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背景:一项多家医疗单位合作的加强耐多药结核病(MDR-TB)管理计划的城市结核病控制规划;目的:评估由多家医疗机构提供治疗的原发性耐多药结核病的疗效。设计:回顾性研究队列为1992-1997年间结核病患者,纳入条件为,1)分离的结核分枝杆菌至少耐异烟肼及利福平;2)第一次收集MDR-TB标本前接受抗结核治疗≤30天。结果:100多家医疗机构及提供治疗单位共报告了856例耐多药结核病患者。HIV阴性者中治疗完成率达70%,HIV阳性者中则为30%。队列中有57.2%的患者在治疗完成前死亡,26.5%完成治疗,16%迁出、拒绝治疗或失访,还有0.2%的患者仍继续治疗。HIV阳性者中,在研究后期确诊或肺内有空洞是完成治疗的独立相关因素。完成治疗的227例中,有8例(3.5%)复发(复发率为1.01/100人年),2例为药物敏感菌株。结论:虽然由多家医疗单位给予治疗管理,一项综合的MDR-TB控制规划仍提高了HIV感染者及非HIV感染者的疗效,在完成推荐治疗方案的患者中,复发率并不多见。
Background: A city tuberculosis control program to strengthen multidrug-resistant tuberculosis (MDR-TB) management plan in cooperation with multiple medical units; Objectives: To evaluate the efficacy of primary MDR-TB treated by multiple medical institutions. DESIGN: A retrospective cohort of patients with tuberculosis from 1992 to 1997 was enrolled in 1) isolates of Mycobacterium tuberculosis resistant to at least isoniazid and rifampin; 2) received anti-TB prior to the first collection of MDR-TB specimens Treatment ≤ 30 days. Results: A total of 856 MDR-TB cases were reported by more than 100 medical institutions and treatment units. The rate of treatment completion was 70% in HIV-negative individuals and 30% in HIV-positive individuals. In the cohort, 57.2% of patients died before treatment was completed, 26.5% completed treatment, 16% moved out, refused treatment or lost their follow-up, and 0.2% continued treatment. Among HIV-positive individuals, diagnosed later in the study or empty in the lung is an independent and relevant factor in completing the treatment. Among the 227 patients who completed the treatment, 8 (3.5%) relapsed (the recurrence rate was 1.01 / 100 person-years) and 2 were drug-susceptible strains. Conclusion Although a comprehensive program of MDR-TB control has improved the efficacy of HIV-infected and non-HIV-infected patients despite treatment management being administered by multiple medical units, the relapse rate is rare in patients who have completed the recommended regimen .