肺結核治療におけるRFP併用例とRFP非併用例との排菌陰性化後の経過の比較

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Because of highly effective anti-tuberculostatic activity of rifampicin (RFP), it was anticipated that the improvement of pulmonary tuberculosis, especially of chest X-ray findings could be achieved faster by combined chemotherapy with RFP than that without RFP. The authors compared retrospectively the grade of improvement of chest X-ray findings between patients receiving combined chemotherapy with RFP (RFP group) and those without RFP (non-RFP group). In all cases, sputa converted to negative and lasted for at least 6 months. A matched pair method was used in this study, and cases with similar background factors composed a pair. Original treatment pairs were 26, and retreatment pairs were 20. The grade of improvement of chest radiogram was estimated and determined by all the research group members, according to the evaluation standard of Gakken classification, every 3 months for 2 years after the start of treatment.<BR>Tubercle bacilli in sputum converted to negative in nearly all cases at the 7 th month, but there-after a few cases in both groups showed transient positive results and, bacteriological relapse was found in each one case of retreatment groups with and without RFP. Continuous positive bacilli in these cases started at the 21st month (Table 4), and these 2 cases were excluded from the evaluation of radiogram at the 21st and the 24th month.<BR>The improvement of chest radiogram was obtained more or less in all cases of original treatment at the 12th month on routine radiogram, and the improvement of non-sclerotic walled cavity at the 9th month on tomogram. No significant difference was observed between both groups, although the improvement was faster in the RFP group than in the non-RFP group. No further improvement was seen 18 months or later (Table 5).<BR>The chest radiogram in the re-treatment group improved slowly and no more improvement was seen 21 months or later; the rates of cases showing improvement were about 58% in RFP group and about 80% in non-RFP group on routine radiogram (Table 6). It is considered that the difference was due to the difference in factors which were neglected in making matched pairs more patients had longer duration of the disease and more resistant drugs in the RFP group than in non-RFP group (Table 2). The improvement of sclerotic walled cavity on tomogram was similar in re-treatment groups; about 85% showed improvement at the 21st month and no further improvement was seen thereafter (Table 6).<BR>In conclusion, the grade of improvement on chest radiogram in RFP group and in non-RFP group was similar, although the improvement was seen faster in RFP group than in non-RFP group.<BR>If RFP is bactericidal against tubercle bacilli, the improvement of chest radiogram is not concerned with the prognosis of pulmonary tuberculosis, as there will be no bacterial relapse. But RFP has not yet been proved to be bactericidal. Accordingly, the improvement of radiogram correlates with the improvement of chronic pulmonary tuberculosis, as radiographic improvement is parallel to the improvement of pathological processes. Based on the above findings, a marked shortening of the duration of chemotherapy in chronic pulmonary tuberculosis could not be expected, even though a regimen including RFP might be a stronger regimen than the standard combination of SM·EPAS·EINH.
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