利奈唑胺对非结核分枝杆菌肺病的疗效观察  

Analysis of the early efficacy and safety of linezolid in the treatment of nontuberculosis mycobacterial pulmonary disease

作　　者：李雪莲[1] 邵玲玲 梁清涛[1] 张芸 郭茹[1] 韩喜琴[1] 段鸿飞[1] Li Xuelian;Shao Lingling;Liang Qingtao;Zhang Yun;Guo Ru;Han Xiqin;Duan Hongfei(Department of The 3rd Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院结核三科,101149

出　　处：《北京医学》2023年第10期874-878,共5页Beijing Medical Journal

基　　金：通州区高层次人才发展支持计划(YHLD201920)

摘　　要：目的探讨利奈唑胺(linezolid,LZD)在非结核分枝杆菌肺病(nontuberculous mycobacterial pulmonary disease,NTM-PD)患者治疗中的有效性及安全性。方法选取2020年8月至2022年8月首都医科大学附属北京胸科医院NTM-PD患者61例,根据治疗方案中是否含有LZD分为LZD组(31例)和Non-LZD组(30例),评估其抗NTM治疗后的早期疗效及药物不良反应(adverse drug reactions,ADR)情况,采用多因素logistic回归方程分析NTM-PD患者发生LZD相关ADR的影响因素。结果61例NTM-PD患者中男27例,女34例,年龄20~77岁,平均(53.3±14.5)岁;其中鸟-胞内分枝杆菌肺病患者35例(57.4%),脓肿分枝杆菌肺病21例(34.4%),堪萨斯分枝杆菌肺病5例(8.2%)。两组7 d内临床症状缓解情况和缓解时间的比较,差异均无统计学意义(P>0.05);LZD组患者治疗后痰菌阴转率、影像学总改善率及ADR发生率高于Non-LZD组(64.5%比36.7%,96.8%比80.0%,77.4%比46.7%),治疗失败率低于Non-LZD组(29.0%比40.0%),差异均有统计学意义(P<0.05)。24例发生ADR患者中有17例与LZD相关,不良反应出现的平均时间为(5.0±3.4)个月。多因素logistic回归分析结果显示,合并支气管扩张的NTM-PD患者发生LZD相关ADR的风险越低(P<0.05)。结论LZD可提高NTM-PD患者治疗早期的痰菌阴转率和影像学总改善率,但ADR的发生率较高。合并支气管扩张是NTM-PD患者发生LZD相关ADR的危险因素。Objective To explore the efficacy and safety of linezolid(LZD)in the treatment of patients with nontuberculosis mycobacterial pulmonary disease(NTM-PD).Methods A total of 61 patients with NTM-PD in Beijing Chest Hospital affiliated to Capital Medical University from August 2020 to August 2022 were selected,and were divided into LZD group(31 cases)and non-LZD group(30 cases)according to whether or not LZD in the treatment plan.The efficacy and adverse drug reactions(ADR)were evaluated,and the risk factors of LZD-related ADR were analyzed by multivariate logistic regression.Results Among the 61 patients with NTM-PD,there were 27 males and 34 females,aged from 20 to 77 years,with an average age of(53.3±14.5)years.There were 35 cases(57.4%)of M.avium complex pulmonary disease,21 patients(34.4%)of M.abscessus complex and five patients(8.2%)of M.kansasii.There was no significant difference between the two groups in clinical symptom remission and remission time within seven days(P>0.05).The sputum conversion rate,the radiological presentation and the incidence of ADR in LZD group were higher than those in Non-LZD group after treatment.(64.5%vs.36.7%,96.8%vs.80.0%,77.4%vs.46.7%).The failure rate of treatment was lower than that of Non-LZD group(29.0%vs.40.0%),and the difference was statistically significant(P<0.05).Among 24 ADR patients,17 cases were related to LZD,and the average time of adverse reactions was(5.0±3.4)months.Multivariate logistic regression analysis showed that the risk of LZD-related ADR in NTM-PD patients with bronchiectasis was lower(P<0.05).Conclusions LZD can significantly improve the sputum conversion rate and the radiological presentation at the early stage of treatment,but the incidence of ADR is high.Bronchiectasis is a risk factor for LZD-related ADR in NTM-PD patients.

关 键 词：利奈唑胺 非结核分枝杆菌肺病 治疗 疗效 安全性 

分 类 号：R563[医药卫生—呼吸系统]