일차 항결핵제 치료 5개월 후 도말 양성 및 배양 음성을 보이는 폐결핵 환자의 임상 양상
Clinical Manifestations of Persistent Smear Positive and Culture Negative Sputum Tests 5 Months after 417First-line Anti-Tuberculous Chemotherapy
황수희 (국립마산병원)
전두수 (국립마산병원)
민진홍 (국립마산병원)
강형석 (국립마산병원)
박승규 (국립마산병원)
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초록
연구배경: 일차 항결핵제 치료 5개월 이후 배양 음전되었으나 도말 양성을 보이는 폐결핵 환자들의 임상적 특성과 치료 후 경과에 대하여 알아보고자 하였다.방 법: 2002년 1월 1일부터 2003년 12월 31일까지 일개 결핵 전문 병원에 입원한 환자 중 일차 항결핵제로 치료를 종결하였고 약제감수성 검사상 일차 항결핵제에 모두 감성이거나 리팜핀을 제외한 단일 약제 내성이면서 추적관찰이 되었던 환자를 대상으로 임상적 특성과 재발여부와 이에 관련한 위험인자를 후향적으로 분석하였다.결 과: 대상 환자는 60명이었고 모두 치료에 성공하였다. 객담 도말 검사상 음전은 평균 8.3±2.3개월이었고, 객담 배양 검사상 음전은 평균 2.0±0.8개월이었다. 당뇨는 14명(23%), 초치료는 46명(77%), 약제감수성 검사상 일차 항결핵제에 모두 감성인 경우가 37명(62%), 흉부방사선 사진상 중증인 경우가 49명(81%)이었다. 재발률은 치료 1년 후 3.8%, 2년 후 10%, 5년 후 25.8%이었고 나이, 성별, 당뇨, 치료 2개월째의 배양검사 결과, 과거 치료력, 흉부방사선 사진 소견, 치료기간에 따라 재발률의 차이는 통계적으로 유의하지 않았다.
- keywords
- Pulmonary tuberculosis, Acid-fast bacilli, Relapse, Pulmonary tuberculosis, Acid-fast bacilli, Relapse
Abstract
Background: It is not known with certainty whether patients with persistently positive sputum smear results who have also had negative sputum culture results require prolongation of treatment for tuberculosis in order to avoid an increased risk of eventual relapse. The purpose of the present study was to retrospectively describe the treatment characteristics and evaluate the appropriate duration of treatment in these patients. Methods: Sixty of 69 patients with sputum smear positive and culture negative tests at 5 months after first line anti-tuberculous chemotherapy from 2002 to 2003 were retrospectively analyzed. Exclusion criteria included incomplete treatment or resistance to rifampicin or two additional antibiotics, as determined by a drug susceptibility test (DST). Results: Smear conversion of the study subjects was observed after 8.3±2.3 months treatment, and the patients were culture negative after 2.0±0.8 months. The relapse rates of the study subjects were 3.8, 10.0, and 25.8% after 1, 2, and 5 years of anti-tuberculosis chemotherapy, respectively. The relapse rates were not significantly affected by a series of risk factors such as age, sex, presence of diabetes, a sputum culture examination after 2 months treatment, previous treatment history, chest radiograph, and duration of the treatment (p＞0.05). Conclusion: Regimen change is not required for patients with persistent smear positive but culture negative tests in the fifth month for first line antituberculous treatment. However, a further study will be needed to clarify the high relapse rate in this specific group of patients. (Tuberc Respir Dis 2007;63:417-422)
- keywords
- Pulmonary tuberculosis, Acid-fast bacilli, Relapse, Pulmonary tuberculosis, Acid-fast bacilli, Relapse
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