Yield of continued monthly sputum evaluation among tuberculosis patients after culture conversion.

SETTING: New York City. OBJECTIVE: To evaluate the yield of continued monthly sputum monitoring after culture conversion. DESIGN: A retrospective review of tuberculosis patients verified between 1 January 1995 and 31 December 1996 who had: 1) pulmonary tuberculosis with organisms susceptible to isoniazid and rifampin; 2) culture conversion; and 3) completed therapy. We assessed time to smear and culture conversion and number of persons who developed a positive culture after culture conversion (culture reversion). RESULTS: Of 1440 patients, 379 were cared for by tuberculosis control program providers and 1061 were cared for by other providers; 813 (56%) were initially smear-positive. After the fifth month, 44 (5.3%) were smear-positive; four of these were culture-positive. Eighteen (1.3%) had culture reversions; eight were smear-positive. Excluding one specimen per patient collected at treatment completion, 7967 sputum samples were collected after culture conversion. The minimum estimated cost per culture reversion detected was $26,557. CONCLUSION: Continued monthly monitoring of sputum after culture conversion identified a very small number of patients who had culture reversion. However, patients who cannot tolerate or adhere to a standard regimen may need continued monitoring to assess response to treatment. For all patients a specimen should be collected at the end of treatment to document cure.     

Efficacy and safety of kanamycin, ethionamide, PAS and cycloserine in multidrug-resistant pulmonary tuberculosis patients

BACKGROUND: We carried out this study to determine the efficacy and safety of a regimen containing kanamycin, ethionamide, isoniazid, para-aminosalicylic acid (PAS) and cycloserine in the treatment of multidrug-resistant tuberculosis (MDR-TB). METHODS: A prospective, uncontrolled study of 39 pulmonary tuberculosis patients, who had received adequate first-line antituberculosis treatment including supervised category II retreatment regimen, and were still sputum smear positive for acid-fast bacilli (AFB) in whom sputum culture revealed isolates of M. tuberculosis resistant to rifampicin and isoniazid with and without resistance to other antituberculosis drugs. They received kanamycin (initial 4-6 months), ethionamide, isoniazid, PAS and cycloserine for a minimum period of two years. RESULTS: Out of 39 patients, 29 (74.3%) achieved sputum conversion within six months and remained so at the end of two years. Two (5.1%) patients died, six (20.6%) patients were lost to follow up, and two (5.1%) patients remained sputum smear-positive for AFB through out the period of study. Twenty-nine patients, declared cured, were followed for an average period of 16 months (3-48 months), during which two (6.9%) patients relapsed, four (13.8%) patients were lost to follow-up and remaining 23 remained sputum smear-negative. Eight (21.1%) patients developed major side effects which required stoppage/change of drugs. CONCLUSION: In MDR-TB patients, regimen consisting of ethionamide, isoniazid, PAS and cycloserine and kanamycin appears to be effective and safe.     

Sputum smear conversion during directly observed treatment for tuberculosis

Setting: Treatment program for tuberculosis in a refugee camp in Thailand.Objectives: To determine the cumulative frequency of conversion of sputum smears examined by direct microscopy by month of treatment and to identify factors predicting failure to convert.Methods: Analysis of conversion based on three sputum smear examinations (performed monthly) in a cohort of patients with sputum smear-positive tuberculosis treated with a directly observed daily regimen containing rifampicin throughout. Nested case-control study of patients failing to convert definitively within four months compared to controls who did convert.Results: Sputum conversion after the 2-month intensive phase was 75.0%, with a range from 61.7% to 90.9% in patients with initially strongly- and weakly-positive smears, respectively. The strongest predictor identified for no definitive conversion within four months of treatment was a positive sputum smear result at the end of the 2-month intensive phase (adjusted relative odds 4.2, 95% confidence interval 1.5–11.4). Of those patients who did not convert, positive smears were an isolated phenomenon in 15, repeatedly in four who definitely converted with a prolongation of treatment, and persistently positive in two requiring a re-treatment regimen.Conclusions: Definitive sputum smear conversion is judged to be slower if a strict program of sputum smear examination is undertaken than under routine program conditions, but positive results late in the course are commonly an isolated phenomenon and possibly of little significance. Sputum smear results at two months strongly predict bacteriologic results beyond three months of treatment, and thus identify cases who might benefit from a prolongation of the intensive phase.     

