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背景:某县级拘留所。 目标:描述结核感染者的治疗特点,在某县级拘留所囚犯中比较利福平/吡嗪酰胺2个月方案与传统6-12个月异烟肼方案对完成治疗的影响。 设计:回顾性查阅1998年1月至2000年12月的结核病登记资料。 结果:在2127名结核菌素试验阳性的囚犯中,146人开始抗结核治疗。这些病人刑期长,能在狱中完成整个疗程。2个月治疗方案的治疗完成率为88%(67/76)6-12个月治疗方案的治疗完成率为74%(51/69)(P=0.03),总治疗完成率为82%。病人对这两种治疗方案的接受程度相似,但是接受异烟肼治疗的囚犯获释的可能性更大(尽管其刑期较长),这些人一旦回到社区就容易中止治疗。按照原来的指南,37%的病人不必接受治疗,而根据新的指南,这些病人则应当接受治疗。 结论:2个月利福平/吡嗪酰胺方案的治疗完成率比疗程较长的异烟肼方案高,也没有更多的的毒性作用,从而可以应用于更多的病人。以能在监狱里完成治疗方案的囚犯为目标人群的结核感染者化学疗法实现了高治疗完成率。
Background: a county-level detention center. Objectives: To characterize the treatment of TB patients by comparing the 2-month regimen of rifampicin / pyrazinamide versus the traditional 6-12-month isoniazid regimen in completing treatment in prisoners in a county detention facility. Design: Retrospective review of tuberculosis registration data from January 1998 to December 2000. Results: Of 2127 prisoners tested positive for tuberculin, 146 started anti-TB treatment. These patients have long sentences and can complete the entire course of treatment in prison. The 2-month regimen achieved a complete cure rate of 88% (67/76). The 6-12-month regimen achieved 74% (51/69) complete treatment (P = 0.03) and 82% of completed treatment. Patients were similarly receptive to both treatment options, but prisoners receiving isoniazide were more likely to be released (despite their longer sentences), and those individuals were able to discontinue treatment once they returned to the community. According to the original guidelines, 37% of patients do not have to be treated, and under the new guidelines, these patients should be treated. CONCLUSIONS: The 2-month rifampin / pyrazinamide regimen has a higher rate of completion than the longer-course isoniazid regimen and no more toxic effects and can be used in more patients. Chemotherapy for tuberculosis-infected patients, targeted at prisoners who can complete treatment programs in prison, achieved high rates of treatment completion.