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【medical-news】研究发现广谱抗药结核仍可治愈
BOSTON (Reuters) - Tuberculosis resistant to most drugs can still be cured in 60 percent of cases using aggressive treatment with at least five drugs, doctors reported on Wednesday.
They said their finding offers hope for people with extensively drug-resistant TB or XDR-TB, an infection that is not stopped by two first-line drugs used to treat the disease, along with three of the six classes of second-line drugs.
"It's essential that the world know that XDR-TB is not a death sentence," said Carole Mitnick of Harvard Medical School in Boston, who led the study.
"As or even more importantly, our study shows that effective treatment does not require hospitalization or indefinite confinement of patients," Mitnick said in a statement.
The researchers started with 650 patients in Lima, Peru, who had drug-resistant TB. Of them 48 had XDR-TB and none were infected with the AIDS virus, a complication that makes such TB virtually untreatable.
Doctors offered patients free individualized treatment with at least five drugs given simultaneously, along with surgery to cut out clumps of badly infected tissue and nutritional and psychological support.
Sixty percent were cured by the end of the treatment compared to 66 percent of the 603 volunteers whose TB showed resistance to fewer drugs, Mitnick's team reported in the New England Journal of Medicine.
"Aggressive regimens -- with many drugs, at the highest tolerated doses -- were used to maximize the chemotherapeutic benefit," they wrote.
"Treatment was protracted, lasting more than two years in most patients. The results of drug-susceptibility testing were used to design (and adjust) regimens containing at least five drugs that were likely to be effective whenever possible," they added.
"This encouraging result constitutes a true change in the current perception of the disease as a virtual death sentence," Dr. Mario Raviglione of the World Health Organization wrote in a commentary on the findings.
"The challenge is to make this approach a sustainable reality worldwide."
Raviglione said the study did not report the frequency or seriousness of the side effects, and raised the question of why aggressive treatment programs in the United States and Europe have not been as successful.
"Possibly, the strains causing their disease were resistant to more drugs than the strains in Peru," Raviglione wrote.
A second study of 174 tuberculosis patients treated at National Jewish Health in Denver, a specialty U.S. center, found patients with XDR-TB were almost eight times as likely to die as patients with multi-drug resistant tuberculosis.
Of 174 MDR-TB patients, 10 were classified as XDR-TB. Just 14 of the 164 MDR-TB patients died, compared to half the XDR patients.
"Over the years, we have become quite proficient at treating multi-drug resistant tuberculosis with initial treatment success rates greater than 90 percent in recent years," said Dr. Michael Iseman, who led the study.
"Extensively drug-resistant cases, however, are much more difficult to treat and we still lose more of these patients than we save."
http://www.reuters.com/article/healthNews/idUSN0645684620080806 一般Extensive Drug Resistant TB 译作“泛耐药结核”。 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 研究表明泛耐药结核仍可治愈
波士顿（路透社）——医务工作者在周三报道，通过使用至少5种药物强力治疗，60%泛耐药结核患者仍可治愈。
他们说这给那些耐多药结核的患者带来了希望，这些患者的感染无法通过2种一线抗结核药物配合3类（共6类）二线抗结核药物控制。
该研究的负责人，波士顿哈佛医学院的Carole Mitnick说，这意味着向全世界宣称，泛耐药结核不意味着死亡。
Mitnick在报告中称，更为重要的是，我们的研究发现有效的治疗可以使患者无需住院或无限期的接受医学监控。
研究人员在秘鲁的利马观察了650名耐药结核病人。其中48人有泛耐药结核，无人感染艾滋病毒，感染艾滋病的并发症会使这些结核患者无药可治。
医生给予患者个体化的治疗，至少同时使用5种抗结核药物，同时外科手术切开严重感染的组织，营养和心理治疗。
Mitnick在新英格兰医学杂志报道， 60%的患者通过以上治疗治愈，相比而言，603名较少耐药的结核患者治愈率为66%。
他们写道，强有力的治疗——使用多种药物的可耐受的最大剂量，来确保疗效的最大化。
他们补充说，大多数病人的治疗持续了两年以上。药敏试验的结果用于选择和调整用药，可能的话，至少使用5种有效的药物。
世界卫生组织的Mario Raviglione博士在评价这一结果时写道，先前认为泛耐药结核是不治之症，这一鼓舞人心的结果对此构成了真正的挑战。
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作者:admin@医学,生命科学 2011-04-06 14:07
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