Can serial qualitative polymerase chain reaction monitoring predict outcome of pulmonary tuberculosis treatment?

BACKGROUND: The aim of this study was to assess the use of qualitative one-tube nested polymerase chain reaction (PCR) for monitoring the treatment response in smear-positive pulmonary tuberculosis, and the factors determining the negative conversion of sputum smear, culture, and PCR during treatment. METHODOLOGY: A total of 53 patients receiving a standard short course of chemotherapy with 24 months follow-up period after treatment cessation were included in the study. Sputum specimens were collected serially for smear, culture, and PCR until the treatment was complete. RESULTS: The conversion rate for sputum culture, smear, and PCR at 8 weeks after treatment were 84.9, 58.5, and 47.1%, and at 16 weeks of treatment were 100, 88.7, and 79.2%, respectively. At the end of the treatment period, there were four PCR persisters, one of whom had disease relapse. Only cavitary disease had an influence over the negative conversion of the smear and PCR at 8 weeks (RR 3.5, 95% CI 1.04-11.95, P=0.04 for smear; RR 5.06, 95% CI 1.196-21.42, P=0.03 for PCR). CONCLUSION: Qualitative PCR was not useful for monitoring therapy in smear-positive pulmonary tuberculosis. Mycobacterium DNA was cleared slowly in cavitary disease. The PCR may be performed at the time of treatment cessation to identify those with potential for disease relapse.     

分子药物敏感性试验对复治涂阳肺结核患者化疗的指导及效果分析

目的 评价分子药物敏感性试验(简称“药敏试验”)对复治涂阳肺结核患者化疗的指导及效果。方法 采用前瞻性随机对照的方法,选取2016年3月至2020年1月上海市肺科医院诊治的400例复治涂阳肺结核患者作为研究对象,收集患者的痰液或支气管肺泡灌洗液行分枝杆菌培养,培养阳性且鉴定为MTB的分离株采用微孔板法进行表型药敏试验;按就诊时间顺序依随机数字表法对其中200例患者的同一份标本采用PCR-反向点杂交法进行分子药敏试验,检测异烟肼和利福平耐药相关基因。微孔板法结果回报前,PCR-反向点杂交法检测为异烟肼和(或)利福平耐药的患者予异烟肼和(或)利福平耐药化疗方案,其余患者予异烟肼、利福平敏感复治化疗方案;微孔板法结果回报后,以微孔板法结果为标准调整化疗方案。比较微孔板法确诊的利福平耐药患者中行PCR-反向点杂交法者与未行PCR-反向点杂交法者在微孔板法结果回报时的痰涂片抗酸杆菌阴转率和痰涂片阳性标本荷菌量,以及在应用耐药方案治疗3、6、9、12个月末的痰菌阴转率。结果 在微孔板法确诊的利福平耐药患者中,行PCR-反向点杂交法与未行PCR-反向点杂交法的患者在微孔板法结果回报时的痰涂片抗酸杆菌阴转率分别为18.9%(10/53)和5.9%(3/51),差异有统计学意义(χ²=4.007,P=0.045);行PCR-反向点杂交法患者痰涂片阳性标本抗酸杆菌分级计数“+、++、+++、++++”分别占48.8%(21/43)、25.6%(11/43)、16.3%(7/43)、9.3%(4/43),未行PCR-反向点杂交法患者分级计数分别占16.7%(8/48)、35.4%(17/48)、33.3%(16/48)、14.6%(7/48),差异有统计学意义(χ²=11.212,P=0.011),前者痰标本荷菌量更少。行PCR-反向点杂交法的患者治疗3、6、9、12个月末的痰菌阴转率分别为64.0%(32/50)、84.8%(39/46)、82.9%(34/41)、84.2%(32/38),高于未行PCR-反向点杂交法的患者治疗3、6、9、12个月末的痰菌阴转率[分别为58.8%(30/51)、81.0%(34/42)、81.6%(31/38)、81.6%(31/38)],差异均无统计学意义(χ²=0.285,P=0.593;χ²=0.593,P=0.218;χ²=0.025,P=0.874;χ²=0.093,P=0.761)。结论 复治涂阳肺结核患者中根据PCR-反向点杂交法制定化疗方案的利福平耐药患者能在时间上更早获得痰涂片抗酸杆菌阴转率的上升和痰涂片阳性标本荷菌量的下降。     

Bacteriological follow-up of tuberculosis treatment: a comparative study of smear microscopy and culture results at the second month of treatment.

