含头孢西丁方案治疗高度耐药的快速生长型非结核分枝杆菌肺部感染16例疗效观察  

The effect of the regimen containing cefoxitin on highly drug-resistant rapidly growing nontuberculous mycobacterial pulmonary disease

作　　者：沙巍[1] 梁莉[1] 蒋瑞华[1] 方勇[1] 尹洪云[1] 肖和平[1] 

机构地区：[1]同济大学附属上海市肺科医院结核科,200433

出　　处：《中华结核和呼吸杂志》2011年第4期265-268,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的 探讨含头孢西丁的治疗方案对高度耐药的快速生长型非结核分枝杆菌（NTM）肺疾病患者的疗效和安全性.方法 回顾性分析2007年1-12月经上海市肺科医院确诊的快速生长型NTM肺疾病患者16例,其中男7例,女9例,年龄32～74岁,平均（56±10）岁,既往治疗时间为6～48个月,平均（15±11）个月,而痰菌未阴转.化疗方案包括头孢西丁、第3代以上氟喹诺酮、大环内酯类、磺胺甲噁唑等,其中头孢西丁在强化期使用,疗程为3个月,总疗程1.5年以上,观察患者的痰菌阴转率、影像学表现及不良反应.结果 16例中5例无既往慢性疾病史,有支气管扩张症史5例,COPD史2例,结核病史3例,慢性白血病骨髓移植术后1例.治疗前主要症状为咳嗽、咳痰,影像学表现均为多发斑片状、小结节状阴影合并空洞形成.菌株对抗结核药物高度耐药,16例中耐链霉素15例,耐异烟肼16例,耐利福平14例,耐乙胺丁醇13例;15例中耐阿米卡星14例,耐卷曲霉素15例,耐氧氟沙星14例.治疗后患者的临床症状均缓解,8例在治疗半年内痰菌阴转并维持至疗程结束,另外8例的痰菌未能阴转.疗程结束时6例病灶吸收,其中4例为显著吸收,2例为吸收;10例病灶无变化;4例空洞闭合,2例空洞缩小,10例空洞无改变.治疗痊愈率为8/16.未出现因头孢西丁引起的不良反应.结论 含头孢西丁化疗方案对高耐药性的快速生长型NTM肺疾病有一定疗效,在无条件行菌种鉴定和药敏检测的前提下,可联合其他药物组成经验性化疗方案.Objective To evaluate the therapeutic effect and safety of the regimen containing cefoxitin on highly drug-resistant rapidly growing nontuberculous mycobacterial （RGM） pulmonary disease.Methods From January to December 2007, 16 patients with RGM pulmonary disease, who had been treated for 6 -48 months, average （ 15 ± 11 ） months but still sputum positive, were included in the study and treated with a new regimen containing cefoxitin, fluoroquinolone, macrolid, and SMZco.Cefoxitin was used in the first 3 months and the total duration of therapy was 18 months.Sputum conversion rate, radiology change and side effects were observed before and after the therapy.Results Underlying chronic diseases including COPD （ n = 2）, tuberculosis （ n = 3 ）, bone-marrow transplantation due to chronic leukemia （ n =1 ） and bronchiectasis （ n = 5）, were present in 11 patients.Main symptoms before therapy were cough and expectoration.There were multi-focal patchy, small nodular shadows with cavities on CT scans.The 16 clinical strains were highly resistant to anti-tuberculous drugs： 15/16 to streptomycin, 16/16 to isoniazid,14/16 to rifampin, 13/16 to ethambutol, 14/15 to amikacin, 15/15 to capreomycin and 14/15 to ofloxacin.After treatment, the clinical symptoms improved in all patients.Eight of the 16 patients became sputum negative by 6 months which lasted to the end of the therapy, while another 8 patients remained sputum positive.Six patients showed radiological improvement.No one experienced side effects induced by cefoxitin.The total cure rate was 8/16.Conclusion The regimen containing cefoxitin has certain effect on highly drug-resistant nontuberculous mycobacterial pulmonary disease, especially for RGM.

关 键 词：分枝杆菌感染 抗药性 多种 细菌 头孢西丁 

分 类 号：R563.1[医药卫生—呼吸系统]