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背景:耐多药结核病(MDR-TB)是国家卫生系统一项艰巨的负担。这个问题仍然没有达成共识,在治疗规范、治疗效果和各种治疗方案上都有争议。方法:本研究报告介绍了伊朗第二次全国耐多药结核病人治疗的队列研究情况。这项研究包括2002—2006年间伊朗所有在我们中心记录的耐多药结核病例。所有患者都接受了由氧氟沙星,环丝氨酸,丙硫异烟胺和丁胺卡那霉素组成的标准的二线药化疗方案。根据药敏试验的结果,化疗方案中添加了乙胺丁醇和吡嗪酰胺。结果:43例确诊的耐多药结核病人接受了治疗,其平均年龄为44.38±19.05岁,其中27例(62.8%)是男性。23例(53.5%)为伊朗人,其余的都是阿富汗人。所有病人都是获得性耐多药结核病例。43例病人中,25例(58.1%)发生了严重的临床不良反应;29例(67.5%)治疗成功, 14例(32.5%)疗效较差(6例[14%]治疗失败和8例[18.6%]死亡)。在伊朗患者和因药物不良反应而改变早期治疗方案的患者中死亡率较高, P值分别为0.039和0.01。结论:与以往的研究相比,我们采用标准化疗方案治疗耐多药结核病,获得了更好的疗效。
Background: Multidrug-resistant tuberculosis (MDR-TB) is a daunting burden on national health systems. There is still no consensus on this issue, which is controversial in the treatment norms, treatment effects and various treatment options. Methods: This study presents the cohort study of the second national MDR-TB treatment in Iran. This study includes all MDR-TB cases recorded in our center in Iran from 2002-2006. All patients received standard second-line chemotherapy consisting of ofloxacin, cycloserine, prothionamide and amikacin. According to the results of susceptibility testing, ethambutol and pyrazinamide were added to the chemotherapy regimen. RESULTS: Forty-three confirmed MDR-TB patients were treated, with an average age of 44.38 ± 19.05 years, of whom 27 (62.8%) were men. 23 (53.5%) were Iranians and the rest were Afghans. All patients are acquired MDR-TB cases. Of the 43 patients, 25 (58.1%) developed serious clinical adverse reactions; 29 (67.5%) were successfully treated and 14 (32.5%) were less effective (6 [14%] failed) and 8 18.6%] death). Mortality was higher in patients in Iran and in patients who changed their early treatment regimens due to adverse drug reactions, with P values of 0.039 and 0.01, respectively. CONCLUSIONS: Compared with previous studies, we used standard chemotherapy to treat multidrug-resistant tuberculosis and achieved better efficacy.