研究背景：世界衛生組織為了監視每個國家達成結核病防治目標的進展，於是訂定了相關的標準監測定義。針對結核病患治療結果，亦提出了六項互相獨立的分類包括：治癒、完治、死亡、失敗、失落、轉出，在病患接受治療12個月後進行治療結果的評估。雖然世界衛生組織定義的分類方式淺顯易懂，但是近年來卻發現這些指標在進行國家間比較時發生困難，且無法客觀的評估人口結構邁向老年化的國家之防治成效。台灣地區已進入老年化社會，是否亦存在著類似問題，仍有值得進一步探討的空間。
研究目的：本研究利用綜觀的方式，評估治療結果監測上的缺失，包含現行監測系統未釐清的病患死因，以及未結案個案療程較長的原因，並進一步討論現行治療結果分類「成功」與「未成功」的合理性，以建立有效的監測系統。
研究方法：以台南市於2006年1月1日至3月31日通報至疾病管制局的結核病新發個案作為研究世代，進行世代追蹤研究。此外依照結核病對病患死亡之影響，將死亡個案區分為結核病導致死亡、非結核病導致死亡及關係未知，釐清死亡原因，並利用衛生所結核病管理負責人之訪視紀錄和都治日誌（結核病人服藥紀錄）判斷未結案病患延長治療的原因。
研究結果：本研究一共納入98位結核病確診新發個案作為研究對象，追蹤治療結果顯示治療成功率為67.4%，未達防治目標85%，主要的原因為致死率較高（24.5%）。進一步分析病患死亡與罹患結核病之間的關係，發現僅有27%屬於結核病導致死亡，且所佔的比例有隨著年齡的上升而下降的現象。在非結核病導致死亡的部分，大多個案伴隨罹患惡性腫瘤、腎衰竭、糖尿病與高血壓。本研究世代共有6位「未結案」個案，皆屬於經追蹤12個月後仍在接受治療之病患，分析療程較長的原因可區分為具有藥物副作用（17%）、藥物抗藥性（33%）、合併罹患其它疾病（50%）。其中有2位個案（33%）已於民國97年6月完治，顯示延長治療之個案亦有成功治療的可能。若將非結核病導致死亡和未結案之個案視為治療成功，則本研究世代之治療成功率將達到89%，解決因人口老化所帶來的影響。
結論：世界衛生組織之標準監測方式無法有效評估台南市結核病患之治療結果，未來應該根據我國結核病的流行現況來訂定適當的監測標準。

Background: In order to monitor the progress of countries towards achieving the tuberculosis control targets, the World Health Organization has made the standardization of surveillance definitions across countries. To be aimed at treatment outcome, the Working Group recommends using a minimal set of six mutually exclusive categories of treatment outcome: cure, treatment completed, death, failure, defaulted, and transfer out. Although the treatment outcome categories set by the World Health Organization appear to be clear, they have limitations to compare the data between different countries and can not to permit an objective evaluation of control achievements in oldest countries. Due to the Taiwan area has become the aging society, whether the similar problem existed was worth further studying.
Objective: To show the limitations on treatment outcome monitoring, include do not find out the causes of death of notified tuberculosis patients and the reasons of patients who are still on treatment after 12 months. Further discusses the rationality on successful and unsuccessful treatment outcome, in order to establish the effective tuberculosis surveillance system.
Materials and methods: We conducted a retrospective cohort study among all new cases of tuberculosis who were reported to the Taiwan Center for Disease Control between 1 January 2006 and 31 March 2006 in Tainan. According to the effect on tuberculosis to death, the causes of death were classified into three categories: “tuberculosis cause death”, “non-tuberculosis cause death” and “unknown”. To judge the reason for patients who are still on treatment after 12 months using the post notification questionnaires and the DOTS diary records.
Results: Among the 98 patients included, the total treatment success rate was 67.4% failing to achieve the tuberculosis control target (85%). The low successful treatment rate was partly due to high fatality rate (24.5%). Further analyzes the relation between tuberculosis and death, we find that only 27% belong to “tuberculosis cause death” and the proportion has dropped along with the age rise. Most of the patients belong to “non-tuberculosis cause death” were following suffer from malignant tumor, renal failure, diabetes and hypertension. In our study cohort there were six patients who were still on treatment after 12 months. The reason can divide into having side effect (17%), drug resistance (33%), and comorbidity (50%). Of the six patients two has completed treatment in June 2008. If we regard the patients who belong to “non-tuberculosis cause death” and “still on treatment” as successful treatment, then the treatment success rate will achieve 89%.
Conclusion: Using the World Health Organization standard monitor way can not be objective evaluation of treatment outcome for patients with tuberculosis in Tainan city. We should establish a suitable monitoring guideline of tuberculosis according to the epidemiological pattern of tuberculosis in Taiwan.

中文文獻
龔佩珍、蔡文正：影響結核病個案完治關鍵因素之研究。行政院衛生署疾病管制局九十二年度科技研究發展計畫（計畫編號：DOH92-DC-1109），2003。
行政院衛生署疾病管制局：民國九十年結核病防治年報，2002：1-158。
行政院衛生署疾病管制局：台灣結核病防治年報，2007：1-158。
行政院衛生署疾病管制局：結核病診治指引（第二版），2006：1-94。
王培東、李燕鳴：臺北市登錄之結核病發生率及其共生疾病分析。北市醫學雜誌，2005；2(9)：810-819。

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