Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The Clinical Characteristics and Outcomes of Short-term Treatment in Patients with Recurrent Pulmonary Tuberculosis

한 대학병원에서 반복성 폐결핵 환자의 임상적 특성과 6개월 단기요법의 치료 성적

  • Yoo, Seung Soo (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kwon, Jee Suk (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kang, Yeh Rim (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Lee, Jeong Woo (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Cha, Seung Ick (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Park, Jae Yong (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Jung, Tae Hoon (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kim, Chang Ho (Department of Internal Medicine, School of Medicine, Kyungpook National University)
  • 유승수 (경북대학교 의과대학 내과학교실) ;
  • 권지숙 (경북대학교 의과대학 내과학교실) ;
  • 강예림 (경북대학교 의과대학 내과학교실) ;
  • 이정우 (경북대학교 의과대학 내과학교실) ;
  • 차승익 (경북대학교 의과대학 내과학교실) ;
  • 박재용 (경북대학교 의과대학 내과학교실) ;
  • 정태훈 (경북대학교 의과대학 내과학교실) ;
  • 김창호 (경북대학교 의과대학 내과학교실)
  • Received : 2008.03.03
  • Accepted : 2008.04.25
  • Published : 2008.05.30
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Abstract

Background: Recurrent pulmonary tuberculosis (TB) can be due to relapse of the original infecting strain or due to reinfection with a new strain of Mycobacterium tuberculosis. We investigated the clinical characteristics and efficacy of short-term treatment (6 months) in patients with recurrent pulmonary TB. Methods: Twenty-nine patients with recurrent pulmonary TB were compared with control patients who received primary treatment for pulmonary TB with respect to drug sensitivity and outcomes of treatment. Results: Most patients with recurrent pulmonary TB (25 cases, 86.2%) recurred more than 2 years after the completion of previous treatment. Twenty-three patients (82.1%) with recurrent pulmonary TB were sensitive to all anti-tuberculous drugs and a ratio was similar to the drug sensitivities observed in control patients. The outcomes of short-term treatment in patients with drug-sensitive TB were not significantly different between the two groups. Conclusion: Recurrent pulmonary TB in the study area was likely due to reinfection with new strains. Thus the short-term treatment of patients with drug-sensitive recurrent pulmonary TB may be successful.

연구배경: 반복성 폐결핵은 재발과 재감염으로 구분되고, 각각의 치료기간이 다를 수 있다. 이에 반복성 폐결핵 환자의 임상적 특성과 약제 내성 검사 결과를 알아보고, 이를 바탕으로 반복성 폐결핵 환자에서 6개월 단기 표준 요법의 치료 가능성을 알아보고자 하였다. 방법: 2005년 1월에서 2007년 1월까지 경북대학병원을 내원한 환자 중 과거 폐결핵으로 치료완료 한 적이 있으며, 흉부사진 상에 침윤소견과 함께 객담 검사에서 결핵균이 배양된 재치료 환자 31명과 512명의 초치료 환자 중 무작위로 선택한 31명에 대해 그 임상적 특성과 약제 감수성 결과 및 치료 결과를 비교하였다. 결과: 재치료 환자에서 이전 치료완료 후부터 재치료 시까지 걸린 기간은 2년 이후가 25명(86.2%)으로 대부분 2년 이후에 재치료를 요하였고, 모든 약제에 감수성을 보인 환자는 23명(82.1%)으로 초치료 환자에서의 약제 감수성 결과와 비슷하였다. 약제 감수성을 보인 재치료 환자 23명 중 6개월 단기 표준요법이 19명(82.6%), 9개월에서 12개월의 연장된 치료가 4명(17.4%)에서 시행되었으며, 이들을 각각 평균 17개월, 18개월 관찰한 동안 모두에서 재발한 예는 없었다. 이는 초치료 환자의 치료성적과 비슷하였다. 결론: 과거 폐결핵치료를 완료한 후 재치료를 요하는 폐결핵 환자에서 2년 이후 재발하고, 모든 약제에 감수성을 보이며, 공동 및 2개월 때 객담 배양 양성의 위험요소가 없는 예에서는 6개월 표준단기요법의 치료 가능성을 제시한다.

Keywords

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