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肺结核早期微生物学标志物 肺结核治疗结果
Mandar Sudhir Paradkar1,2, Neeta Nitin Pradhan1,2, Subramanyam Balaji3
1BJ Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.
Annals of the American Thoracic Society
|December 1, 2023
概括
早期发现不良的肺结核治疗结果至关重要. 第二周的呼吸道菌根培养是最早的微生物标记物,有助于监测缩短的抗结核治疗.
科学领域:
- 医学微生物学 医学微生物学
- 传染性疾病 传染性疾病
- 公共卫生 公共卫生
背景情况:
- 肺结核 (PTB) 治疗结果的早期生物标志物对于有效的监测至关重要,特别是在缩短的抗结核治疗方案 (ATT) 中.
- 识别早期的微生物学指标可以帮助预测不良治疗反应,并指导临床管理.
研究的目的:
- 确定早期的微生物学标记,预测药物敏感性肺结核患者的不良治疗结果.
- 在ATT期间不同时间点评估各种基于唾液的微生物学测试的实用性.
主要方法:
- 印度 (2013-2019) 两项前性队列研究的子分析,涉及1,098名参与者,为药物敏感PTB启动6个月的ATT.
- 在基线和第2,4和第8周使用Xpert MTB/RIF,AFB显微镜和液体/固体培养物分析了液样本.
- 波桑回归评估了微生物标记物与治疗后18个月失败,复发或死亡的复合结果之间的关联.
主要成果:
- 22%的参与者 (251/1,098) 经历了不良结果 (失败,复发或死亡).
- 阳性Xpert MTB/RIF,AFB涂抹和基线液体培养与不良结果有关.
- 第二周的阳性液体培养是最早显著的微生物学预测因子 (aIRR,1.47;95% CI,1.04-2.09).
- 在第8周的正面AFB涂抹和液体培养也预测了不利的结果.
结论:
- 第二周呼吸道菌根菌培养成为预测不良肺结核治疗结果的最早的微生物标志物.
- 这些发现支持使用早期微生物学监测来识别有治疗失败,复发或死亡风险的患者.
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