1例耐多药结核患者的循证治疗  

EVIDENCE-BASED TREATMENT FOR A PATIENT WITH MULTI-DRUG RESISTANCE TUBERCULOSIS

作　　者：吴桂辉[1] 陈雪融[2] 梁宗安[2] 王莉[3] 王佑娟[2] 唐晓燕[2] 杨铭[1] 

机构地区：[1]成都市传染病医院 [2]四川大学华西医院呼吸内科 [3]中国循证医学中心

出　　处：《现代预防医学》2010年第11期2152-2154,共3页Modern Preventive Medicine

摘　　要：[目的]为1例耐多药结核病人循证制定治疗方案和该方案治疗效果分析。[方法]检索Cochrane图书馆(2007年第2期)、MEDLINE光盘数据库(1966～2007.7)、EMbase数据库(1984～2007.7)、维普中文科技期刊数据库(1989～2007年7月)、万方数据库(1997～2007.7)、中国学术期刊全文数据库(1994～2007.7),手工检索《中华结核和呼吸杂志》、《中国防痨杂志》杂志,筛选截至2007年7月的关于耐多药结核控制规范的文献和指南,评定文献质量,并进行综合分析。[结果]共纳入7篇文献,其中3篇为临床指南,1篇为Meta分析,3篇RCT。上述文献显示,对于已使用过一线药和二线药的耐多药结核患者,推荐使用个体化策略进行治疗。至少使用4种以上可能有效的抗结核药物组成化疗方案,按药物效力决定选用顺序。依据患者的细菌学变化情况、不良反应的监测情况、方案组成药物的抗菌效力等因素决定强化期疗程,整个疗程为痰分枝杆菌培养阴转后至少18个月。手术疗法是有效的辅助治疗方式。根据患者病情,制定出相应化疗方案,强化期6月,总疗程22月,患者获临床治愈。[结论]循证治疗耐多药结核可有效提高疗效。[Objective] To explore the methods of evidence-based treatment for a patient with multi-drug resistance tuberculosis （ MDR -TB） and analyze their effect. [ Methods] We electronically searched the Cochrane Library （ Issue 2, 2007）, MEDLINE （1966 to July 2007）, EMbase （1984 to July 2007）, Vip Chinese Periodical Database （1989 to July 2007）, Wangfang database （1997 to December 2006）, CNKI （1994 to July 2007） and hand searched Journals such as Chinese Journal of tuberculosis and respiratory diseases and the Journal of the Chinese Antituberculosis Association to identify literatures and guidelines on control criterion of MDR-TB. The quality of literatures and guidelines was assessed and analyzed. [Results] Seven literatures including three guidelines, one Meta analysis and three RCT were identified. They suggested that the solution in MDR-TB cases who had received both first- and second-line drugs in the past was individualized management. Regimens should consist of at least four drugs with certain effectiveness. According to potency the drugs were arranged in proper order. The length of intensive phase should be decided in the context of efficacy and number of the drugs in the regimen, the patient’s bacteriological status and monitoring of adverse effects. Duration of treatment was for a minimum duration of 18 months beyond conversion. Surgery was effective as adjunctive therapies. Based on the patient’s conditions a regimen was designed with intensive phase of six months and total period of treatment of twenty-two months. Clinical cure was achieved. [Conclusion] Treating MDR-TB according to evidence-based medicine could improve effect.

关 键 词：耐多药结核 循证治疗 

分 类 号：R52[医药卫生—内科学]