Infectious Disease Department, Avicenne Hospital, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France; IAME, INSERM UMR 1137, Université de Paris, Université Sorbonne Paris Nord, Paris, France.
Clinical Research Unit, Bichat Hospital, Paris, France.
Infect Dis Now. 2022 Oct;52(7):389-395. doi: 10.1016/j.idnow.2022.08.004. Epub 2022 Sep 5.
Patients lost to follow-up and treatment failure in tuberculosis disease (TB) are major public health issues. In the absence of appropriate treatment, approximately 70 % of smear-positive patients will die within 10 years of disease progression. This study, conducted in the French region with the highest incidence, aimed to assess tuberculosis treatment outcomes and its determinants.
A prospective, multicenter cohort study (CO1TB) of adults and children treated for TB was conducted in four hospitals in the North of Paris. Treatment outcome at 1 year and associated socioeconomic and clinical factors were studied by multivariate logistic regression.
Among 145 TB cases included from May 2018 to January 2020, patients were mainly born abroad and most lived in difficult socioeconomic conditions. During treatment, 25/145 (17 %) patients experienced adverse effects, which were not significantly associated with discontinuation of treatment (p = 0.99). At 1 year, 114 (78 %) had completed treatments, 26 (19 %) were lost to follow-up, three (2.1 %) were still being treated and two (1.4 %) had died. In the multivariate analysis, a history of TB was significantly associated with unfavorable treatment outcome (aOR = 5.3, 95 %CI (1.5;18.6) and a trend towards significance (p < 0.2) was observed among patients aged under 24 years (aOR = 2.9, 95 %-CI 0.95;8.5).
In this precarious population, socioeconomic conditions were not found to be associated with unfavorable treatment outcome, whereas history of tuberculosis and young age played a role. Increased monitoring is thus required for these patients.
结核病（TB）患者失访和治疗失败是主要的公共卫生问题。未经适当治疗，大约 70%的涂片阳性患者在疾病进展 10 年内将死亡。本研究在法国发病率最高的地区进行，旨在评估结核病的治疗结果及其决定因素。
对在巴黎北部的四家医院接受结核病治疗的成人和儿童进行了一项前瞻性、多中心队列研究（CO1TB）。通过多变量逻辑回归研究了 1 年时的治疗结果以及与社会经济和临床相关的因素。
在 2018 年 5 月至 2020 年 1 月期间纳入的 145 例 TB 病例中，患者主要为在国外出生，大多数生活在困难的社会经济条件下。在治疗期间，25/145（17%）名患者出现不良反应，但与治疗中断无显著相关性（p=0.99）。1 年后，114 名（78%）完成了治疗，26 名（19%）失访，3 名（2.1%）仍在治疗中，2 名（1.4%）死亡。在多变量分析中，TB 病史与不良治疗结果显著相关（aOR=5.3，95%CI（1.5;18.6），24 岁以下患者的结果有显著趋势（p<0.2）（aOR=2.9，95%CI 0.95;8.5）。
在这个脆弱的人群中，社会经济状况与不良治疗结果无关，而结核病病史和年轻年龄起了作用。因此，这些患者需要加强监测。
