耐多药结核病患者生存状况及死亡影响因素研究进展
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摘要
近年来,耐药结核病的全球传播给世界各国带来了巨大挑战,尤其是耐多药结核与广泛耐药结核因治疗周期长、费用高以及药物的副作用而导致中断治疗或者规范治疗后失访较多,为患者的跟踪带来一定困难。开展耐多药结核(MDR-TB)患者生存状况与死亡的危险因素研究,可为中国有效控制耐多药结核病可干预的死亡危险因素,提高耐多药结核患者的生存时间提供依据。研究表明广泛耐药结核患者生存时间为1.54～6.00年,发展中国家的患者生存时间短于发达国家;耐多药结核患者生存时间略长,为3.78～9.70年。耐多药结核患者死亡的主要危险因素包括治疗延迟、感染艾滋病病毒、年龄、行为生活方式、并发症、营养状况、耐药类型等。在耐多药结核防控工作中应有针对性地开展相关研究,采取积极的应对措施,提高患者生存时间。
Recent wide spread of drug-resistant tuberculosis is a big challenge to the world. The patients with multidrugresistant tuberculosis/extensively drug-resistant tuberculosis(MDR-TB/XDR-TB) discontinue the treatment frequently due to long-term duration, expensive cost and side effect of the treatment, which results in increased loss to follow-up. Studies on MDR-TB survival and hazard factors of MDR-TB are aimed to control risk factors and to contribute evidences of effective strategy for improving survival among MDR-TB patients. Studies have estimated a median survival of 1.54 – 6.0 years for XDR-TB patients and the survival of the patients in developing countries was lower than those in developed countries; the median survival is 3.78 – 9.70 years for MDR-TB patients, which is slightly higher than that of XDR-TB patients. Delayed treatment, human immunodeficiency virus(HIV) infection, age, lifestyle and behavior, complications, nutritional status, and type of resistance are strongly associated with mortality among drug-resistant tuberculosis patients. Studies on prevention and control of MDR-TB in the future need to be promoted for developing effective interventions on the survival of the patients.
Recent wide spread of drug-resistant tuberculosis is a big challenge to the world. The patients with multidrugresistant tuberculosis/extensively drug-resistant tuberculosis(MDR-TB/XDR-TB) discontinue the treatment frequently due to long-term duration, expensive cost and side effect of the treatment, which results in increased loss to follow-up. Studies on MDR-TB survival and hazard factors of MDR-TB are aimed to control risk factors and to contribute evidences of effective strategy for improving survival among MDR-TB patients. Studies have estimated a median survival of 1.54 – 6.0 years for XDR-TB patients and the survival of the patients in developing countries was lower than those in developed countries; the median survival is 3.78 – 9.70 years for MDR-TB patients, which is slightly higher than that of XDR-TB patients. Delayed treatment, human immunodeficiency virus(HIV) infection, age, lifestyle and behavior, complications, nutritional status, and type of resistance are strongly associated with mortality among drug-resistant tuberculosis patients. Studies on prevention and control of MDR-TB in the future need to be promoted for developing effective interventions on the survival of the patients.
引文
[1]World Health Organization.Global tuberculosis control 2011[R].Geneva:World Health Organization,2011.
[2]Drobniewski F,Eltringham I,Graham C,et al.A national study of clinical and laboratory factors affecting the survival of patients with multiple drug resistant tuberculosis in the UK[J].Thorax,2002,57(9):810-816.
[3]World Health Organization.Global tuberculosis report 2015.WHO/HTM/TB2015.12[S].Geneva:World Health Organization,2015
[4]Orenstein EW,Basu S,Shah NS,et al.Treatment outcomes among patients with multidrug-resistant tuberculosis:systematic review and meta-analysis[J].Lancet Infectious Diseases,2010,10(4):153-161.
[5]Blower SM,Gerberding JL.Understanding,predicting and controlling the emergence of drug-resistant tuberculosis:a theoretical framework[J].Mol Med,1998,76(9):624-636.
[6]Bloss E,Kuksa L,Holtz TH,et al.Adverse events related to multidrug-resistant tuberculosis treatment,Latvia,2000-2004[J].Int J Tuberc Lung Dis,2010,14(3):275-281.
[7]Nathanson E,Gupta R,Huamani P,et al.Adverse events in the treatment of multidrug-resistant tuberculosis:results from the dotsplus initiative[J].Int J Tuberc Lung Dis,2004,8(11):1382-1384.
[8]Inge LD,Wilson JW.Update on the treatment of tuberculosis[J].Am Fam Physician,2008,78(4):457-465.
[9]潘莉,初乃慧.宁夏耐多药结核病患者和非耐多药患者生存情况的比较分析[J].医学信息,2017,30(2):54-56.
[10]孙燕妮,王国杰,甄新安,等.河南省耐多药与非耐多药肺结核病患者9年生存比较分析[J].中华流行病学杂志,2013,34(2):133-136.
[11]宋其生,任彦微,蔡春葵,等.耐多药肺结核标准化治疗效果评价及生存分析[J].医学与哲学(B),2016,37(06):50-52.
[12]Balabanova Y,Ignatyeva O,Fiebig L,et al.Survival of patients with multidrug-resistant TB in Eastern Europe:what makes a difference?[J].Thorax,2016,71(9):854-861.
