复治涂阳肺结核患者化学治疗新方案研究  

A novel chemotherapy regimen for retreatment of smear-positive pulmonary tuberculosis

作　　者：施伎蝉 蒋贤高 余志杰[2] 何贵清 宁洪叶 吴正兴 蔡玉伟 虞荷荷 

机构地区：[1]温州市中心医院感染科,325000 [2]温州医科大学附属第一医院科研中心

出　　处：《中华临床感染病杂志》2015年第2期118-122,共5页Chinese Journal of Clinical Infectious Diseases

摘　　要：目的探讨复治涂阳肺结核患者化学治疗新方案的疗效和安全性。方法选取2013年7月至2014年3月在温州市中心医院确诊的初次复治涂阳肺结核患者88例，随机分为超短疗程组（58例）和标准疗程组（30例）。超短疗程组采用5MfxRfb（Rft）PaZE方案（Mfx：莫西沙星，Rib：利福布汀，Rft：利福喷丁，Pa：对氨基水杨酸异烟肼，Z：吡嗪酰胺，E：乙胺丁醇），标准疗程组采用2SHREZ／6HRE或3HREZ／6HRE方案（S：链霉素，H：异烟肼，R．利福平）。观察患者的临床症状、体征，第2个月末及疗程结束时痰涂片、痰培养转阴率，肺部病灶吸收及空洞闭合等情况。采用t检验或，检验进行数据分析。结果因各种原因未完成治疗10例，共78例肺结核患者完成治疗（超短疗程组50例，标准疗程组28例）。疗程结束时，两组患者症状体征疗效指数比较差异无统计学意义（χ^2=0．836，P〉0．05）。治疗第2个月末，超短疗程组痰涂片、痰培养转阴率分别为76．00％（38／50）和72．00％（36／50），标准疗程组分别为71．43％（20／28）和67．86％（19／28），两组比较差异无统计学意义（χ^2=0．197和0．148，P〉0．05）；疗程结束时，超短疗程组痰涂片及痰培养转阴率均为92．00％（46／50），标准疗程组均为85．71％（24／28），差异亦无统计学意义（χ^2=0．239，P〉0．05）。治疗结束时，超短疗程组胸部CT显示病灶显著吸收33例，吸收12例，不变4例，恶化1例；标准疗程组显著吸收8例，吸收13例，不变5例，恶化2例。两组病灶变化差异有统计学意义（χ^2=10．582，P〈0．05），但空洞变化差异无统计学意义（χ^2=1．825，P〉0．05）。总体转归方面，超短疗程组治愈44例，完成疗程5例，失败1例；标准疗程治愈24例，完全疗程2例，失败2例，两组比较差异无统计学意义（χ^2=1．468，P〉0．05）。两组�Objective To assess the clinical efficacy and safety of a novel chemotherapy regimen for retreatment of smear-positive pulmonary tuberculosis. Methods A total of 88 cases of recurrent smear- positive pulmonary tuberculosis for the first time were enrolled from Wenzhou Central Hospital during July 2013 and March 2014. All subjects were randomly divided into ultra-short course group （58 cases） and standard course group （30 cases）. Patients in ultra-short course group were given 5MfxRfb （Rft） PaZE regimen （ Mfx ： moxifloxacin, Rfb ： rifabutin, Rft ： rifapentine, Pa ： isoniazid aminosalicylate, Z ： pyrazinamide, E： ethambutol） , and those in standard course group were given 2SHREZ/6HRE or 3HREZ/ 6HRE regimen （S： streptomycin, H： isoniazid, R： rifampicin）. Clinical symptoms and signs, negative conversion rates of sputum smear or culture at the end of the second month and the end of the course, absorption of pulmonary lesions and cavity closure were observed, t test or chi-square test was used for data analysis. Results There were 10 patients withdrew from the study, and the rest 78 patients completed whole treatments （50 cases in uhra-short course group and 28 cases in standard course group）. No significant difference was observed in the improvements of clinical symptoms and signs between two groups at the end of the treatment （χ^2 = 0. 836, P 〉 0. 05）. Negative conversion rates of sputum smear and culture at the end of the second month were 76. 00% （38/50） and 72. 00% （36/50） in ultra-short course group, while in standard course group were 71. 43% （20/28） and 67.86% （19/28） , and there was no significant difference between two groups （χ^2 =0. 197 and 0. 148, P 〉0. 05）. At the end of the treatment, negative conversion rates of both sputum smear and cuhure in uhra-short course group were 92. 00% （46/50） , while those in the standard course group were 92. 00% （46/50） （χ^2 = 0. 239, P 〉 0. 05 ）. In ultra-short course group, marked lesi

关 键 词：结核 肺 复发 治疗 

分 类 号：R521[医药卫生—内科学]