tibljТуберкулез и болезни легкихTuberculosis and Lung Diseases2075-12302542-1506Медицинские знания и технологии10.21292/2075-1230-2017-95-10-9-15tiblj-1048Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВЛИЯНИЕ РАЗНЫХ ПРОТИВОТУБЕРКУЛЕЗНЫХ И АНТИБАКТЕРИАЛЬНЫХ ПРЕПАРАТОВ НА ЭФФЕКТИВНОСТЬ ЛЕЧЕНИЯ БОЛЬНЫХ ТУБЕРКУЛЕЗОМ С МНОЖЕСТВЕННОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮTHE EFFECT OF DIFFERENT TB DRUGS AND ANTIMICROBIAL AGENTS ON THE EFFICIENCY OF TREATMENT OF TUBERCULOSIS PATIENTS WITH MULTIPLE DRUG RESISTANCEВасильеваИ. А.VasilyevaI. A.

доктор медицинских наук, профессор, директор,

127473, Москва, ул. Достоевского, д. 4

Doctor of Medical Sciences, Professor, Director,

4, Dostoevsky St., Moscow, 127473

СамойловаА. Г.SamoylovaA. G.

кандидат медицинских наук, заместитель директора,

127473, Москва, ул. Достоевского, д. 4

Doctor of Medical Sciences, Deputy Director,

4, Dostoevsky St., Moscow, 127473

ЛовачеваО. В.LovachevaO. V.

доктор медицинских наук, профессор, ведущий научный сотрудник клинико-диагностического отдела,

107564, Москва, Яузская аллея, д. 2

Doctor of Medical Sciences, Professor, Leading Researcher of Clinical Diagnostics Department,

2, Yauzskaya Alleya, Moscow, 107564

lovoll@yandex.ruЧерноусоваЛ. Н.ChernousovaL. N.

доктор биологических наук, профессор, руководитель отдела микробиологии,

107564, Москва, Яузская аллея, д. 2

Doctor of Biological Sciences, Professor, Head of Microbiology Department,

2, Yauzskaya Alleya, Moscow, 107564

lchernousova@mail.ruБагдасарянТ. Р.BagdasaryanT. R.

кандидат медицинских наук, заведующая 1-м терапевтическим отделением,

107564, Москва, Яузская аллея, д. 2

Candidate of Medical Sciences, Head of First Therapy Department,

2, Yauzskaya Alleya, Moscow, 107564

Национальный медицинский исследовательский центр фтизиопульмонологии и инфекционных заболеваний МЗ РФРоссияNational Medical Research Center of Phthisiopulmonology and Infectious DiseasesRussian FederationНИИ фтизиопульмонологии ФГБОУ ВО «Первый Московский государственный медицинский университет им. И. М. Сеченова» МЗ РФРоссияResearch Institute of Phthisiopulmonology by I.M. Sechenov First Moscow State Medical UniversityRussian FederationФГБНУ «Центральный НИИ туберкулеза»РоссияCentral Tuberculosis Research InstituteRussian Federation2017171120179510915Copyright © Васильева И.А., Самойлова А.Г., Ловачева О.В., Черноусова Л.Н., Багдасарян Т.Р., 20172017Васильева И.А., Самойлова А.Г., Ловачева О.В., Черноусова Л.Н., Багдасарян Т.Р.Vasilyeva I.A., Samoylova A.G., Lovacheva O.V., Chernousova L.N., Bagdasaryan T.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tibl-journal.com/jour/article/view/1048Цель исследования

Цель исследования: изучить влияние конкретных противотуберкулезных и антибактериальных препаратов в схемах химиотерапии на эффективность лечения больных туберкулезом с разным спектром множественной лекарственной устойчивости возбудителя.

Материалы и методы

Материалы и методы. В исследование включено 412 больных туберкулезом легких с бактериовыделением и разным спектром множественной лекарственной устойчивости возбудителя (117 пациентов с ТБ-МЛУ (без преШЛУ и ШЛУ); 120 пациентов с ТБ-преШЛУ и 175 – с ТБ-ШЛУ). Состав пациентов в подгруппах сопоставим по полу и возрасту. Пациентам назначили схему химиотерапии из 5-6 препаратов, учитывая лекарственную устойчивость возбудителя. В качестве суррогатной точки эффективности лечения избрано прекращение бактериовыделения (культуральный метод) к году химиотерапии. Оценку влияния конкретных противотуберкулезных и антибактериальных препаратов на эффективность лечения проводили путем вычисления отношения шансов (ОШ) достижения суррогатной точки у пациентов, получавших и не получавших этот препарат.

Результаты

Результаты. В подгруппе ТБ-преШЛУ достоверное повышение шансов абациллирования продемонстрировали препараты: этамбутол (ОШ 11,8), пиразинамид (ОШ 10,2), моксифлоксацин (ОШ 7,8), капреомицин (ОШ 4,41). Все 11 пациентов, получавших бедаквилин, прекратили бактериовыделение. В подгруппе ТБ-ШЛУ положительное достоверное влияние на абациллирование установлено для бедаквилина (ОШ 9,62), линезолида (ОШ 8,15), циклосерина (ОШ 7,88), пиразинамида (ОШ 7,29), моксифлоксацина (ОШ 7,08), этамбутола (ОШ 6,69). Препарат офлоксацин продемонстрировал достоверное отрицательное влияние на процесс абациллирования (95%-ный ДИ 0,06-0,32). 

Objective of the study

Objective of the study: to study the effect of specific TB drugs and antimicrobial agents constituting chemotherapy regimens on the efficiency of treatment of tuberculosis patients with various patterns of multiple drug resistance.

Subjects and Methods

Subjects and Methods. 412 pulmonary tuberculosis patients with bacillary excretion and various patterns of multiple drug resistance were enrolled into the study (117 patients with MDR TB (non pre-XDR and non-XDR); 120 patients with pre-XDR TB and 175 with XDR TB). Patients in the subgroups were compatible regarding sex and age. The patients were prescribed regimens including 5-6 drugs in accordance with their drug resistance pattern. The time of sputum conversion (by culture) versus the year of treatment was selected as a surrogate endpoint. The effect of specific TB drugs and antimicrobial agents on treatment efficiency was assessed through calculation of odds ratio (OR) of achieving a surrogate endpoint in the patients receiving and not receiving a certain drug.

Results

Results. In the subgroup of pre-XDR TB, the following drugs demonstrated the valid increase of odds of sputum conversion: ethambutol (OR 11.8), pyrazinamide (OR 10.2), moxifloxacin (OR 7.8), capreomicin (OR 4.41). Sputum conversion was achieved in all 11 patients treated with bedaquiline.

In the subgroup of XDR TB, the following drugs provided a positive effect on the achievement of sputum conversion: bedaquiline (OR 9.62), linezolid (OR 8.15), cycloserine (OR 7.88), pyrazinamide (OR 7.29), moxifloxacin (OR 7.08), and ethambutol (OR 6.69). Ofloxacin demonstrated a confident negative effect on achieving sputum conversion (95% CI 0.06-0.32). 

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The authors declare that there are no conflicts of interest present.