SETTING: Significance of a positive bacillary examination of sputum at 2 months of treatment in relation to the viability of the bacilli and the final treatment result. OBJECTIVE: To compare the results of smear microscopy and sputum culture at the second month of tuberculosis treatment and to follow the progress of the patients. METHODS: Follow-up of 297 patients with smear-positive pulmonary tuberculosis in Madagascar, 152 of whom were smear-positive at 2 months of treatment and 145 smear-negative. The number of bacilli was recorded, as were the culture results and the final outcome of treatment. RESULTS: Among the 152 patients who were smear-positive at the second month, 77 (51%) were culture-negative; there were 12 (8%) treatment failures and four relapses (4.6%). Among the 145 smear-negative patients, 22 (15%) were culture-positive, of which one was a treatment failure (1%). CONCLUSION: The majority of failures and relapses were observed in the group of smear-positive patients. It is important to reinforce the surveillance of these patients in order to reduce the number lost to follow-up. Furthermore, a positive smear microscopy at the end of the second month is not sufficiently specific for early identification of treatment failures. It is preferable to wait until the fifth month, as the great majority of patients who are positive at 2 months achieve cure. The treatment strategy currently recommended in Madagascar is satisfactory.     

Evaluation of a unified treatment regimen for all new cases of tuberculosis using guardian-based supervision.

SETTING: Ntcheu District, Malawi, using an oral antituberculosis treatment regimen. OBJECTIVE: To determine whether directly observed treatment (DOT) during the initial phase of treatment supervised either in hospital, at health centres or by guardians in the community, was associated with 1) satisfactory 2-month and 8-month treatment outcomes, and 2) with a reduction of in-patient hospital-bed days. DESIGN: Prospective data collection of all tuberculosis (TB) patients registered between 1 April 1996 and 30 June 1997, with 2-month and 8-month treatment outcomes, sputum smear conversion in smear-positive pulmonary TB patients (PTB) and in-patient hospital-bed days. RESULTS: Among the 600 new patients, 302 had smear-positive PTB, 150 smear-negative PTB and 148 extrapulmonary TB (EPTB). Eight-month treatment completion was 65% for smear-positive PTB patients, which was significantly higher than in patients with smear-negative PTB (45%) and EPTB (54%), due mainly to high 8-month mortality rates. The site of the intensive phase was determined in 596 patients: 178 (30%) received DOT from guardians, 115 (19%) from a health centre and 303 (51%) in hospital. At 2 months, mortality rates were significantly higher in hospitalised patients. Two-month treatment outcomes (including sputum smear conversion rates in smear-positive PTB patients) were similar between patients receiving DOT at health centres or from guardians. Decentralised DOT resulted in a 25% reduction in hospital-bed days in patients alive at 2 months compared with that predicted using the old regimens. CONCLUSION: Decentralising DOT to health centres and to guardians during the intensive phase is associated with satisfactory treatment outcomes.     

Treatment outcome among Rwandan and Burundian refugees with sputum smear-positive tuberculosis in Ngara, Tanzania.

SETTING: Tuberculosis programme in six camps (Benaco, Musuhura, Lumasi, Lukole, Keza and Kitali) for Rwandan and Burundian refugees in Ngara district, Tanzania, where treatment was directly observed throughout. OBJECTIVES: To evaluate the treatment outcome of sputum smear-positive tuberculosis cases recruited in refugee camps in Ngara, and to determine the cumulative frequency of conversion of sputum smears by direct microscopy. DESIGN: Retrospective review of tuberculosis registers from January 1995 to December 1999. RESULTS: Of 546 patients with smear-positive tuberculosis who were notified in the programme, 363 (66.5%) had completed treatment and were bacteriologically cured after 7 months, 10.9% had died, 7.1% had defaulted and 14.5% had transferred out. Sputum conversion after the 2-month intensive phase was 88%, and increased to 99% after 7 months of chemotherapy. CONCLUSION: The involvement of the Tanzania NTLP in collaboration with health NGOs has led to a satisfactory outcome. These data suggest that it is possible for tuberculosis control programmes to perform successfully in refugee settings.     

