阿米卡星与卷曲霉素治疗耐多药和广泛耐药结核病的药物不良反应比较  

Comparison of Adverse Drug Reactions between Amikacin and Capreomycin in the Treatment of Multidrug-resistant and Extensively Drug:resistant Tuberculosis

作　　者：王敬[1] 聂文娟[1] 王淑霞[1] 冶赓祉 初乃惠[1] Wang Jing;Nie Wenjuan;Wang Shuxia;Ye Gengzhi;Chu Naihui(Department of tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院结核一科,101149 [2]青海省第四人民医院呼吸一科

出　　处：《结核病与胸部肿瘤》2020年第1期51-55,共5页Tuberculosis and Thoracic Tumor

基　　金：“十三五”重大新药创制科技重大专项(2017ZX09304009);2019年北京市科委滚动项目(JHG0-2019-01-CNH)。

摘　　要：目的比较阿米卡星与卷曲霉素治疗耐多药和广泛耐药肺结核的药物不良反应发生情况。方法选择2014年1月至2017年8月于首都医科大学附属北京胸科医院就诊并采用阿米卡星或卷曲霉素作为治疗药物的耐药结核病患者264例,其中阿米卡星组142例,卷曲霉素组122例。所有患者均进行病史采集、查体、听力、尿常规、肝肾功能和电解质检查,每2周进行耳毒性和肾毒性药物不良反应的评价。结果阿米卡星组56例(39.4%)患者治愈,卷曲霉素组49例(40.2%)患者治愈,差异无显著性(P>0.05)。阿米卡星组平均用药时长为92 d,卷曲霉素组为101 d,差异有显著性(P<0.05)。两组均有患者发生耳毒性药物不良反应,包括耳鸣、听力下降或眩晕症状,阿米卡星组耳毒性发生率(23.9%)高于卷曲霉素组(10.7%),差异有显著性(P<0.05)。两组均有患者发生肾毒性,包括合并尿蛋白阳性或肾功能异常,阿米卡星组肾毒性发生率(7.0%)与卷曲微素组(11.5%)比较差异无显著性(P>0.05)。阿米卡星组无低钾血症发生,卷曲霉素组21.3%发生低钾血症,差异有显著性(P<0.05)。结论相较与阿米卡星,使用卷曲霉素治疗耐多药和广泛耐药肺结核可延长强化期疗程,且耳毒性药物不良反应发生率更低。Objective To compare the adverse drug reactions between amikacin and capreomycin in the treatment of multidrug resistant and extensively drug-resistant pulmonary tuberculosis.Methods From January 2014 to August 2017,264 patients with drug:resistant tuberculosis were treated with amikacin or capreomycin in Beijing Chest Hospital affliated to Capital Medical University,including 142 patients in amikacin group and 122 patients in capreomycin group.Al1 patients were examined for medical history,body examination,hearing,urine routine,liver and kidney function and electrolytes,and the adverse drug reactions of ototoxicity and nephrotoxicity were evaluated every 2 weeks.Results 56 cases(39.4%)of amikacin group were cured,49 cases(40.2%)of capreomycin group were cured,there was no signifcant difference(P>0.05).The average duration of administration was 92 days in amikacin group and 101 days in capreomycin group(P<0.05).The incidence of ototoxicity in amikacin group(23.9%)was higher than that in capreomycin group(10.7%),and the diference was significant(P<0.05).There was renal toxicity in both groups,including positive urinary protein or abnormal renal function.the incidence of renal toxicity in amikacin group(7.0%)was not significantly diferent from that in capreomycin group(11.5%)(P>0.05).There was no hypokalemia in amikacin group,but in capreomycin group,hypokalemia occurred in 21.3%(P<0.05).Conclusion Compared with amikacin,capreomycin in the treatment of multidrug resistant and multidrug-resistant pulmonary tuberculosis can prolong the course of intensive treatment,and the incidence of ototoxicity is lower.

关 键 词：阿米卡星 卷曲霉素 耐多药肺结核 广泛耐药肺结核 

分 类 号：R52[医药卫生—内科学]