Evans C, Devadatta S, Fox W, Gangadharam P R, Menon N K, Ramakrishnan C V, Sivasubramanian S, Somasundaram P R, Stott H, Velu S
Bull World Health Organ. 1969;41(1):1-16.
This report from the Tuberculosis Chemotherapy Centre, Madras, describes the progress, over a 5-year period, of 341 patients with newly diagnosed, sputum-positive tuberculosis. All the patients were treated on a domiciliary basis. In the first year, the patients received, on the basis of random allocation, a standard regimen of isoniazid plus PAS or 1 of 3 regimens of isoniazid alone. Previous reports have shown that the response in the first year was substantially superior with the standard regimen, and that the bacteriological relapse rates in the second year were fairly similar for the 4 regimens. The findings in the present report extend the latter conclusion to the end of 5 years. Further, when considered together with the findings in an earlier study, they have shown that isoniazid, given as maintenance chemotherapy in the second year, was highly effective in preventing bacteriological relapse in patients who, at 1 year, had bacteriologically quiescent disease and no residual cavitation; the effect was, however, less marked in patients with residual cavitation at 1 year.Patients who were clear-cut failures of the allocated chemotherapy and those who had a bacteriological relapse in the second or subsequent years were usually re-treated with streptomycin plus PAS or streptomycin plus pyrazinamide, and if this was ineffective, with cycloserine plus thioacetazone or cycloserine plus ethionamide.Considering the findings over the 5-year period for all patients, 16 died from non-tuberculous causes and 1 took his discharge prematurely. Of the remainder, 86% had bacteriologically quiescent disease at 5 years, 6% had bacteriologically active disease and 8% had died of tuberculosis. These findings confirm the value of well-organized domiciliary chemotherapy, which was established by an earlier report from the Centre, and are particularly encouraging for developing countries such as India, where tuberculosis is a major problem and resources are limited.
这份来自马德拉斯结核病化疗中心的报告，描述了341例新诊断出的痰涂片阳性肺结核患者在5年期间的病情进展。所有患者均接受家庭治疗。第一年，患者根据随机分配，接受异烟肼加对氨基水杨酸的标准方案，或单独使用异烟肼的3种方案之一。此前的报告显示，第一年采用标准方案时反应明显更好，而且这4种方案在第二年的细菌学复发率相当相似。本报告中的研究结果将后一个结论延伸至5年结束时。此外，与早期一项研究的结果相结合，这些结果表明，对于那些在1年时细菌学上病情静止且无残留空洞的患者，第二年给予异烟肼作为维持化疗，在预防细菌学复发方面非常有效；然而，对于1年时有残留空洞的患者，效果则不太明显。那些被明确判定为所分配化疗方案失败的患者，以及在第二年或之后几年出现细菌学复发的患者，通常会接受链霉素加对氨基水杨酸或链霉素加吡嗪酰胺的再治疗，如果无效，则使用环丝氨酸加硫代乙酰腙或环丝氨酸加乙硫异烟胺。考虑到所有患者5年期间的研究结果，16例死于非结核性原因，1例提前出院。其余患者中，86%在5年时细菌学病情静止，6%有细菌学活动性疾病，8%死于肺结核。这些研究结果证实了该中心早期一份报告所确立的有组织的家庭化疗的价值，对于像印度这样结核病是一个主要问题且资源有限的发展中国家来说尤其鼓舞人心。