复治涂阳肺结核患者化疗后2个月末痰涂片阴转与未阴转情况分析

目的 分析2011-2012年复治涂阳肺结核患者强化期2个月末痰涂片检查的阴转情况,探讨当前影响复治涂阳肺结核阴转的相关因素及对转归的影响。 方法 对广州市胸科医院第二门诊辖区内登记的复治涂阳肺结核患者131例化疗后2个月末的痰进行2次抗酸染色和镜检,痰培养阳性的标本采用绝对浓度间接法进行耐药性测定。同时分析可能对痰阴转产生影响的各种因素。 结果 131例患者中化疗后2个月末未查痰涂片者13例,查后发现阴转者91例,未阴转者27例;后者3个月末阴转者15例,4个月末阴转者6例,5个月末阴转者6例。通过研究5个大变量因素,发现造成复治涂阳肺结核患者2个月末痰未能阴转的主要原因在于是否多耐药［阴转患者5.3％（3/57）,未阴转患者10.0％（2/20）;χ²＝4.457,P<0.05］或者耐多药［阴转患者28.1％(16/57),未阴转患者70.0％（14/20）;χ²＝5.456,P<0.05］、是否合并糖尿病［阴转患者12.1％（11/91）,未阴转患者25.9％（7/27）;χ²=3.973,P<0.05］。 结论 耐药或合并糖尿病是影响复治涂阳肺结核患者2个月末痰涂片阴转的关键因素。     

耐多药肺结核对异烟肼和利福平复敏的治疗疗效分析

目的探讨复敏后的耐多药肺结核INH、RFP联合治疗的疗效。方法 50例经痰结核菌培养确定的耐多药肺结核对INH、RFP均复敏的患者随机分为两组,治疗组采用3HRZAKPT/18HRPT化疗方案治疗;对照组采用3VZPTAKCTM/18VPTCTM化疗方案治疗。比较治疗3个月、6个月、12个月、18个月、21个月的痰菌阴转率（涂片与培养）,X线胸片变化及药物不良反应。结果治疗组疗程满3个月痰菌涂片与培养阴转率（32%,28%）分别与对照组（16%,12%）无明显差异（P〉0.05）;两组满疗程痰菌涂片阴转率（48%,40%）、培养阴转率（44%,40%）,X线病灶吸收率（68%,64%）和空洞闭合率（24%,28%）均无明显差异（P〉0.05）;两组均无严重不良反应。结论 INH、RFP对复敏后的耐多药肺结核,近期临床疗效不比对照组第三线化疗方案[1]的疗效差,而且治疗费用低,值得临床推广。     

When are follow-up sputum smears actually examined in patients treated for new smear-positive pulmonary tuberculosis?

SETTING: All 44 non-private hospitals (four central, 22 district and 18 mission) in Malawi that registered and treated tuberculosis (TB) cases, October-December 2001. OBJECTIVES: To determine, in new smear-positive pulmonary tuberculosis (PTB) patients, for the 2-, 5- and 7-month smear examinations, 1) the proportion with smears examined and 2) the actual timing of smear examination. STUDY DESIGN: Retrospective data collection using TB registers, TB treatment cards and laboratory sputum registers. Timing of smear examinations was judged acceptable if 2-month smears were examined at 2 or 3 months, 5-month smears at 4, 5 or 6 months and 7-month smears at 6, 7, 8 or 9 months. RESULTS: Of 1994 patients, for those alive and on treatment, 78% had smears definitely examined at 2 months, 75% at 5 months and 74% at 7 months. Of these, 82% had smears examined at an acceptable time for the 2-month smear, 71% for the 5-month smear and 78% for the 7-month smear. Smears were examined after the 8-month treatment regimen for the 2- and 5-month smear in respectively 2% and 9% of patients. Smears were done more frequently in female than male patients, and in district/mission hospitals than central hospitals. Smears were done at acceptable times more frequently in younger than older patients and in mission/central hospitals than district hospitals. CONCLUSION: During supervision, the actual time of follow-up sputum smear examinations needs to be monitored more closely.     

