Ormerod L P, Bentley C
Chest Clinic, Blackburn Royal Infirmary.
J R Coll Physicians Lond. 1997 Nov-Dec;31(6):662-5.
We have compared the management of 925 cases of pulmonary tuberculosis reported to the 1993 national tuberculosis notification survey with the recommended standards of treatment. Forty-eight per cent of patients were white, 36% came from the Indian subcontinent (ISC) and 15% were of other ethnic origin. Most patients (86%) were under the care of thoracic physicians. Sputum microscopy was positive in 44%, and culture confirmation was obtained in 64% of cases. Drug resistance was reported in 30/582 isolates (5%), ranging from 13% in Black-Africans to 4.5% in ISC ethnic groups and 2% in the whites, with none reported in those of Black-Caribbean origin. Almost all patients (94.5%) were started on a recommended drug combination, but only 74% continued to receive one, with thoracic physicians significantly more likely than other physicians to use a recommended combination. Non-standard durations of either initial and/or continuation phase therapy were used in 303 patients, but in only 167 was a satisfactory reason given for the modification. Definite or suspected drug toxicity was reported in 79 (9%) and was significantly more likely with non-standard regimens. Seventy-two patients died before the survey was carried out one year after their notification, only 15 of them directly due to tuberculosis. Of the 815 cases observed to treatment completion, 430 (53%) were then discharged. There were adequate reasons for follow-up after the end of treatment in all but 98 of those so managed. Although the results were satisfactory overall, continued efforts are required to increase the percentage of patients treated with evidence-based recommended regimens and durations of chemotherapy.
我们将1993年全国结核病通报调查所报告的925例肺结核病例的管理情况与推荐的治疗标准进行了比较。48%的患者为白人，36%来自印度次大陆（ISC），15%为其他种族。大多数患者（86%）由胸科医生负责治疗。44%的患者痰涂片显微镜检查呈阳性，64%的病例获得了培养确诊。在582株分离菌株中有30株（5%）报告有耐药性，其中非洲黑人的耐药率为13%，ISC族裔群体为4.5%，白人为2%，加勒比黑人后裔中未报告有耐药情况。几乎所有患者（94.5%）都开始使用推荐的药物组合，但只有74%的患者继续接受该组合治疗，胸科医生比其他医生更有可能使用推荐的组合。303例患者在初始和/或继续治疗阶段采用了非标准疗程，但只有167例给出了修改疗程的满意理由。79例（9%）报告有明确或疑似药物毒性，采用非标准治疗方案时发生药物毒性的可能性显著更高。72例患者在通报后一年调查开展前死亡，其中只有15例直接死于结核病。在观察到完成治疗的815例病例中，430例（53%）随后出院。在所有接受如此管理的患者中，除98例之外，其余患者在治疗结束后均有充分的随访理由。尽管总体结果令人满意，但仍需继续努力提高接受循证推荐方案和化疗疗程治疗的患者比例。
