茜草素联合标准抗结核化疗方案治疗耐多药肺结核的临床疗效和安全性  

Efficacy and safety of alizarin combined with standard anti-tuberculosis therapy in treatment of multidrug-resistant pulmonary tuberculosis

作　　者：丁汀[1] 毛咏旻[2] 徐金田[4] 兰海平[4] 施军平[3] 娄国强[3] 

机构地区：[1]浙江中医药大学临床医学二系,杭州310053 [2]杭州师范大学附属医院医务科,310015 [3]杭州师范大学附属医院感染科,310015 [4]杭州师范大学附属医院医务科结核科,310015

出　　处：《中华临床感染病杂志》2016年第3期265-269,共5页Chinese Journal of Clinical Infectious Diseases

基　　金：国家自然科学基金项目（81070316）;浙江省医药卫生项目（2013KYB212）;杭州市卫生科技计划项目（2013A20）

摘　　要：目的：评估茜草素治疗耐多药肺结核（MDR－PTB）感染患者的临床疗效和不良反应。方法选择2013年6月至2015年6月杭州师范大学附属医院确诊的 MDR－PTB 患者200例，所有患者随机分为茜草素联合治疗组（观察组）和单纯抗结核治疗组（对照组），各100例。对照组采用标准抗结核化疗方案治疗，观察组在对照组治疗方案上联合茜草素治疗，两组疗程均为8个月。采用χ2检验比较两组患者（包括不同中医证候分型患者的观察组和对照组）的临床疗效、痰培养结核分枝杆菌转阴率、肺部空洞及病灶吸收情况和不良反应。结果观察组临床显效39例，有效51例，无效10例，总有效率为90％（90／100）；对照组临床显效22例，有效35例，无效43例，总有效率为57％（57／100），两组比较差异有统计学意义（χ2＝28．262，P ＜0．01）。热毒郁肺证患者和气滞血瘀证患者中，观察组临床疗效的总有效率均高于对照组（78．78％∶63．33％，χ2＝7．187，P ＜0．05；95．74％∶42．31％，χ2＝73．997，P ＜0．01），而气血不足证患者中两组临床疗效的总有效率比较差异无统计学意义（95．00％∶88．89％，χ2＝5．025，P ＞0．05）。治疗8个月后观察组痰菌转阴率（76％）稍高于对照组痰菌转阴率（55％），但两组比较差异无统计学意义（χ2＝2．190，P ＞0．05）。观察组空洞及病灶吸收率为91％，明显高于对照组（54％），两组比较差异有统计学意义（χ2＝38．294，P ＜0．01）。观察组不良反应发生率为27％，显著低于对照组（66％，χ2＝30．570，P ＜0．01）。结论茜草素联合抗结核化疗药物可提高 MDR－PTB 感染患者的临床疗效，减少化疗药物不良反应。Objective To evaluate the clinical efficacy and adverse reactions of alizarin combined with anti-tuberculosis therapy for multidrug resistant pulmonary tuberculosis （MDR-PTB）.Methods A total of 200 confirmed MDR-PTB patients admitted in the Affiliated Hospital of Hangzhou Normal University during June 2013 and June 2015 were enrolled in the study.Patients were randomly divided into study group and control group （100 in each）.Both groups were given standard anti -tuberculosis treatment for 8 months,nbsp;and additional alizarin was given to study group .Chi-square test was used to assess the differences in clinical efficacy, sputum negative conversion rate, cavity closure and lesion absorption rate , as well as the incidence of adverse reactions between two groups （ including patients categorized according to TCM syndrome ）. Results There were 39 markedly effective cases, 51 improved cases, 10 ineffective cases in study group, and 22 markedly effective cases, 35 improved cases, 43 ineffective cases in the control group.The total effective rate in study group was significantly higher than that in control group （90% vs.57%, χ2 =28.262, P 〈0.01）.For patients with TCM syndrome differentiation as phlegm -heat stagnating lung and those with qi-stagnation induced blood-stasis, alizarin combination therapy had significantly higher total effective rate than standard anti -tuberculosis treatment （78.78% vs.63.33%, χ2 =7.187, P 〈0.05;95.74% vs.42.31%, χ2 =73.997, P 〈0.01）, but the difference was not observed in patients with TCM syndrome differentiation as deficiency of qi and blood （95.00% vs.88.89%, χ2 =5.025, P 〉0.05）. There was no significant difference in sputum negative conversion rate between two groups （76% vs.55%,χ2 =2.190, P 〉0.05）.The cavity closure and lesion absorption rate in study group （ 91%） was significantly higher than that in the control group （54%,χ2 =38.294, P 〈0.01）.The adverse reaction rate in study group was 27%, which was significantly lower than

关 键 词：结核 肺 中草药 茜草素 抗药性 治疗结果 

分 类 号：R521[医药卫生—内科学]