含氯法齐明化疗方案对耐多药肺结核心电图QT间期的影响及危险因素分析  

Effect of clofazimine chemotherapy on QT interval of electrocardiogram in patients with multi-drug resistant pulmonary tuberculosis and analysis of risk factors

作　　者：刘晓飞[1] 孙金昊[1] 贺向红[1] 陶磊[1] 张春艳[1] LIU Xiaofei;SUN Jinhao;HE Xianghong;TAO Lei;ZHANG Chunyan(Hebei Chest Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省胸科医院,河北石家庄050000

出　　处：《中国临床医生杂志》2023年第8期903-906,共4页Chinese Journal For Clinicians

基　　金：河北省医学科学研究课题项目(20210712)。

摘　　要：目的初步探讨使用含氯法齐明的化疗方案对耐多药肺结核(multi-drug resistant pulmonary tuberculosis,MDR-TB)患者的疗效及心电图QT间期的影响,并对其危险因素进行分析,为氯法齐明临床使用的安全性提供依据。方法选取2018年1月至2020年1月河北省胸科医院收治的肺结核患者78例,按随机数字表分为常规组与氯法齐明组,各39例。观察两组治疗后的痰菌变化、病灶吸收、不良反应和QT间期,对两组QT间期延长进行单因素分析和多因素logistics回归分析。结果氯法齐明组治疗12个月后和18个月后的转阴率明显高于常规组(P<0.05);氯法齐明组治疗后复查肺部病灶的吸收率明显高于常规组(P<0.05)。但氯法齐明组中大部分患者都出现不同程度的局部皮肤发红、紫红或紫黑的色素沉着情况,而常规组无发生色素沉着情况(P<0.05)。单因素分析中,患者的性别、体重指数、耐药类型均与QT间期延长无明显相关性(P>0.05);而患者的年龄、治疗方案与QT间期延长的发生有相关性(P<0.05)。在logistics回归多因素分析中,年龄≥45岁(OR=3.931,95%CI 1.484~10.414)、治疗方案含有氯法齐明(OR=6.032,95%CI 2.738~13.288)是导致QT间期延长的独立危险因素。结论对于年龄较大的患者,使用含氯法齐明的化疗方案时,需密切监测QT间期,以防心血管事件的发生。Objective Explore the effect of clofazimine on the efficacy and QT interval of MDR-TB patients,furthermore,analyze its risk factors and provide basis for the safety of clinical use of clofazimine.Methods 78 patients with pulmonary tuberculosis from January 2018 to January 2020 were randomly divided into routine group(n=39)and clofazimin group(n=39).The changes of sputum bacteria quantity,shadow absorption,adverse reactions and QT interval were observed in the two groups after treatment.Univariate analysis and multivariate Logistics regression analysis were used to analyze the prolongation of QT interval in the two groups.Results The negative conversion rate of clofazimin group after 12 and 18 months treatment was significantly higher than that of routine group(P<0.05),and the absorption rate of pulmonary lesions after treatment in clofazimine group was significantly higher than that of routine group(P<0.05).However,most of the patients in the clofazimine group had different degrees of local skin redness,purple or purple pigmentation,while there was no pigmentation in the routine group(P<0.05).In univariate analysis,sex,BMI and type of drug resistance were not significantly correlated with QT interval prolongation,but age and treatment regimen were correlated with QT interval prolongation.In Logistics regression multivariate analysis,age≥45 years old(OR=3.931,95%CI 1.484~10.414)and treatment regimen containing clofazimine(OR=6.032,95%CI 2.738~13.288)were risk factors for prolonged QT interval.Conclusion For older patients,when using clofazimine chemotherapy,the QT interval should be closely monitored to prevent the occurrence of cardiovascular events.

关 键 词：氯法齐明 耐多药肺结核 疗效 QT间期 危险因素 

分 类 号：R978.3[医药卫生—药品]