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异烟肼单耐药结核病的特征和治疗结果:一项回顾性研究。

Characteristics and Treatment Outcomes of Isoniazid Mono-Resistant Tuberculosis: A Retrospective Study.

机构信息

Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.

出版信息

Yonsei Med J. 2020 Dec;61(12):1034-1041. doi: 10.3349/ymj.2020.61.12.1034.

Abstract

PURPOSE

Isoniazid (INH) mono-resistant tuberculosis (Hr-TB) is a highly prevalent type of drug-resistant TB, possibly associated with unfavorable treatment outcomes. However, definitive guidelines on an optimal treatment regimen and duration for Hr-TB are currently under discussion. We evaluated the characteristics and treatment outcomes of Hr-TB patients.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of Hr-TB patients treated at a South Korean tertiary referral hospital from January 2005 to December 2018.

RESULTS

We included 195 Hr-TB patients. 113 (57.9%) were male, and the median age was 56.6 [interquartile range, 40.2-68.6] years. Mutations in were the most frequent [54 (56.3%)], followed by those in the [34 (35.4%)]. Favorable and unfavorable outcomes were noted in 164 (84.1%) and 31 (15.9%) patients, respectively. Smoking history [odds ratio (OR)=5.606, 95% confidence interval (CI): 1.695-18.543, =0.005], low albumin level (OR=0.246, 95% CI: 0.104-0.578, =0.001), and positive acid-fast bacilli culture at 2 months (OR=7.853, 95% CI: 1.246-49.506, =0.028) were associated with unfavorable outcomes.

CONCLUSION

A tailored strategy targeting high-risk patients is imperative for improved treatment outcomes. Further research on the rapid and accurate detection of resistance to INH and other companion drugs is warranted.

摘要

目的

异烟肼(INH)单耐药结核病(Hr-TB)是一种高度流行的耐药结核病类型,可能与不良治疗结果有关。然而,目前正在讨论针对 Hr-TB 的最佳治疗方案和疗程的明确指南。我们评估了 Hr-TB 患者的特征和治疗结果。

材料和方法

我们回顾性地审查了 2005 年 1 月至 2018 年 12 月在韩国一家三级转诊医院接受治疗的 Hr-TB 患者的病历。

结果

我们纳入了 195 例 Hr-TB 患者。113 例(57.9%)为男性,中位年龄为 56.6 [四分位间距(IQR):40.2-68.6] 岁。 最常见的突变是 [54 例(56.3%)],其次是 [34 例(35.4%)]。164 例(84.1%)患者治疗结果良好,31 例(15.9%)患者治疗结果不佳。吸烟史[比值比(OR)=5.606,95%置信区间(CI):1.695-18.543,=0.005]、低白蛋白水平(OR=0.246,95%CI:0.104-0.578,=0.001)和 2 个月时阳性抗酸杆菌培养(OR=7.853,95%CI:1.246-49.506,=0.028)与不良结局相关。

结论

针对高危患者制定个体化策略对于改善治疗结果至关重要。需要进一步研究快速准确检测 INH 和其他伴随药物耐药性的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ce9f/7700875/b70a094b58f2/ymj-61-1034-g001.jpg

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