在几内亚，采用较短方案治疗耐多药结核病（MDR-TB）可获得更好的临床结局：一项回顾性队列研究。
Better programmatic outcome with the shorter regimen for the treatment of multidrug-resistant tuberculosis (MDR-TB) in Guinea: A retrospective cohort study.
机构信息
Action Damien, Conakry, Guinea.
Action Damien, Research Department in Brussels, Brussels, Belgium.
出版信息
PLoS One. 2020 Aug 10;15(8):e0237355. doi: 10.1371/journal.pone.0237355. eCollection 2020.
SETTING
Since August 2016, after the Ebola outbreak, the Guinean National Tuberculosis Programme and Damien Foundation implemented the shorter treatment regimen (STR) for multidrug-resistant tuberculosis (MDR-TB) in the three MDR-TB sites of Conakry. Previously, the longer regimen was used to treat MDR-TB.
OBJECTIVES
In a post-Ebola context, with a weakened health system, we describe the MDR-TB treatment uptake, patients characteristics, treatment outcomes and estimate the effect of using the longer versus STR on having a programmatically adverse outcome.
DESIGN
This is a retrospective cohort study in RR-TB patients treated with either the longer regimen or STR.
RESULTS
In Conakry, in 2016 and 2017, 131 and 219 patients were diagnosed with rifampicin-resistant tuberculosis (RR-TB); and 108 and 163 started treatment, respectively. Of 271 patients who started treatment, 75 were treated with the longer regimen and 196 with the STR. Patients characteristics were similar regardless of the regimen except that the median age was higher among those treated with a longer regimen (30 years (IQR:24-38) versus 26 years (IQR:21-39) for the STR. Patients treated with a STR were more likely to obtain a programmatically favorable outcome (74.0% vs 58.7%, p = 0.01) as lost to follow up was higher among those treated with a longer regimen (20.0% vs 8.2%, p = 0.006). Patients on a longer regimen were more than 2 times more likely (aOR: 2.5; 95%CI:1.3,4.7) to have a programmatically adverse outcome as well as being 45 years or older (aOR: 2.8; 95%CI:1.3,6.2), HIV positive (aOR:3.3; 95%CI:1.6,6.6) and attendance at a clinic without NGO support (aOR:3.0; 95%:1.6,5.7).
CONCLUSION
In Guinea, patients treated with the STR were more likely to have a successful outcome than those treated with the longer MDR-TB treatment regimen. Lost to follow-up was higher in patients on the longer regimen. However, STR treatment outcomes were less good than those reported in the region.
背景
自 2016 年 8 月埃博拉疫情爆发以来，几内亚国家结核病规划和达米安基金会在科纳克里的三个耐多药结核病（MDR-TB）地点实施了较短的治疗方案（STR）治疗耐多药结核病（MDR-TB）。此前，使用较长的方案治疗 MDR-TB。
目的
在埃博拉疫情后的背景下，卫生系统较为薄弱，我们描述了 MDR-TB 治疗的接受情况、患者特征、治疗结果，并估计了使用较长方案与 STR 方案对治疗结果的影响。
设计
这是一项在科纳克里的利福平耐药结核病（RR-TB）患者中进行的回顾性队列研究，这些患者接受了较长方案或 STR 治疗。
结果
2016 年和 2017 年，科纳克里共有 131 名和 219 名患者被诊断为耐利福平结核病（RR-TB）；分别有 108 名和 163 名患者开始接受治疗。在 271 名开始治疗的患者中，75 名接受了较长方案治疗，196 名接受了 STR 治疗。无论方案如何，患者特征都相似，除了接受较长方案治疗的患者的中位年龄较高（30 岁（IQR：24-38）比 STR 治疗的患者高（26 岁（IQR：21-39）。接受 STR 治疗的患者更有可能获得方案有利的结果（74.0%对 58.7%，p=0.01），因为接受较长方案治疗的患者失访率更高（20.0%对 8.2%，p=0.006）。接受较长方案治疗的患者发生方案不良结局的可能性是接受 STR 治疗的患者的两倍多（优势比[OR]：2.5；95%CI：1.3，4.7），年龄在 45 岁或以上（OR：2.8；95%CI：1.3，6.2），HIV 阳性（OR：3.3；95%CI：1.6，6.6），以及在没有非政府组织支持的诊所就诊（OR：3.0；95%CI：1.6，5.7）。
结论
在几内亚，接受 STR 治疗的患者比接受较长 MDR-TB 治疗方案的患者更有可能取得成功的结果。接受较长方案治疗的患者失访率更高。然而，STR 治疗结果不如该地区报告的结果好。
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