Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes PROSICS Barcelona, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
Hospital Nossa Senhora da Paz, Cubal, Angola.
Am J Trop Med Hyg. 2019 Sep;101(3):502-509. doi: 10.4269/ajtmh.19-0175.
Treatment for multidrug-resistant tuberculosis (MDR TB) is associated with adverse events (AE). Patients treated with an MDR TB regimen in Hospital Nossa Senhora da Paz, Cubal, Angola, were prospectively enrolled from May 2013 to July 2015. Baseline characteristics, AE, and clinical and microbiological outcomes were recorded. A total of 216 patients were treated with an MDR TB regimen and 179 (82.9%) patients developed at least one AE. The most common AE were elevation of liver enzymes (46.8% of patients), elevated creatinine (44.4% of patients), and ototoxicity (40.7% of patients). Previous TB treatment was associated with the occurrence of AE (OR 4.89, 95% CI: 2.09-11.46, < 0.001) and months on treatment was associated to severe AE (OR 1.11 95% CI: 1.04-1.18, = 0.001). Successful treatment was achieved in 117 (54.2%) patients. Incidence of AE was associated with an unsuccessful outcome (OR 1.23, 95% CI: 1.09-1.40, = 0.001). Patients treated with MDR TB treatment frequently experience AE, and these are related with previous TB treatment and duration of treatment. Given the high percentage of patients experiencing AE and the low treatment success rates, more effective and less toxic drugs to treat MDR TB are urgently needed.
在安哥拉 Cubal 的 Nossa Senhora da Paz 医院，对多药耐药结核病（MDR-TB）患者进行前瞻性研究，自 2013 年 5 月至 2015 年 7 月期间，入组了所有接受 MDR-TB 方案治疗的患者。记录了患者的基线特征、不良事件（AE）以及临床和微生物学结局。共对 216 例 MDR-TB 患者进行了治疗，其中 179 例（82.9%）患者出现至少 1 次 AE。最常见的 AE 包括肝酶升高（46.8%的患者）、肌酐升高（44.4%的患者）和耳毒性（40.7%的患者）。既往结核病治疗与 AE 的发生相关（OR 4.89，95%CI：2.09-11.46，<0.001），治疗时间与严重 AE 相关（OR 1.11 95%CI：1.04-1.18，=0.001）。117 例（54.2%）患者的治疗获得成功。AE 的发生率与治疗失败相关（OR 1.23，95%CI：1.09-1.40，=0.001）。接受 MDR-TB 治疗的患者经常出现 AE，这些 AE 与既往结核病治疗和治疗时间有关。鉴于出现 AE 的患者比例较高和治疗成功率较低，迫切需要更有效和毒性更低的药物来治疗 MDR-TB。
