含贝达喹啉方案治疗48例耐药肺结核患者的临床分析  

Clinical analysis of 48 cases of drug-resistant pulmonary tuberculosis treated with bedaquiline containing regimen

作　　者：冯治宇[1] 黄艳霞 汪敏[1] 黄显林 张宏[1] 袁园[1] 邝浩斌[1] FENG Zhi-yu;HUANG Yan-xia;WANG Min(Department Four of Internal Medecine,Guangzhou Chest Hospital,Guangzhou 510095,China)

机构地区：[1]广州市胸科医院内四科,呼吸疾病国家重点实验室,510095

出　　处：《中国现代药物应用》2023年第24期6-11,共6页Chinese Journal of Modern Drug Application

基　　金：广州市医学重点学科(项目编号:2021-2023)结核病学;广东省医学科学技术研究基金项目(项目编号:A2022328)。

摘　　要：目的研究含贝达喹啉(BDQ)方案治疗48例耐药肺结核[包括利福平耐药肺结核(RR-TB)、耐多药肺结核(MDR-TB)、广泛耐药肺结核(XDR-TB)/准广泛耐药肺结核(Pre-XDR-TB)]患者的疗效及使用贝达喹啉后Q-T间期(QTc)延长的不良反应发生情况。方法将50例接受贝达喹啉治疗的患者纳入回顾性队列研究,其中2例失访,最终纳入48例完成治疗的患者。所有患者均采用贝达喹啉联合背景方案组成的联合化疗方案进行治疗。分析患者治疗后的临床症状、痰菌情况、肺部病灶变化、心电图QTc、治疗失败情况。结果48例完成24周贝达喹啉治疗的患者均有不同程度的临床症状,包括咳嗽、咳痰、发热、气促、咯血、盗汗消瘦、纳差等,经治疗24周后临床症状均有所好转或消失。48例完成24周贝达喹啉治疗的患者中,8周末痰涂片转阴率为81.25%(39/48),痰培养转阴率为85.42%(41/48),24周末痰菌转阴率为97.92%(47/48)。可见使用贝达喹啉治疗8周内痰菌能否转阴是使用贝达喹啉治疗24周痰菌能否转阴的关键。48例完成24周贝达喹啉治疗的患者分别在治疗第12周和24周复查胸部CT,动态观察胸部病灶变化,12周后肺部病灶吸收率为100.00%(48/48),其中显吸占8.33%(4/48),吸收占91.67%(44/48),无不变和恶化病例;有空洞的37例患者中缩小占59.46%(22/37),闭合占18.92%(7/37),不变占21.62%(8/37)。24周后肺部病灶吸收率为100.00%(48/48),其中显吸占50.00%(24/48),吸收占50.00%(24/48),无不变和恶化病例;有空洞的37例患者中缩小占37.84%(14/37),闭合占48.65%(18/37),不变占13.51%(5/37)。从2个阶段影像学变化可以看出,使用贝达喹啉组成合理的抗结核治疗方案,可以促进肺部病灶的吸收,空洞的缩小或闭合,即使是治疗24周后痰菌无法转阴的患者,肺部病灶亦可吸收。48例患者中25例心电图监测出现QTc延长(QTc≥450 ms),占52.08%,发生率较高。在基线心电图QTc均正常的患者�Objective To investigate the efficacy of bedaquinoline(BDQ)containing regimen in the treatment of 48 patients with drug-resistant pulmonary tuberculosis[including rifampicin-resistant tuberculosis(RR-TB),multidrug resistant tuberculosis(MDR-TB),extensively drug-resistant tuberculosis(XDR-TB)/pre-extensively drug-resistant tuberculosis (Pre-XDR-TB)] and the occurrence of corrected QT interval (QTc) prolongation after bedaquinoline use. Methods A retrospective cohort study was conducted on 50 patients who received treatment with bedaquiline, 2 of whom were lost to follow-up, and 48 patients who completed treatment were included. All patients were treated with combination chemotherapy consisting of bedaquinoline combined with background regimen. The clinical symptoms, sputum bacteria, changes in lung lesions, QTc on electrocardiogram and treatment failure were analyzed. Results 48 patients who completed 24 weeks of bedaquinoline treatment had different degrees of clinical symptoms, including coughing, expectoration, fever, shortness of breath, hemoptysis, night sweating and weight loss, and poor appetite, and the clinical symptoms improved or disappeared after 24 weeks of treatment. Among 48 patients who completed 24 weeks of bedaquinoline treatment, the sputum smear conversion rate was 81.25% (39/48) at the end of 8th week, sputum culture conversion rate was 85.42% (41/48), and sputum conversion rate was 97.92% (47/48) at the end of 24th week. Whether sputum could convert to negative after 8 weeks of treatment with bedaquinoline was the key to whether sputum can convert to negative after 24 weeks of treatment with bedaquinoline. 48 patients who completed 24 weeks of treatment with betamethasone underwent chest CT scans at the 12th and 24th weeks of treatment, dynamically observing changes in chest lesions. After 12 weeks, the absorption rate of lung lesions was 100.00% (48/48), of which 8.33% (4/48) were significantly absorbed and 91.67% (44/48) were absorbed, no unchanged or deteriorating cases;of the 37 patients

关 键 词：贝达喹啉 Q-T间期延长 耐药肺结核 痰菌转阴率 病灶吸收 

分 类 号：R521[医药卫生—内科学]