含贝达喹啉耐药结核治疗方案对患者心电图QT间期的影响  

Effect of treatment regimen containing Bedaquiline for drug-resistant tuberculosis on the QT interval of electrocardiogram

作　　者：万荣 李光妹 季永静 刘蕾 崔灿灿 李明武 Wan Rong;Li Guangmei;Ji Yongjing;Liu Lei;Cui Cancan;Li Mingwu(Second Department of Tuberculosis,Kunming Third People's Hospital,Kunming 650041,China;School of Public Health,Dali University,Dali 671003,China)

机构地区：[1]昆明市第三人民医院结核二科,云南昆明650041 [2]大理大学公共卫生学院,云南大理671003

出　　处：《临床荟萃》2024年第7期630-634,共5页Clinical Focus

基　　金：昆明市卫生健康委员会卫生科研课题项目——含新药贝达喹啉治疗耐药肺结核的临床观察(2021-03-08-006)。

摘　　要：目的探索含贝达喹啉耐药结核治疗方案对患者心电图QT间期的影响。方法选取2018年8月-2022年12月在昆明市第三人民医院结核科接受耐药治疗结核病患者204例。治疗方案含贝达喹啉(观察组)84例,其中退出4例、死亡2例,最终78例。治疗方案不含贝达喹啉(对照组)120例,死亡1例、退出4例,最终115例。收集并记录两组治疗不同阶段心电图QT间期和临床资料。结果与基线比较,观察组治疗的第2、4、8、12、16、20、24周心电图QT间期均较高,差异有统计学意义(P<0.05)。观察组治疗第16、20、24周较对照组QT期间长,差异均有统计学意义(P<0.05)。观察组QT间期大于500 ms有15例(19.2%,15/78),其中7例背景方案含氯法齐明和莫西沙星。结论含贝达喹啉的治疗方案会引起患者心电图QT间期的延长,但背景方案含氯法齐明和喹诺酮类更会加重QT间期的延长,因此使用贝达喹啉联合氯法齐明和喹诺酮类时更应加强心电图监测及心脏检查。Objective To explore the effect of treatment regimen containing Bedaquiline for drug-resistant tuberculosis on the QT interval of electrocardiogram.Methods A total of 204 patients with drug-resistant tuberculosis admitted in the Department of Tuberculosis,Kunming Third People's Hospital from August 2018 to December 2022 were selected.Eighty-four patients treated with Bedaquiline-containing regimen were included in the observation group.After excluding 4 dropouts and 2 deaths,78 cases were finally included in the observation group.A total of 120 patients treated with the regimen without Bedaquiline were enrolled in the control group,and finally 115 were eligible(4 dropouts and 1 death).The QT interval and clinical data of two groups at different stages of treatment were compared.Results Compared with the baseline,the QT interval of electrocardiogram in the observation group was significantly higher at the 2 nd,4 th,8 th,12 th,16 th,20 th and 24 th weeks of treatment significantly(P<0.05).The QT period of the observation group was significantly longer than that of the control group at the 16 th,20 th and 24 th week of treatment(P<0.05).In the observation group,there were 15 cases(19.2%,15/78)with QT interval greater than 500 ms,including 7 cases of background regimen containing clofazimine and moxifloxacin.Conclusion Treatment regimen containing Bedaquiline for drug-resistant tuberculosis prolongs QT interval,but the background regimen containing Clofazimine and Quinolones aggravates the prolonged QT interval.Therefore,electrocardiogram monitoring and cardiac examination should be strengthened when using betamethasone in combination with Clofazimine and Quinolones.

关 键 词：结核 抗多种药物性 QT间期延长 贝达喹啉 氯法齐明 喹诺酮 

分 类 号：R52[医药卫生—内科学]