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背景耐多药结核病(MDR-RB)的治疗往往漫长、具有毒性、昂贵且临床效果不佳。研究者通过单个病例Meta分析评价不同类型、数量、疗程的药物对治疗耐多药结核病结局的影响。方法与结果研究者共纳入基于3项已发表系统综述中的32项观察性研究共计9 153例耐多药结核患者,通过联系原作者获取每1例患者的治疗与结局信息,进行了一项单个病例资料的Meta分析。结果显示,相对于失败与复发,治疗成功常常与以下这些药物的使用相关:新一代喹诺酮类药物(调整比值比[aOR]:2.5[95%CI 1.1～6.0])氧氟沙星(aOR:2.5[95%CI 1.6～3.9]),乙硫异烟胺或丙硫异烟胺(aOR:1.7[95%CI 1.3～2.3]),在最初强化期使用四种或更多的可能有效的药物(aOR:2.3[95%CI 1.3～3.9]),在持续期使用3种或更多的可能有效的药物(aOR:2.7[95%CI 1.7～4.1])。与治疗失败与复发或死亡相比时,结果相似,治疗成功与下列药物的使用因素相关:新一代喹诺酮类药物(aOR:2.7[95%CI 1.7～4.3),氧氟沙星(aOR:2.3[1.3～3.8]),乙硫异烟胺或丙硫异烟胺(aOR:1.7[95%CI 1.4～2.1]),在最初强化期使用4种以上可能有效的药物(aOR:2.7[95%CI1.9～3.9]),以及在持续期使用3种以上可能有效的药物(aOR:4.5[95%CI 3.4～6.0])。结论该研究显示耐多药结核病治疗的成功与患者生存情况与某些特定的氟喹诺酮类药物、乙硫异烟胺以及丙硫异烟胺的使用有关,然而还亟待随机对照临床试验对耐多药结核病的治疗进行验证。
Background Multidrug-resistant tuberculosis (MDR-RB) is often long, toxic, expensive and clinically ineffective. The researchers evaluated the impact of different types, numbers, and duration of medications on MDR-TB outcomes through a single case meta-analysis. METHODS AND RESULTS Investigators enrolled a total of 9,153 MDR-TB patients based on 32 observational studies of three published systematic reviews, obtained information on the treatment and outcome of each patient by contacting the original author, Meta-analysis of individual case data. The results show that treatment success is often associated with the use of these drugs relative to failure and relapse: a new generation of quinolones (OR: 2.5 [95% CI 1.1-6.0]) ofloxacin (aOR: 2.5 [95% CI 1.6-3.9], ethionamide or prothiamine (aOR: 1.7 [95% CI 1.3-2.3]) using four or more potentially effective Drugs (aOR: 2.3 [95% CI 1.3-3.9]) with 3 or more potentially effective drugs (aOR: 2.7 [95% CI 1.7-4.1]) for the duration of the study. Results similar to treatment failure and relapse or death were associated with the use of newer quinolones (aOR: 2.7 [95% CI 1.7-4.3), ofloxacin (aOR: 2.3 (AOR: 1.7 [95% CI 1.4-2.1]) in the initial intensive phase using more than four potentially effective drugs (aOR: 2.7 [95 % CI 1.9 ~ 3.9]), and more than three types of drugs that may be effective during the duration (aOR: 4.5 [95% CI 3.4-6.0]). Conclusions The study shows that the success of MDR-TB treatment and patient survival are related to the use of certain specific fluoroquinolones, ethionamide and prothionamide, but there is an urgent need for randomized controlled clinical trials of resistance Drug TB treatment to verify.