Department of Tuberculosis, Public Health Clinical Center of Chengdu, Jingjusi 18 Street, Jingjiang District, Chengdu, Sichuan, China.
Department of Imaging, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China.
Sci Rep. 2024 Jul 29;14(1):17347. doi: 10.1038/s41598-024-68550-0.
The treatment of multidrug-resistant tracheobronchial tuberculosis poses challenges, and research investigating the efficacy of bedaquiline or delamanid as treatment for this condition is limited. This retrospective cohort study was conducted from 2017 to 2021. The study extracted data of patients with multidrug-resistant tracheobronchial tuberculosis from medical records and followed up on prognoses. Participants were divided into three groups: the bedaquiline, delamanid, and control group. Clinical outcomes and the risk factors associated with early culture conversion were analyzed. This study included 101 patients, with 32, 25, and 44 patients in the bedaquiline, delamanid, and control groups respectively. The differences in the treatment success rates among the three groups did not show statistical significance. Both the bedaquiline and delamanid groups had significantly higher culture conversion rates compared to the control after 2 or 6 months of treatment, with significantly shorter median times to culture conversion (bedaquiline group: 2 weeks, delamanid group: 2 weeks, control group: 12 weeks, P < 0.001). Treatment with bedaquiline or delamanid were identified as independent predictors of culture conversion at 2 months (bedaquiline group: aOR = 13.417, 95% CI 4.067-44.260, delamanid group: aOR = 9.333, 95% CI 2.498-34.878) or 6 months (bedaquiline group: aOR = 13.333, 95% CI 3.379-52.610, delamanid group: aOR = 5.000, 95% CI 1.357-18.426) of treatment through multivariable logistic regression analyses. The delamanid group showed better improvement in lumen stenosis compared to bedaquiline. Regimens containing bedaquiline or delamanid may accelerate the culture conversion during the early treatment phase in multidrug-resistant tracheobronchial tuberculosis, and delamanid appears to have the potential to effectively improve airway stenosis.
多药耐药性气管支气管结核的治疗具有挑战性，关于贝达喹啉或德拉马尼作为该病治疗药物的疗效研究有限。本回顾性队列研究于 2017 年至 2021 年进行。研究从病历中提取多药耐药性气管支气管结核患者的数据，并对预后进行随访。参与者分为贝达喹啉组、德拉马尼组和对照组。分析了临床结果和与早期培养转换相关的危险因素。本研究共纳入 101 例患者，贝达喹啉组、德拉马尼组和对照组分别为 32、25 和 44 例。三组治疗成功率的差异无统计学意义。贝达喹啉组和德拉马尼组在治疗后 2 个月和 6 个月时的培养转化率均显著高于对照组，培养转换的中位时间显著缩短（贝达喹啉组：2 周，德拉马尼组：2 周，对照组：12 周，P<0.001）。多因素逻辑回归分析显示，贝达喹啉或德拉马尼治疗可作为 2 个月（贝达喹啉组：aOR=13.417，95%CI 4.067-44.260，德拉马尼组：aOR=9.333，95%CI 2.498-34.878）或 6 个月（贝达喹啉组：aOR=13.333，95%CI 3.379-52.610，德拉马尼组：aOR=5.000，95%CI 1.357-18.426）培养转换的独立预测因子。多变量逻辑回归分析显示，与贝达喹啉组相比，德拉马尼组在改善管腔狭窄方面有更好的改善。包含贝达喹啉或德拉马尼的方案可能会加速多药耐药性气管支气管结核早期治疗阶段的培养转换，而德拉马尼似乎有潜力有效改善气道狭窄。
