Эффективность лечения туберкулеза у беременных в сравнении с больными туберкулезом без беременности

The objective of the study: to compare the effectiveness of tuberculosis chemotherapy and treatment outcomes in the pregnant patients versus those nonpregnant.Subjects and methods. Medical records of 218 HIV negative women ill with tuberculosis were analyzed: TB + Pregnancy Group included 109 pregnant tuberculosis patients; and TB Group included 109 nonpregnant female tuberculosis patients. The patients from TB Group were enrolled in order to match patients from TB + Pregnancy Group regarding the age, social status, specific features of the disease, lung tissue destruction, bacillary excretion, and drug resistance profile.During treatment of tuberculosis, 72.5% (n = 79) of patients from the main group got pregnant. Pregnancy resulted in delivery in 67.0% (n = 73) of women, and in 23.0% (n = 25) of women, it was electively terminated before the 12th week of pregnancy.First line drugs were prescribed to 55.0 and 42.2% of patients from Groups 1 and 2 (pχ2 > 0.05); combinations of first line and reserve drugs (due to resistance to isoniazid) were used in 22.0 and 37.6% (pχ2 > 0.05) respectively; and reserve drugs (due to MDR/XDR TB) were used in 22.9 and 23.9% (pχ2 > 0,05) of patients. The main course of tuberculosis treatment lasted for 11.6 ± 4.7 months in the pregnant patients and 14.3 ± 3.8 months in those nonpregnant. And pregnant patients had one forth part of their chemotherapy coinciding with their pregnancy.Results: Only pregnant patients developed hepatotoxic reactions to anti-tuberculosis drugs. In HIV negative patients, treatment effectiveness was compatible in the pregnant and nonpregnant patients (58.7 ± 4.7 and 61.5 ± 4.7%, pχ2 > 0.05). Mortality due to progression of tuberculosis in the pregnant did not exceed the mortality in the nonpregnant ones (5.5 ± 2.2 and 7.4 ± 2.1%, pχ2 > 0.05). The frequency of relapses was the same in the pregnant women receiving anti-tuberculosis therapy and those nonpregnant (3.1 and 4.4%, pχ2 > 0.05).Цель исследования: сравнить эффективность химиотерапии и результаты лечения туберкулеза у женщин в зависимости от наличия беременности.Материалы и методы. Проведен анализ медицинской документации 218 женщин, больных туберкулезом с ВИЧ-негативным статусом: группа ТБ + Б ‒ 109 беременных пациенток с туберкулезом, группа ТБ ‒ 109 пациенток с туберкулезом, без беременности. Пациентки группы ТБ отобраны по принципу «копия-пара» к пациенткам группы ТБ + Б с учетом возраста, социального статуса, характера течения туберкулезного процесса, деструкции легочной ткани, бактериовыделения и спектра лекарственной устойчивости возбудителя.На фоне лечения туберкулеза беременность наступила у 72,5% (n = 79) пациенток основной группы. Беременность закончилась родами у 67,0% (n = 73) женщин, у 23,0% (n = 25) ‒ искусственным прерыванием беременности по желанию женщины в сроках до 12 нед. беременности.Лечение препаратами основного ряда назначали 55,0 и 42,2% пациенткам 1-й и 2-й групп (pχ2 > 0,05); комбинацию препаратов основного и резервного рядов (в случае лекарственной устойчивости к изониазиду) использовали 22,0 и 37,6% (pχ2 > 0,05); препаратами резерва (по поводу МЛУ/ШЛУ-ТБ) 22,9 и 23,9% (pχ2 > 0,05) пациенток. Длительность основного курса лечения туберкулеза у беременных женщин составила 11,6 ± 4,7 мес., у небеременных 14,3 ± 3,8. При этом у беременных женщин четверть курса химиотерапии пришлась на беременность.Полученные результаты. Гепатотоксические реакции на противотуберкулезные препараты имели место только у беременных. При ВИЧ-негативном статусе эффективность лечения туберкулеза у беременных сопоставима с таковой у женщин без беременности (58,7 ± 4,7 и 61,5 ± 4,7%, pχ2 > 0,05). Летальность от прогрессирования туберкулеза у беременных не превышала летальность пациенток без беременности (5,5 ± 2,2 и 7,4 ± 2,1%, pχ2 > 0,05). Развитие рецидива туберкулеза регистрировали с одинаковой частотой у женщин, которые получали противотуберкулезную терапию во время беременности, и у женщин без беременности (3,1 и 4,4%, pχ2 > 0,05)

Effectiveness of tuberculosis treatment in the pregnant tuberculosis patients versus those nonpregnant

The objective of the study: to compare the effectiveness of tuberculosis chemotherapy and treatment outcomes in the pregnant patients versus those nonpregnant.Subjects and methods. Medical records of 218 HIV negative women ill with tuberculosis were analyzed: TB + Pregnancy Group included 109 pregnant tuberculosis patients; and TB Group included 109 nonpregnant female tuberculosis patients. The patients from TB Group were enrolled in order to match patients from TB + Pregnancy Group regarding the age, social status, specific features of the disease, lung tissue destruction, bacillary excretion, and drug resistance profile.During treatment of tuberculosis, 72.5% (n = 79) of patients from the main group got pregnant. Pregnancy resulted in delivery in 67.0% (n = 73) of women, and in 23.0% (n = 25) of women, it was electively terminated before the 12th week of pregnancy.First line drugs were prescribed to 55.0 and 42.2% of patients from Groups 1 and 2 (pχ2 > 0.05); combinations of first line and reserve drugs (due to resistance to isoniazid) were used in 22.0 and 37.6% (pχ2 > 0.05) respectively; and reserve drugs (due to MDR/XDR TB) were used in 22.9 and 23.9% (pχ2 > 0,05) of patients. The main course of tuberculosis treatment lasted for 11.6 ± 4.7 months in the pregnant patients and 14.3 ± 3.8 months in those nonpregnant. And pregnant patients had one forth part of their chemotherapy coinciding with their pregnancy.Results: Only pregnant patients developed hepatotoxic reactions to anti-tuberculosis drugs. In HIV negative patients, treatment effectiveness was compatible in the pregnant and nonpregnant patients (58.7 ± 4.7 and 61.5 ± 4.7%, pχ2 > 0.05). Mortality due to progression of tuberculosis in the pregnant did not exceed the mortality in the nonpregnant ones (5.5 ± 2.2 and 7.4 ± 2.1%, pχ2 > 0.05). The frequency of relapses was the same in the pregnant women receiving anti-tuberculosis therapy and those nonpregnant (3.1 and 4.4%, pχ2 > 0.05)