[13]Balabanova Y,Radiulyte B,Davidaviciene E,et al.Survival of drug resistant tuberculosis patients in Lithuania:retrospective national cohort study[J].BMJ Open,2011,1(2):e000351.
[14]Zemedu TG,Bayray A,Weldearegay B.Survival and perdictors of mortality among patients under multidrug resistant tuberulosi treatment in Ethiopia[J].Int J Pharm Sci Res,2013,4(2):776-787.
[15]Shenoi SV,Brooks RP,Barbour R,et al.Survival from XDR-TB is associated with modifiable clinical characteristics in rural South Africa[J].PLoS One,2012,7(3):e31786.
[16]Kim DH,Kim HJ,Park SK.Treatment outcomes and survival based on drug resistance patterns in multidrug-resistant tuberculosis[J].Am J Respir Crit Care Med,2010,182(1):113-119.
[17]薛浩.江苏省部分地区耐多药肺结核患者生存状态的影响因素分析[C].苏州:第三届耐药结核病防控与诊治新进展研讨会,2016:6.
[18]周昀,沈宇清.人类免疫缺陷病毒(HIV)与结核杆菌(TB)双重感染致病机制的研究进展[J].病毒学报,2013,29(4):452-456.
[19]朱莉贞.耐药结核病的治疗[J].中华结核和呼吸杂志,2000,23(2):77-78.
[20]Johnston JC,Shahidi N,Sadatsafavi M,et al.Treatment outcomes of multidrug-resistant tuberculosis:a systematic review and metaanalysis[J].PLoS One,2009,4(9):e6914.
[2]Drobniewski F,Eltringham I,Graham C,et al.A national study of clinical and laboratory factors affecting the survival of patients with multiple drug resistant tuberculosis in the UK[J].Thorax,2002,57(9):810-816.
[3]World Health Organization.Global tuberculosis report 2015.WHO/HTM/TB2015.12[S].Geneva:World Health Organization,2015
[4]Orenstein EW,Basu S,Shah NS,et al.Treatment outcomes among patients with multidrug-resistant tuberculosis:systematic review and meta-analysis[J].Lancet Infectious Diseases,2010,10(4):153-161.
[5]Blower SM,Gerberding JL.Understanding,predicting and controlling the emergence of drug-resistant tuberculosis:a theoretical framework[J].Mol Med,1998,76(9):624-636.
[6]Bloss E,Kuksa L,Holtz TH,et al.Adverse events related to multidrug-resistant tuberculosis treatment,Latvia,2000-2004[J].Int J Tuberc Lung Dis,2010,14(3):275-281.
[7]Nathanson E,Gupta R,Huamani P,et al.Adverse events in the treatment of multidrug-resistant tuberculosis:results from the dotsplus initiative[J].Int J Tuberc Lung Dis,2004,8(11):1382-1384.
[8]Inge LD,Wilson JW.Update on the treatment of tuberculosis[J].Am Fam Physician,2008,78(4):457-465.
[9]潘莉,初乃慧.宁夏耐多药结核病患者和非耐多药患者生存情况的比较分析[J].医学信息,2017,30(2):54-56.
[10]孙燕妮,王国杰,甄新安,等.河南省耐多药与非耐多药肺结核病患者9年生存比较分析[J].中华流行病学杂志,2013,34(2):133-136.
[11]宋其生,任彦微,蔡春葵,等.耐多药肺结核标准化治疗效果评价及生存分析[J].医学与哲学(B),2016,37(06):50-52.
[12]Balabanova Y,Ignatyeva O,Fiebig L,et al.Survival of patients with multidrug-resistant TB in Eastern Europe:what makes a difference?[J].Thorax,2016,71(9):854-861.
[13]Balabanova Y,Radiulyte B,Davidaviciene E,et al.Survival of drug resistant tuberculosis patients in Lithuania:retrospective national cohort study[J].BMJ Open,2011,1(2):e000351.
[14]Zemedu TG,Bayray A,Weldearegay B.Survival and perdictors of mortality among patients under multidrug resistant tuberulosi treatment in Ethiopia[J].Int J Pharm Sci Res,2013,4(2):776-787.
[15]Shenoi SV,Brooks RP,Barbour R,et al.Survival from XDR-TB is associated with modifiable clinical characteristics in rural South Africa[J].PLoS One,2012,7(3):e31786.
[16]Kim DH,Kim HJ,Park SK.Treatment outcomes and survival based on drug resistance patterns in multidrug-resistant tuberculosis[J].Am J Respir Crit Care Med,2010,182(1):113-119.
[17]薛浩.江苏省部分地区耐多药肺结核患者生存状态的影响因素分析[C].苏州:第三届耐药结核病防控与诊治新进展研讨会,2016:6.
[18]周昀,沈宇清.人类免疫缺陷病毒(HIV)与结核杆菌(TB)双重感染致病机制的研究进展[J].病毒学报,2013,29(4):452-456.
[19]朱莉贞.耐药结核病的治疗[J].中华结核和呼吸杂志,2000,23(2):77-78.
[20]Johnston JC,Shahidi N,Sadatsafavi M,et al.Treatment outcomes of multidrug-resistant tuberculosis:a systematic review and metaanalysis[J].PLoS One,2009,4(9):e6914.