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与耐多药结核病治疗相关的不良事件

Multidrug-resistant tuberculosis (MDR一TB) is a growing public health problem. Due to long duration of therapy and concurrent use of multiple second一line drugs, adverse drug events (ADEs) are re一 garded as the most important clinical consideration in patients undergoing anti一MDR一TB treatment. To evaluate the frequency and type of treatment一related ADEs owing to MDR一TB therapy. The Cochrane Library, MEDLINE, and EMBASE were searched from inception through October 1, 2012, with additional manual search of International Journal of Tuberculosis and Lung Disease. Studies with available ADEs were selected if MDR一TB patients were treated with regimen including second一 line drugs. Pooled estimations of incidence for each specific type of ADEs were calculated with 95% confidence intervals using random一effects model. Of the 5346 patients included, 2602 (57 .3%) expe一 rienced at least 1 kind of ADE. The 3 most common side effects were gastrointestinal disorders (32.1%), ototoxicity (14.6%), and psychiatric disorders (13.2%). Subgroup analyses based on each characteristic (study population, previous tuberculosis treated, human immunodeficiency virus prevalence, and length of treatment) did not show any significant difference between groups. Addi一 tionally, among 1519 patients who developed ADEs with available data of impact on MDR一TB therapy, 70.4% required change of MDR一TB treatment. Adverse events were common among MDR一TB cases, occurring in more than half of the cases, with over two一thirds requiring change of anti一MDR一TB treatment. MDR一TB patients should be monitored closely and managed aggressively for side effects during therapy, especially for ototoxicity and psychiatric disorders.