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地点:SMIRA(意大利抗结核药品耐药性研究)网络,包括意大利全国46 个主要临床单位和22 个实验室。目的:确定1995 年1 月至1999 年12 月登记的耐多药结核病人(MDR-TB)的特点、对WHO 指南的依从性以及治疗结果。设计:根据WHO 的建议,先作耐药水平测试,然后进行观察性研究。结果分为治疗方案适当和治疗方案不合理(少于三种有效药物)。根据治疗的合理程度分析治疗结果。用单变量和多变量分析法分析危险因素和治疗结果预报因素(显著性水平P<0.05)。结果:共诊断127 个耐多药病人。总的治疗成功率低(39%)。70%的病人至少使用过3 种有效药物。治疗成功的预报因素有,新治MDR-TB 病人(OR=3.45;95%CI:1.22-9.87;P<0.05)和治疗≥12 个月(OR=5.03;95%CI:1.65-15.31;P<0.05)。在新治MDR-TB 病人中,移民和艾滋病病毒感染是主要的危险因素。结论:应该给所有新诊断MDR-TB 病人提供现有的最好治疗,避免使用不适宜的治疗方案。MDR-TB病人应该被转诊到专业机构诊治。
Location: SMIRA (Italian Anti-TB Drug Resistance Study) network comprising 46 major clinical units and 22 laboratories throughout Italy. Objectives: To determine the characteristics of MDR-TB patients registered between January 1995 and December 1999, their adherence to the WHO guidelines, and treatment outcomes. Design: According to WHO’s recommendations, the first drug resistance test, and then observe the study. The results were categorized as appropriate treatment regimens and treatment regimens unreasonable (less than three effective drugs). The treatment outcome is analyzed based on the reasonableness of the treatment. Univariate and multivariate analyzes were used to analyze risk factors and predictors of treatment outcome (significance level P <0.05). Results: A total of 127 MDR patients were diagnosed. The overall success rate of treatment was low (39%). 70% of patients have used at least 3 effective drugs. The predictors of successful treatment were newer MDR-TB patients (OR = 3.45; 95% CI: 1.22-9.87; P <0.05) and treatment of ≥12 months (OR = 5.03; 95% CI: 0.05). Among newly diagnosed MDR-TB patients, immigration and HIV infection are the major risk factors. Conclusion: All new diagnosed patients with MDR-TB should be offered the best treatment available, avoiding the use of inappropriate treatment options. MDR-TB patients should be referred to a specialist institution for treatment.