Is TB contact screening relevant in a developing country setting? Experiences from eastern Nepal, 1996-1998.

SETTING: A tuberculosis programme run by a non-governmental organisation in eight hill and mountain districts of eastern Nepal. OBJECTIVE: To assess the impact of contact screening on case-finding. DESIGN: A retrospective cohort study of contacts of smear-positive, smear-negative and extra-pulmonary tuberculosis patients diagnosed and registered during 1996-1998 ('index cases'). Contacts, defined as household members identified by index cases, were screened by sputum examination; two positive smears were taken to indicate smear-positive pulmonary disease. RESULTS: Approximately 50% (668) of registered cases identified contacts; 75% (2298) of the contacts identified provided one or more sputum specimens. An overall smear-positive case yield of 0.61% (14) was obtained from contacts tested, all except one of which were contacts of smear-positive index cases. For smear-positive index cases with a smear grading of > or = 2+, the yield was 7.2 times greater (P = 0.04) than for those with a grading of 1+. CONCLUSION: In this setting, sputum examination of household contacts of smear-negative and extrapulmonary tuberculosis cases is not justified. Further assessment is needed to evaluate the utility of testing contacts of smear-positive cases without symptom screening, and whether cost effectiveness can be improved by restricting testing to contacts of cases with high bacterial (> or = 2+) loads.     

330例菌阳初治肺结核支气管镜检查结果分析

目的 探讨痰菌阳性初治肺结核患者行支气管镜检查的必要性.方法 分析我院2007年1月～ 2010年12月住院的330例行支气管镜检查的痰菌阳性初治肺结核患者的临床资料.结果 在菌阳初治肺结核患者中,支气管结核的发生率明显高于文献报道的肺结核患者.结论 重视痰菌阳性初治肺结核患者的支气管镜检查,可减少EBTB的误诊与漏诊.     

Number of concentrated sputum smears needed to adequately assess infectivity of patients with pulmonary tuberculosis

PURPOSE: Investigating the usefulness of 3rd concentrated sputum smear for assessments of infectivity of pulmonary tuberculosis patients. OBJECT AND METHOD: Retrospective study of the results of diagnostic 3 consecutive concentrated-sputum-smear (fluorochrome stain) of culture-proven pulmonary tuberculosis cases at our hospital from Jan. 2002 to Sep. 2003. RESULT: Altogether 362 cases were available for analysis, and 306 (84.0%) cases were smear-positive on 3 consecutive sputum tests. Of these cases, 26 cases (8.6% of smear-positive cases) were firstly smear-positive by the 3rd sputum. Of 278 cases that were already smear-positive at first and/or second sputum smear, 40 cases (13.2% of smear-positive cases) showed the highest smear-positive grade at 3rd sputum-smear, but only 6 cases (2.0% of smear-positive cases) had smear-positive grade higher by two-grade (+/- to more than 2+, or 1+ to 3+). CONCLUSION: From the results of this study together with literature review, sensitivity of 2 concentrated sputum-smear tests by fluorochrome stain is presumed to be same as, or better than that of 3 direct sputum-smear tests by Ziehl-Neelsen stain. We have to re-consider the number of concentrated sputum smear tests needed to assess the infectivity of pulmonary tuberculosis.     

2016—2018年喀什地区初治涂阳肺结核患者治疗效果及其影响因素分析

目的 探索喀什地区初治涂阳肺结核患者治疗效果及其影响因素,以提高治疗成功率并为制定适宜的干预措施提供参考。方法 采用分层整群抽样法,抽取喀什地区12个县(市)结核病定点医疗机构在2016—2018年期间登记治疗且已完成规定抗结核疗程的4970例初治涂阳肺结核患者中的240例作为研究对象,231例患者完成问卷调查、现场访谈及个案调查分析。收集患者的一般人口学资料、服药管理、治疗转归和不良反应等信息,采用单因素和多因素logistic回归模型分析纳入患者的治疗效果及其影响因素。结果 231例完成调查的研究对象中,治疗成功率为77.49%(179/231)。多因素logistic回归分析结果显示:患者体质量指数(BMI)18.50~24.00(OR=0.036,95%CI:0.002~0.700)、2个月末痰涂片阴性(OR=0.054,95%CI:0.003~0.930)、5个月末痰涂片阴性(OR=0.003,95%CI:0.000~0.057)、按剂量服药(OR=0.013,95%CI:0.001~0.107)、规律服药(OR=0.077,95%CI:0.022~0.268)、知晓肺结核的主要传播途径(OR=0.076,95%CI:0.008~0.768)和知晓治疗多久后可以停药(OR=0.254,95%CI:0.074~0.875)是影响初治涂阳肺结核患者治疗效果的保护因素。结论 喀什地区初治涂阳肺结核患者治疗成功率较低,与患者营养状况、随访痰检结果、按剂量规律服药及患者自身防治意识等因素有关。应进一步加强喀什地区初治涂阳肺结核患者的治疗管理、营养支持和健康宣教工作,以提高初治涂阳肺结核患者的治疗成功率。     

Randomized controlled trial of zinc and vitamin A as co-adjuvants for the treatment of pulmonary tuberculosis

Objective To assess the efficacy of weekly zinc or zinc plus retinol as adjuncts for the treatment of pulmonary tuberculosis. Methods Double‐blind, randomized, placebo‐controlled trial in 350 patients >15 years old with smear‐positive tuberculosis in Nigeria (ISRCTN36636609). In addition to antituberculous treatment, patients were randomly allocated to weekly supplements of zinc (90 mg), zinc plus retinol (5000 IU) or placebos for 6 months. Primary outcomes were time to sputum smear conversion and resolution of radiographic abnormalities. Results After 8 weeks of treatment, 68% had achieved sputum smear conversion, and the median conversion time was 6.5 weeks. Hazard ratios (HR, 95%CI) for sputum conversion relative to the placebo group were not significant for zinc (1.07, 0.92–1.29) or zinc plus retinol (0.89, 0.76–1.07). Significant predictors of time to sputum conversion were lung abnormality score, sputum smear grade, age and serum C‐reactive protein. HIV co‐infection and gender were not independent predictors of time to sputum conversion. There were no significant differences between supplement groups in clinical, radiological or laboratory outcomes at 2 months or 6 months. There were 9, 9 and 2 deaths in patients receiving zinc, zinc plus retinol or placebos, respectively. Mortality in those who received zinc (HR 1.71, 0.88–3.58) or zinc plus retinol (HR 1.54, 0.78–3.26) did not differ significantly from those who received placebos. Most deaths occurred in patients co‐infected with HIV. Conclusions Supplementation with zinc or zinc plus retinol did not lead to better outcomes than placebos, and caution is warranted regarding routine micronutrient supplementation, particularly in patients co‐infected with HIV.     

Implementation of the DOTS strategy for tuberculosis in the Leningrad Region, Russian Federation (1998-1999).

SETTING: The DOTS pilot project for tuberculosis control in the Leningrad Region of the Russian Federation, supported by the Finnish Lung Health Association and the World Health Organization (WHO). OBJECTIVE: To assess the efficacy of WHO-recommended standard short-course chemotherapy in newly detected pulmonary tuberculosis cases positive by smear or with extensive lung lesions suggestive of culture positivity, under project conditions. METHODS: Analysis of data on case detection, sputum smear conversion and treatment outcome based on standardised (WHO) registers from districts and a central computerised database. RESULTS: Of 859 adult pulmonary tuberculosis cases (292 smear-positive) notified in the Leningrad Region in the study period, 312 new cases were included in the project. The sputum conversion rate at the end of the second month was 82.8% and 91.1% at the end of the third month. Of bacteriologically confirmed cases, 71.3% were successfully treated, 4.9% died, 11.7% defaulted and 8.1% failed. CONCLUSION: In the first year of the pilot project in the Leningrad Region, the DOTS strategy revealed feasibility and moderate efficacy among new pulmonary tuberculosis cases who were either smear-positive or showed extensive lung lesions on chest X-ray, and who were therefore of high epidemiological and medical priority.     

