ガイドラインに沿った肺 Mycobacterium avium complex症の治療成績 THE EFFECT OF COMBINED CHEMOTHERAPY FOLLOWING THE GUIDELINES ON TREATMENT FOR MYCOBACTERIUM AVIUM COMPLEX PULMONARY DISEASE

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MAC症に対して, ATSおよび日本結核病学会が提言した治療ガイドラインが臨床上適切かどうか, 過去の治療法との比較も併せ検討した。対象は, 1995年4月から2001年3月までに6カ月以上治療がなされ, 治療開始から12カ月以上経過観察を施行できた肺MAC症159例とした。治療状況は, 抗結核薬。CAM102例, 抗結核薬のみ33例, その他24例であった。治療効果は, 抗結核薬.CAMが菌陰性化率45.1%, 再排菌率39.1%, 臨床的改善率29.4%であった。一方, 抗結核薬のみは菌陰性化率30.3%, 再排菌率70.0%, 臨床的改善率12.1%と不良で, CAMが含まれた治療法で優れた成績が得られていた。次に, 抗結核薬.CAMの治療が行われた102例ではガイドラインに一致した RFP, EB, SM, CAMの治療が41例に施行され, 菌陰性化率58.5%, 再排菌率37.5%, 臨床的改善率36.6%であった。一方, 他の抗結核薬.CAMは61例に施行され, 菌陰性化率36.1%, 再排菌率40.9%, 臨床的改善率24.6%と, ガイドラインに沿った治療法が最も優れた成績であった。<BR>しかし, いまだ肺結核に対する治療効果と比較すると不十分であり, 今後新しい非定型抗酸菌に有効な治療薬の開発が望まれる。

We retrospectively investigated the clinical appropriateness of combined chemotherapy following the Japanese Society for Tuberculosis guidelines corresponding with those of the American Thoracic Society guideline for MAC pulmonary disease including a comparison with the past treatment for MAC pulmonary disease. The subjects of this study were 159 patients at several hospitals surveyed by the Chugoku-Shikoku Research Committee on <I>Mycobacterium</I> who were diagnosed as having MAC pulmonary disease bertween April 1995 and March 2001.<BR>Among them, 102 patients were treated using a regimen of antituberculous drugs with CAM, 33 patients received antituberculous drugs without CAM, and 24 patients were treated using other regimens. With a regimen of antituberculous drugs plus CAM, the sputum conversion rate was 45.1%, the relapse rate was 39.1% and clinical improvement was obtained in only 29.4 %. On a regimen of only antituberculous drugs, the sputum conversion rate was 30.3 %, the relapse rate was 70.0 % and clinical improvement was obtained in 12.1 %. Among the 102 patients receiving the regimen of antituberculous drugs plus CAM, 41 patients were treated with RFP, EB, SM and CAM following exactly the guidelines. The sputum conversion rate was 58.5 %, the relapse rate was 37.5 % and clinical improvment was obtained in 36.6 %. Among 61 patients treated with other antituberculous drugs plus CAM, the sputum conversion rate was 36.1%, the relapse rate was 40.9 % and clinical improvement was obtatined in 24.6%.<BR>The clinical effect of the combined chemotherapy (RFP, EB, SM and CAM) was better than that of the other regimens throughout this study. However, the efficacy of this combined chemotherapy was unsatisfactory compared with the clinical effect for pulmonary tuberculosis. Therefore, the development of new companion drugs for the disease with <I>mycobacteria</I> other than <I>M. tuberculosis</I> is needed.

収録刊行物

  • 結核

    結核 77(6), 435-441, 2002-06-15

    JAPANESE SOCIETY FOR TUBERCULOSIS

参考文献:  13件中 1-13件 を表示

被引用文献:  8件中 1-8件 を表示

各種コード

  • NII論文ID(NAID)
    10008879636
  • NII書誌ID(NCID)
    AN00073442
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00229776
  • NDL 記事登録ID
    026781636
  • NDL 請求記号
    Z19-133
  • データ提供元
    CJP書誌  CJP引用  NDL  J-STAGE 
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