再治療重症肺結核症の排菌陰性化に対する二次抗結核剤の効果の比較および背景因子の重みづけ

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The therapeutic effects of the secondary antituberculous drugs and the influences of the background factors on the negative conversion of tubercle bacilli were analyzed by multi-factor analysis among previously treated severe pulmonary tuberculosis patients. Five hundred and forty cases of previously treated cavitary tuberculosis patients showing resistance to streptomycin (SM), para-aminosalicylic acid (PAS) and isoniazid (INH) were sub jected to this analysis. All patients were treated for more than 6 months with at least one of the following six secondary antituberculous drugs: rifampicin (RFP), ethambutol (EB), kanamycin (KM), ethionamide (TH) and cycloserine (CS). The effects of regimens were evaluated by the negative conversion of bacilli maintained for at least three succesive months. The results obtained were as follows: 1) Partial correlation coefficients of items and category scores of categories for the negative conversion of the bacilli were as follows: sex 0.0809 (male 0, female-5.6×10-4), age 0.0206 (less than 40 years 0, 40 years and more-1.3×10-4), duration of previous chemotherapy 0.0377 (less than 3 years 0, 3 years or longer-2.4×10-4), positivity and amount of bacilli in previous sputum examinations 0.2671 (small: positive but not persistent during the previous 3 months and the amount of colonies less than 200 colonies 0, middle: persistently positive during the previous 3 months or the amount of colonies more than 200 -4.4×10-4, large: persistently positive during the previous 3 months and the amount of colonies more than 200 -20.0×10-4), sum of the inside diameters of cavities O. 1957 (less than 40 mm 0, 40 mm or larger but less than 80 mm-7. 2×10-4, 80mm or larger -18.2×10-4), types of cavities in GAKKEN classification 0.0302 (other than Kz 0, Kz-2.2×10-4), numbers of secondary antituberculous drugs combined 0.0637 (single 0, double 4.3×10-4, triple 9.3×10-4), RFP 0.0974 (not used 0, used 24.4×10-4), EB 0.0944 (not used 0, used 21.7×10-4), KM 0.0769 (not used 0, used 11.0×10-4), TH 0.0844 (not used 0, used 15. 3×10-4), CS 0. 0733 (not used 0, used 11. 1×10-4). Seventy two per cent of the cases could be separated in this program. 2) The most important background factors for the negative conversion of bacilli were the amount of bacilli, followed by the sum of inside diameters of cavities. 3) The effects of combination therapy of the secondary antituberculous drugs seemed to be not only additive but also synergistic. 4) The most effective drug was RFP, followed by EB, and three drugs combination therapy including these two drugs was very effective. 5) According to the sample scores of the cases calculated from summing up each category scores corresponding to each cases, the rate of negative conversion could be estimated as follows: 33.3×10-4 and more 100%, 8.7-33. 2×10-4 82%, -11.0-8. 6×10-4 43%, and less than-11.0×10-4 19%.
一般社団法人日本結核病学会の論文

再治療重症肺結核症の排菌陰性化に対する二次抗結核剤の効果の比較および背景因子の重みづけ

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