贝达喹啉联合背景方案治疗耐药肺结核的疗效  

Efficacy of Bedaquiline Combined with Background Regimen in the Treatment of Drug-Resistant Pulmonary Tuberculosis

作　　者：冯治宇[1,2] 邝浩斌 汪敏[1,2] 张宏 袁园[1,2] 黄显林 FENG Zhi-yu;KUANG Hao-bin;WANG Min;ZHANG Hong;YUAN Yuan;HUANG Xian-lin(Guangzhou Chest Hospital,Guangdong Province,Guangzhou510095;Guangzhou Key Laboratory of Tuberculosis Research,Guangdong Province,Guangzhou510095)

机构地区：[1]广东省广州市胸科医院,广州510095 [2]广东省广州市结核病研究重点实验室,广州510095

出　　处：《实用中西医结合临床》2024年第1期6-9,共4页Practical Clinical Journal of Integrated Traditional Chinese and Western Medicine

基　　金：广东省医学科学技术研究基金项目(编号:A2022328);广东省广州市医学重点学科(2021~2023)结核病学;广东省广州市科技计划项目(编号:2023A03J0539)。

摘　　要：目的:探讨贝达喹啉联合背景方案治疗耐药肺结核的疗效。方法:回顾性选择2022年1月至2023年1月广东省广州市胸科医院收治的159例耐药肺结核患者,按随机对照原则分组。对照组(80例)接受常规背景方案治疗,研究组(79例)在其基础上联合贝达喹啉治疗。于6个月后评估两组病灶吸收率、痰菌转阴率及空洞闭合率,对比两组治疗前后血清肝功能指标、心电图QTc变化,统计两组不良反应发生率。结果:研究组病灶吸收率、痰菌转阴率及空洞闭合率均较对照组高(P<0.05)。两组治疗后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平升高(P<0.05);研究组治疗后ALT、AST水平与对照组相比,差异无统计学意义(P>0.05)。两组治疗后QTcF值升高,心率降低(P<0.05)。且研究组治疗后QTcF值比对照组高,心率比对照组低(P<0.05)。两组转氨酶升高、白细胞减少及胃肠道反应发生率对比,差异无统计学意义(P>0.05);研究组QT间期延长发生率显著高于对照组(P<0.05)。结论:贝达喹啉联合背景方案治疗耐药肺结核的疗效较佳,未引起肝功能指标异常,但QT间期延长发生率较高。Objective:To explore the efficacy of bedaquiline combined with background regimen in the treatment of drug-resistant pulmonary tuberculosis.Methods:A total of 159 patients with drug-resistant pulmonary tuberculosis admitted to Guangzhou Chest Hospital Guangdong Province from January 2022 to January 2023 were retrospctively selected and randomly grouped according to randomized control principle.The control group(80 cases)received conventional background regimen,and the study group(79 cases)was treated with bedaquiline on its basis.After 6 months,the lesion absorption rate,sputum conversion rate,and cavity closure rate were evaluated in both groups.The changes in serum liver function indicators,electrocardiogram QTc interval,and incidence of adverse reactions before and after treatment were compared between the two groups.Results:Compared with the control group,the study group showed significant improvement in lesion absorption rate,sputum conversion rate,and cavity closure rate(P<0.05).Both groups had increased levels of ALT and AST after treatment(P<0.05),but there was no statistically significant difference in ALT and AST levels between the two groups(P>0.05).Both groups showed an increase in QTcF value and a decrease in heart rate after treatment(P<0.05).The study group had significantly higher QTcF value but lower heart rate than the control group(P<0.05).There was no significant difference between the two groups in terms of elevated transaminase level,decreased white blood cell count,or incidence of gastrointestinal reactions(P>0.05),but the incidence of prolonged QT interval was in the study group higher than in control group(P<0.05).Conclusion:Bedaquiline combined with background regimen has good efficacy for treating drug-resistant pulmonary tuberculosis without causing liver dysfunction;However,it is associated with a higher incidence of prolonged QT interval.

关 键 词：耐药肺结核 贝达喹啉 背景方案 疗效 肝功能 

分 类 号：R521[医药卫生—内科学]