Keane V P, de Klerk N, Krieng T, Hammond G, Musk A W
International Organisation for Migration, Harare, Zimbabwe.
Int J Epidemiol. 1997 Oct;26(5):1115-20. doi: 10.1093/ije/26.5.1115.
Acquired resistance to standard chemotherapy for tuberculosis (TB) is an increasing problem worldwide. Vietnam has one of the highest incidences of TB and also has a large population of potential migrants to other countries. Since 1979 the International Organisation for Migration (IOM) has been running a supervised programme of TB treatment for intending migrants from Vietnam where few facilities for bacteriological culture and sensitivity testing exist. This study aimed to assess the most important factors for predicting non-response to first-line treatment as treatment starts and whether any further indicators occur during the course of treatment which may enable more accurate prediction of non-response.
In all, 130 subjects failing to respond to first-line therapy (cases) between 1990 and 1995 were compared with 673 subjects who responded to therapy (controls) on various demographic and clinical characteristics using logistic regression to create a prognostic index. Variables analysed included the patient history of past TB treatment, weight, age, sex and radiological and bacteriological findings. All subjects also tested negative for HIV status.
The chief markers of successful response were x-ray signs and degree of sputum smear positivity. These markers provided a prognostic index with an optimal cutoff providing about 70% sensitivity and 80% specificity. Incorporating further measures obtained through the first 3 months of treatment improved the sensitivity to 80%.
While this study enabled prediction of the majority of subjects failing to respond to first-line therapy, other factors need to be assessed before recommendations for altering treatment regimens can be made. The prognostic index could be useful in assessing subjects for closer supervision.
获得性耐结核标准化疗在全球范围内是一个日益严重的问题。越南是结核病发病率最高的国家之一，且有大量潜在的移民到其他国家。自1979年以来，国际移民组织（IOM）一直在为来自越南的有意移民开展一项结核病治疗监督项目，而当地细菌培养和药敏试验设施很少。本研究旨在评估治疗开始时预测一线治疗无反应的最重要因素，以及在治疗过程中是否出现任何可更准确预测无反应的进一步指标。
总共将1990年至1995年间130例一线治疗无反应的受试者（病例组）与673例治疗有反应的受试者（对照组）就各种人口统计学和临床特征进行比较，采用逻辑回归创建一个预后指数。分析的变量包括患者过去的结核病治疗史、体重、年龄、性别以及放射学和细菌学检查结果。所有受试者的HIV检测均为阴性。
治疗成功的主要标志是X线征象和痰涂片阳性程度。这些标志提供了一个预后指数，最佳临界值的敏感性约为70%，特异性约为80%。纳入治疗前3个月获得的进一步指标后，敏感性提高到80%。
虽然本研究能够预测大多数一线治疗无反应的受试者，但在提出改变治疗方案的建议之前，还需要评估其他因素。该预后指数可能有助于评估受试者以便进行更密切的监测。
