在移植受体中对多种药物耐药性和氨酸耐药性结核病的研究
Cybele Lara R Abad1, Raymund R Razonable2,3
1Department of Medicine, Section of Infectious Diseases, University of the Philippines, Philippine General Hospital, Manila, Philippines.
概括
在移植受体中治疗多耐药结核病 (MDR-TB) 是复杂的,具有显著的并发症和死亡率. 使用Xpert MTB/RIF早期检测耐利结核病 (RR-TB) 有助于及时指导替代疗法.
科学领域:
- 传染性疾病 传染性疾病
- 移植医学 移植医学
- 肺部病理学 肺部病理学
背景情况:
- 管理多抗药结核病 (MDR-TB) 和耐利结核病 (RR-TB) 提出了重大的临床挑战.
- 关于移植受体中MDR-TB/RR-TB的治疗,结果和不良影响的数据有限.
- 本综述解决了在接受移植的免疫功能低下患者群体中关于耐药结核病的知识差距.
研究的目的:
- 检查移植受体中MDR-TB/RR-TB的治疗选择.
- 评估在这个脆弱人群中与MDR-TB/RR-TB治疗相关的结果和不良影响.
- 综合当前关于治疗移植后耐药结核病的文献.
主要方法:
- 从最初到2022年12月,在多个数据库中进行了全面的文献审查.
- 关键词包括各种形式的耐药和多抗药结核病.
- MDR-TB被定义为对异化和利法的耐药性;RR-TB被定义为仅对利法的耐药性. 没有患者级数据或治疗/结果细节的研究被排除在外.
主要成果:
- 分析了12名移植受体 (10个固体器官,2个造血细胞),其中11人患有MDR-TB,1人患有RR-TB.
- 七名接受者发生了不良事件,包括急性损伤,细胞衰竭和黄. 4名患者死亡,其中2人死于结核病.
- 通过Xpert MTB/RIF早期检测RR-TB有助于启动替代疗法,幸存的患者保持了全移植功能.
结论:
- 移植受体中MDR-TB/RR-TB的治疗与高发病率并发症和死亡率有关.
- 专家MTB/RIF测定在RR-TB的早期检测中起着至关重要的作用,可以迅速启动适当的治疗.
- 基于药物敏感性和耐受性概况的个性化治疗方案对于在移植患者中管理耐药结核病至关重要.
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