徐州市两县和乌鲁木齐市涂阳肺结核患者疗效及其影响因素分析

目的 了解江苏省徐州市两县(丰县、沛县)和新疆乌鲁木齐市涂阳肺结核患者诊治过程中是否完成全程痰涂片检查和治疗转归,分析人口学、社会学和疾病临床进展对患者治疗结局的影响。方法 采用前瞻性队列研究方法,对徐州市丰县、沛县和乌鲁木齐市2014—2016年确诊的涂阳肺结核患者进行随访,收集患者治疗过程信息和治疗结局。应用SPSS 22.0软件进行统计分析,计数资料用构成比进行描述,组间比较采用卡方检验或Fisher精确概率检验,多因素分析采用两分类logistic回归,以P值小于0.05为差异有统计学意义。研究共有574例涂阳肺结核患者纳入分析,平均年龄(46±20.8)岁,男性420例(73.2%),其中徐州市两县患者265例(46.2%),乌鲁木齐市患者309例(53.8%)。结果 574例涂阳肺结核患者的治疗成功率为88.2%(506/574),包括391例治愈和115例完成治疗。徐州市丰县、沛县涂阳肺结核患者的治疗成功率明显高于乌鲁木齐市(徐州丰县、沛县:92.8%,246/265,乌鲁木齐:84.1%,260/309,χ ²=10.310,P=0.001)。治疗随访期间,有48例(8.4%,48/574)涂阳肺结核患者未完成全程痰涂片检查。单因素分析结果显示,男性(χ ²=4.342,P=0.037)、外地户籍(χ ²=5.646,P=0.017)及治疗第2个月末痰涂片未阴转(Fisher精确概率检验:P=0.000)的涂阳患者中,发生不良治疗结局的比率明显高于女性、本地户籍及治疗第2个月末痰涂片阴转患者。多因素分析结果显示,男性和治疗第2个月末痰涂片未阴转(OR=6.892,95%CI=3.218~14.762,P=0.000)的涂阳肺结核患者治疗不成功的风险明显高于女性(OR=0.329,95%CI=0.121~0.898,P=0.030)和治疗第2个月末痰涂片阴转患者。 结论 徐州市丰县、沛县涂阳肺结核患者的治疗成功率高于乌鲁木齐市;男性和治疗第2个月末痰涂片未阴转将增加不良结局发生风险。     

Supervised intermittent chemotherapy for pulmonary tuberculosis in a rural area of China

In order to ensure regularity of ambulatory treatment of new cases of pulmonary tuberculosis, a fully supervised intermittent chemotherapy regimen was tried in two rural counties of Beijing. The bare-foot doctors of the village health co-operatives were designated to administer and supervise treatment. The regimen consisted of isoniazid and streptomycin daily for 1 month, then every 3 days for 5 months and then every 5 days for a total of 12 or 18 months. For smear-negative cases the daily phase was omitted. The compliance rate among 229 patients in 1 year was 99.4%. The sputum conversion rate among 104 cases harbouring sensitive bacilli was 95.2%. Discontinuation of the regimen due to side-effects as necessary in 3 cases (1.3%). Since 1979, this treatment programme has been adopted in the whole rural area of Beijing, and the coverage rate among newly diagnosed smear-positive cases in 1983 reached 90%. A reserve regimen consisting of rifampicin and ethambutol for patients who do not convert their sputum after 6 months of treatment with isoniazid and streptomycin was added. The overall conversion rate achieved in 1981 was 97.8%. The average overall cost of drugs for each patient treated in this treatment programme was 49 yuan (RMB), about $24.00 U.S.     

聚合酶链反应对菌阳肺结核治疗的监测

目的探讨痰菌阳性肺结核患者在治疗期及停药２年内痰结核分支杆菌及其ＤＮＡ阴转情况与复发的关系以及聚合酶链反应（ＰＣＲ）对菌阳肺结核患者治疗的监测价值。方法用ＰＣＲ技术、涂片及培养法对８７例菌阳肺结核于治疗期每月检测１次，停药期继续随访２年。结果痰结核分支杆菌ＰＣＲ转阴时间通常比涂片和培养迟１～３个月，痰含菌量越多，ＰＣＲ持续阳性时间越长。８７例中１０例（１１％）ＰＣＲ持续阳性１年以上，其中３例（３０％）分别于停药后８、１２、１６个月时复发，１例ＰＣＲ已转阴病例于１８个月时复发。此４例均有痰菌复阳，胸片示病灶增多而再次接受治疗。结论ＰＣＲ用于临床疗效观察比涂片、培养实用，对估计有可能复发的病例有一定帮助。