结核性脑膜炎患者死亡与初始异烟肼耐药的相关性

目的研究结核性脑膜炎患者死亡与初始异烟肼耐药是否相关。方法回顾性队列研究方法,分析1995年1月至2005年1月京山县人民医院的结核性脑膜炎患者死亡的所有因素,评估死亡与初始异烟肼耐药是否相关。结果 121例患者临床诊断为结核性脑膜炎(结核杆菌培养阳性),其中8例(7%)患者初始药敏显示为异烟肼耐药。在全部患者中,初始异烟肼耐药与死亡之间未经校正的相关性无统计学意义(OR=5.06,95%CI为1.14~22.53)。其中,94例脑脊液结核杆菌培养阳性,初始异烟肼耐药与死亡具显著相关性(未校正OR=12.6,95%CI为1.40~113.31)。校正年龄、性别、HIV感染因素后,二者相关性进一步增高(OR=13.18,95%CI为1.46~119.25)。结论脑脊液结核杆菌培养阳性的结核性脑膜炎患者死亡与初始异烟肼耐药相关;脑脊液结核杆菌培养阳性的结核性脑膜炎患者的常规化疗方案存在高风险和低疗效。

Correlation between initial isoniazid resistance and death in patients with tuberculous meningitis

Objective To determine whether initial isoniazid resistance is associated with death during the treatment of tuberculous meningitis.Methods The retrospective cohort study was adopted.To perform the tuberculosis survey in the Jingshan County People′s Hospital.All the participating patients were clinically diagnosed as tuberculous meningitis and reported between January 1995 and January 2005.To evaluate all death causes during antituberculous treatment.Results 121 patients had the clinical diagnosis of tuberculous meningitis（positive cultures for tubercle bacillus）.Among them,8（7%） cases showed isoniazid resistance in initial susceptibility testing.The uncorrected relativity between initial isoniazid resistance and subsequent death among these 121 patients had no statistical significance（uncorrected odds ratio 5.06,95% confidence interval 1.14 to 22.53）.However,among 94 patients with positive cerebrospinal fluid cultures,a significant uncorrected relativity was found between initial isoniazid resistance and subsequent death（uncorrected odds ratio 12.6,CI 1.40 to 113.31）.This relativity was increased after correction for age,sex and HIV infectious factors（odds ratio 13.18,CI 1.46 to 119.25）.Conclusion Isoniazid resistance on initial susceptibility testing is correlated with subsequent death among cases of tuberculous meningitis with positive cerebrospinal fluid cultures;the current conventional treatment regimens are at high risk of both initial isoniazid resistance and poor clinical outcomes for treating patients with tuberculous meningitis.