Tuberculosis and Respiratory Diseases

  • 제66권3호
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  • Pages.198-204
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  • 2009
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  • 1738-3536(pISSN)
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  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
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다제내성결핵 환자에서 표준 1차 항결핵제 치료 중 발생한 획득 내성

Acquired Drug Resistance during Standardized Treatment with First-line Drugs in Patients with Multidrug-Resistant Tuberculosis

  • 투고 : 2009.02.02
  • 심사 : 2009.03.09
  • 발행 : 2009.03.30
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초록

연구배경: 다제내성결핵 치료에서 감수성으로 증명된 1차 항결핵제는 가장 항결핵효과가 큰 약제로 알려져 있다. 본 연구는 다제내성결핵 환자에서 표준 1차 항결핵제사용 후 1차 항결핵제에 대한 추가 내성 획득의 빈도와 그 위험 인자를 알아보고자 시행되었다. 방 법: 2004년 1월에서 2008년 5월까지 국립마산결핵병원에서 약제감수성 검사가 보고되기 전 표준 1차 항결핵제로 치료받은 다제내성결핵 환자 중에서 1차 항결핵제 치료 전과 1차 항결핵제 치료 후의 연속된 두 시점의 약제 감수성 검사 결과가 모두 있는 환자를 대상으로 하여 의무기록을 후향적으로 검토하였다. 결 과: 표준 1차 항결핵제로 치료 받은 41명 중 14명 (34.1%)에서 ethambutol (EMB) 혹은 pyrazinamide (PZA)에 대한 추가 내성이 획득되었다. 치료 전 isoniazid (INH), rifampicin (RFP)에만 내성을 보였던 11명 중 3명(27.3%)에선 EMB와 PZA에 동시 내성, 3명(27.3%)에선 PZA에 추가 내성이 획득되었다. INH, RFP, EMB에 내성을 보인 18명 중 6명(33.3%)에서 PZA에, INH, RFP, PZA에 내성을 보인 6명 중 2명(33.3%)에서 EMB에 추가 내성이 획득되었다. 대상 환자 중 10명(24.4%)에서 1차 항결핵제 치료 전 내성이었던 약제가 치료 후 감수성으로 전환되었다. 추가 내성획득과 연관된 통계학적으로 유의한 위험인자를 발견할 수 없었다. 결 론: 우리나라의 다제내성결핵 치료에서 1차 항결핵제는 추가 획득 내성의 위험을 고려하여 주의 깊게 사용해야 할 것으로 사료된다.

Background: First-line drugs, if sensitive, are the most potent drugs in the treatment of multidrug-resistant tuberculosis (MDR-TB). This study examined the frequency and risk factors associated with acquired drug resistance to first-line drugs during a standardized treatment using first-line drugs in patients with MDR-TB. Methods: This study included patients who were diagnosed with MDR-TB at the National Masan Tuberculosis Hospital between January 2004 and May 2008, treated with standardized first-line drugs, and for whom the preand post-treatment results of the drug susceptibility test were available. Their medical records were reviewed retrospectively. Results: Of 41 MDR-TB patients, 14 (34.1%) acquired additional resistance to ethambutol (EMB) or pyrazinamide (PZA). Of 11 patients initially resistant to isoniazid (INH) and rifampicin (RFP), 3 (27.3%) acquired additional resistance to both EMB and PZA, and 3 (27.3%) to PZA. Of 18 patients initially resistant to INH, RFP and EMB, 6 (33.3%) acquired additional resistance to PZA. Of 6 patients initially resistant to INH, RFP and PZA, 2 (33.3%) acquired additional resistance to EMB. Ten of the 41 MDR-TB patients (24.4%) changed from resistant to susceptible. No statistically significant risk factors associated with acquired resistance could be found. Conclusion: First-line drugs should be used cautiously in the treatment of MDR-TB in Korea considering the potential acquisition of drug resistance.

키워드

참고문헌

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