不同短疗程化疗方案治疗首次复治肺结核病的疗效及对治疗依从性和预后的影响  

Efficacy and treatment compliance and prognosis of different short-course chemotherapy regimens in patients with first time retreatment of pulmonary tuberculosis

作　　者：金玲玲 蒋贤高 宁洪叶 谢军平[2] JIN Lingling;JIANG Xiangao;NING Hongye;XIE Junping(Department of Infectious Diseases,Wenzhou Central Hospital in Zhejiang Province,Wenzhou 325000,China;Department of Respiratory,Second Affiliated Hospital of Nanchang University,Nanchang,330006,China)

机构地区：[1]浙江省温州市中心医院感染科,浙江温州325000 [2]南昌大学第二附属医院呼吸科,江西南昌330006

出　　处：《中国现代医生》2019年第11期114-119,共6页China Modern Doctor

基　　金：浙江省温州市科技局公益性计划项目(Y20160241)

摘　　要：目的探讨不同短疗程化疗方案在菌阳复治肺结核患者中的疗效及治疗依从性和预后情况。方法选择2014年1月~2016年1月我院治疗的菌阳性复治肺结核患者(135例),随机数表法分为标准组、短疗程组和超短程组,每组45例,标准组给予2HRZE/4HRE标准方案,短疗程组给予5MRftPZ方案,超短程组给予2HRZM/2MR方案,比较三组患者的服药依从性自我效能量表评分、临床疗效、治疗前后痰涂片情况、治疗后复发及不良反应情况。结果短疗程组和超短程组的MASES评分均明显高于标准组(P<0.05)。短疗程组的治疗成功率明显高于标准组和超短程组,差异均有统计学意义(P<0.05),超短程组和短疗程组无统计学差异(P>0.05)。短疗程组的转阴时间明显低于标准组(HR=0.592,P=0.004)和超短程组(HR=0.619,P=0.012),超短程组和标准组间无明显差异(HR=0.956,P=0.789)。短疗程组的复发风险明显低于标准组(HR=0.238,P=0.004)和超短程组(HR=0.274,P=0.012),超短程组和标准组间无明显差异(HR=0.868,P=0.749)。三组的治疗相关不良反应发生率分别为26.67%、11.11%和8.89%,其中,超短程组的不良反应发生率明显低于标准组(P<0.05),而短疗程组与标准组间无统计学差异(P>0.05)。结论在菌阳复治肺结核治疗中应用短疗程方案有较高治疗依从性;2HRMZ/2MR方案与标准方案疗效相当且安全性较好;5MRftPZ方案具有较好的治疗肺结核的疗效,能够明显缩短治疗时间并有效降低复发及治疗不良反应。Objective To investigate the efficacy, treatment compliance and prognosis of different short-course chemotherapy regimens in patients with first time retreatment of pulmonary tuberculosis. Methods A total of 135 patients with bacterial positive and first time retreatment of pulmonary tuberculosis who were treated in our hospital from January 2014 to January 2016 were randomly divided into standard group, short course group and ultra-short-course group, with 45 cases in each group. The standard group was given 2HRZE/4HRE standard regimen, and the short-course group was given 5MRftPZ regimen, and the ultra-short-course group was given 2HRZM/2MR regimen. The treatment adherence, sputum smear negative rate, clinical efficacy, adverse reaction rate and recurrence rate were compared between the three groups. Results The MASES scores of the short-course group and the ultra-short-course group were significantly higher than those of the standard group(P<0.05). The success rate of the short-course group was significantly higher than that of the standard group and the ultra-short-course group, with statistically significant difference(P<0.05). There was no significant difference between the ultra-short-course group and the short-course group(P>0.05).The time of negative conversion in the short course group was significantly lower than that in the standard group (HR=0.592, P=0.004) and the ultra-short-course group(HR=0.619, P=0.012). There was no significant difference between the ultra-short-course group and the standard group(HR=0.956, P=0.789). The risk of recurrence in the short-course group was significantly lower than that in the standard group(HR=0.238, P=0.004) and the ultra-short-course group (HR=0.274, P=0.012). There was no significant difference between the ultra-short- course group and the standard group (HR=0.868, P=0.749). The incidence of treatment-related adverse reactions in the three groups was 26.67%, 11.11%, and 8.89%, respectively. Among them, the incidence of adverse reactions in the ultra-short-course

关 键 词：结核 肺 再治疗 疗程 治疗结果 复发 

分 类 号：R320.2[医药卫生—人体解剖和组织胚胎学]