Matsumoto Kenji, Komukai Jun, Tsuda Yuko, Okumachi Akinori, Furukawa Kanae, Adachi Maiko, Shimizu Naoko, Saito Kazumi
Kekkaku. 2016 Aug;91(8):587-591.
[Purpose] To improve the treatment outcomes by analyzing/evaluating the association between DOTS and treatment outcomes in patients with extra-pulmonary tuber- culosis. [Methods] The subjects were patients with extra-pulmonary tuberculosis newly registered in Osaka City between 2012 and 2014. As controls, patients with pulmonary tuberculosis during this period were enrolled. Patients in whom compli- ance was confirmed once a month or more were regarded as completing DOTS. [Results] There were 434 patients with extra-pulmonary tuberculosis. Treatment was completed in 73.3% of these patients. Defaulted rates accounted for 9.4%. The mortality rate was 13.4%. Treatment is being conducted in 2.8%. Furthermore, 0.7% was transferred out. The results were unclear in 0.5%. We investigated changes in the DOTS and defaulted rates, excluding patients who died, those who were referred to other hospitals, those receiving treatment, and those whose results were unclear. The DOTS rates in 2012, 2013, and 2014 were 85.5, 87.5, and 91.2%, respectively, showing a slight increase. The defaulted rates were 14.5, 10.7, and 7.8%, respectively, showing a decrease. When compar- ing the results between the extra-pulmonary and pulmonary tuberculosis patients, the defaulted rates were 11.4 and 6.2 %, respectively; the percentage was significantly higher in the extra-pulmonary tuberculosis patients. The DOTS rates were 87.7 and 97.2%, respectively; the percentage was sig- nificantly lower in the extra-pulmonary tuberculosis patients. There were 41 defaulted cases. The reasons were "side effects" in 41.5%, "physicians' instructions" in 24.4%, "self- discontinuation/refusal" in 22.0%, and "preferential treatment for other diseases" in 12.2%. In the extra-pulmonary tuberculosis patients, the proportion of those in whom "side effects" led to defaulted was higher than in the pulmonary tubercu- losis patients, and that of those "self-discontinuation/refusal" was significantly lower. [Conclusion] Although the defaulted rate has decreased with an increase in the DOTS rate in patients with extra- pulmonary tuberculosis, both the DOTS and defaulted rates were less favorable than in patients with pulmonary tuber- culosis. In the future, it may be necessary to decrease the defaulted rate by intensifying DOTS. Of the reasons for defaulted, "side effects" and "physicians' instructions" account- ed for a high percentage. Therefore, it may be important to provide medical institutions with information.
[目的] 通过分析/评估直接观察短程治疗（DOTS）与肺外结核患者治疗效果之间的关联，以改善治疗效果。[方法] 研究对象为2012年至2014年在大阪市新登记的肺外结核患者。作为对照，纳入了此期间的肺结核患者。每月或更频繁确认依从性的患者被视为完成DOTS。[结果] 共有434例肺外结核患者。其中73.3%的患者完成了治疗。违约率为9.4%。死亡率为13.4%。2.8%的患者正在接受治疗。此外，0.7%的患者转出。结果不明确的占0.5%。我们调查了排除死亡、转至其他医院、正在接受治疗以及结果不明确的患者后DOTS和违约率的变化。2012年、2013年和2014年的DOTS率分别为85.5%、87.5%和91.2%，呈轻微上升趋势。违约率分别为14.5%、10.7%和7.8%，呈下降趋势。比较肺外结核患者和肺结核患者的结果，违约率分别为11.4%和6.2%；肺外结核患者的违约率明显更高。DOTS率分别为87.7%和97.2%；肺外结核患者的比例明显更低。有41例违约病例。原因是“副作用”占41.5%，“医生指示”占24.4%，“自行停药/拒绝”占22.0%，“优先治疗其他疾病”占12.2%。在肺外结核患者中，因“副作用”导致违约的比例高于肺结核患者，而“自行停药/拒绝”的比例明显更低。[结论] 尽管肺外结核患者的违约率随着DOTS率的增加而下降，但DOTS率和违约率均不如肺结核患者。未来，可能有必要通过强化DOTS来降低违约率。在违约原因中，“副作用”和“医生指示”占比很高。因此，向医疗机构提供信息可能很重要。
