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研究分析耐药结核分枝杆菌的传染性和疾病进展风险
作者:小柯机器人 发布时间:2019/10/28 15:39:11

美国哈佛医学院Megan Murray小组近日进行了一项前瞻性队列研究,分析了耐药结核分枝杆菌的传染性和疾病进展风险。相关论文10月24日在线发表在《英国医学杂志》上。

2009年9月至2012年9月,研究组在秘鲁利马建立了106个卫生中心进行这项前瞻性队列研究。根据3339例肺结核患者的耐药情况,对与他们进行接触的10160名家庭成员进行分组,其中6189名接触结核分枝杆菌敏感株,1659名接触异烟肼或利福平耐药株,1541名接触多药耐药株,即对异烟肼和利福平均耐药。结核感染依据结核菌素皮试阳性,结核病的诊断依据痰涂片或胸片阳性。

随访12个月后,多药耐药肺结核患者的家庭接触者感染风险比药物敏感肺结核患者的家庭接触者高8%,但两组接触者患上结核病的相对危险性却没有显著差异,校正风险比为1.28。

总之,多药耐药肺结核患者的家庭接触者相比较药敏肺结核更容易感染结核病,但两组患结核病的风险相差不大。指南制定者应针对耐药性和药物敏感性结核病采取行动,例如早发现及有效治疗。

附:英文原文

Title: Transmissibility and potential for disease progression of drug resistant Mycobacterium tuberculosis: prospective cohort study

Author: Mercedes C Becerra, Chuan-Chin Huang, Leonid Lecca, Jaime Bayona, Carmen Contreras, Roger Calderon, Rosa Yataco, Jerome Galea, Zibiao Zhang, Sidney Atwood, Ted Cohen, Carole D Mitnick, Paul Farmer, Megan Murray

Issue&Volume: 2019/10/24

Abstract: 

Objective To measure the association between phenotypic drug resistance and the risk of tuberculosis infection and disease among household contacts of patients with pulmonary tuberculosis.

Setting 106 district health centers in Lima, Peru between September 2009 and September 2012.

Design Prospective cohort study.

Participants 10 160 household contacts of 3339 index patients with tuberculosis were classified on the basis of the drug resistance profile of the patient: 6189 were exposed to drug susceptible strains of Mycobacterium tuberculosis, 1659 to strains resistant to isoniazid or rifampicin, and 1541 to strains that were multidrug resistant (resistant to isoniazid and rifampicin).

Main outcome measures Tuberculosis infection (positive tuberculin skin test) and the incidence of active disease (diagnosed by positive sputum smear or chest radiograph) after 12 months of follow-up.

Results Household contacts exposed to patients with multidrug resistant tuberculosis had an 8% (95% confidence interval 4% to 13%) higher risk of infection by the end of follow-up compared with household contacts of patients with drug sensitive tuberculosis. The relative hazard of incident tuberculosis disease did not differ among household contacts exposed to multidrug resistant tuberculosis and those exposed to drug sensitive tuberculosis (adjusted hazard ratio 1.28, 95% confidence interval 0.9 to 1.83).

Conclusion Household contacts of patients with multidrug resistant tuberculosis were at higher risk of tuberculosis infection than contacts exposed to drug sensitive tuberculosis. The risk of developing tuberculosis disease did not differ among contacts in both groups. The evidence invites guideline producers to take action by targeting drug resistant and drug sensitive tuberculosis, such as early detection and effective treatment of infection and disease.

DOI: 10.1136/bmj.l5894

Source: https://www.bmj.com/content/367/bmj.l5894

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj