韩国一家转诊医院 20 多年来的耐多药结核病：趋势和结果。

Multidrug-resistant tuberculosis over 20 years at a referral hospital in South Korea: trends and outcomes.

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul.

Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea.

出版信息

Int J Tuberc Lung Dis. 2019 Feb 1;23(2):174-180. doi: 10.5588/ijtld.18.0295.

DOI:10.5588/ijtld.18.0295

PMID:30808449

Abstract

SETTING

A referral centre in South Korea.

OBJECTIVE

To investigate trends in drug resistance, treatment modalities and outcomes, and adverse events of multidrug-resistant tuberculosis (MDR-TB) over two decades.

DESIGN

MDR-TB patients treated at Seoul National Hospital University between 1996 and 2015 were divided into four 5-year cohorts according to the date of initial diagnosis. Changes in demographic characteristics, drug resistance, drugs used, treatment outcomes and adverse events over time were elucidated.

RESULTS

Between 1996 and 2015, 418 patients were treated for MDR-TB: 86 patients between 1996 and 2000, 125 between 2001 and 2005, 123 between 2006 and 2010, and 84 between 2011 and 2015. The proportion of patients with positive acid-fast bacilli sputum (60.5-29.7%, < 0.001) or cavities on chest radiographs (86.0-40.5%, < 0.001) decreased over time. Resistance to pyrazinamide, fluoroquinolones, cycloserine and p-aminosalicylic acid decreased. Later-generation fluoroquinolones (77.9-90.5%) and linezolid (0-26.2%) became more frequently prescribed. The treatment success rate increased (45.3-88.1%, < 0.001); neurological adverse events, including peripheral neuropathy also increased (4.7-13.1%, = 0.027).

CONCLUSION

MDR-TB patients presented with less severe disease and better resistance profiles over time in South Korea, with treatment outcomes improving continuously.

摘要

背景

韩国的一个转诊中心。

目的

研究二十多年来耐多药结核病（MDR-TB）的耐药趋势、治疗方式和结果以及不良事件。

设计

根据初诊日期，将 1996 年至 2015 年在首尔国立大学医院接受治疗的 MDR-TB 患者分为四个 5 年组。阐述了随时间推移，人口统计学特征、耐药性、所用药物、治疗结果和不良事件的变化。

结果

1996 年至 2015 年期间，共治疗了 418 例 MDR-TB 患者：1996 年至 2000 年 86 例，2001 年至 2005 年 125 例，2006 年至 2010 年 123 例，2011 年至 2015 年 84 例。痰抗酸杆菌阳性（60.5%-29.7%，<0.001）或胸片有空洞（86.0%-40.5%，<0.001）的患者比例随时间推移而下降。对吡嗪酰胺、氟喹诺酮类、环丝氨酸和对氨基水杨酸的耐药性降低。后来一代氟喹诺酮类（77.9%-90.5%）和利奈唑胺（0%-26.2%）的使用更为频繁。治疗成功率增加（45.3%-88.1%，<0.001）；神经不良反应，包括周围神经病，也增加（4.7%-13.1%，=0.027）。