（69.7%）成人和23例（30.3%）儿童，女性占多数。成人和儿童的平均年龄分别为27.96（9.63）岁和12.56（3.83）岁。涉及的肺外部位有39例（51.3%）为淋巴结，15例（19.7%）为脊柱，6例（7.9%）为其他骨骼，9例（11.9%）为胸腔积液，2例（2.6%）为中枢神经系统，5例（6.6%）为播散性肺外疾病。41例（53.9%）患有多重耐药结核病（MDR-TB），29例（38.2%）为对氟喹诺酮耐药的MDR-TB{广泛耐药前结核病（Pre-XDR-TB（FQ）），1例（1.3%）为对氨基糖苷类耐药的MDR-TB（Pre-XDR-TB（AM）），5例（6.6%）根据DST为广泛耐药结核病（XDR-TB）。13例（17.11%）有合并症。无人感染艾滋病毒。2例（2.63%）患有糖尿病。患者按照修订后的结核病控制规划——耐多药结核病规划管理指南进行治疗。强化期（IP）持续时间为6.55（1.22）个月。10例（13.2%）接受了较短疗程，其中由于严重药物不良反应和治疗反应，治疗在12至18个月时停止。62例（81.6%）完成治疗，8例（10.5%）失访，3例（4%）死亡，2例（2.6%）治疗失败，1例（1.3%）转出。三分之二的患者报告有不良事件。
结论
耐多药结核病中肺外病例的患病率为4.4%。治疗完成率非常高（81.6%）。较短疗程有效。
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