含环丝氨酸联合胸腺肽方案治疗耐多药肺结核的疗效及安全性
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摘要
目的探究含环丝氨酸联合胸腺肽方案治疗耐多药肺结核(MDR-TB)的疗效及安全性。方法回顾性分析2013年9月至2016年8月西安市胸科医院收治的130例MDR-TB患者的临床资料,按照不同的治疗方法分为观察组和对照组,每组各65例。对照组予常规耐多药肺结核标准治疗方案治疗,观察组在此基础上予以含环丝氨酸联合胸腺肽方案治疗,两组均治疗24个月。对比两组患者临床疗效、不同时期的痰结核杆菌转阴率及药物不良反应情况。结果观察组患者治疗后6、12、24个月的痰结核杆菌阴转率分别为66. 2%(43/65)、78. 5%(51/65)、92. 3%(60/65),分别高于对照组同期的38. 5%(25/65)、43. 1%(28/65)、63. 1%(41/65),两组比较差异均具有统计学意义(χ~2=6. 224、9. 681、13. 657,P <0. 05)。观察组患者治疗成功率为92. 3%(60/65),高于对照组的63. 1%(41/65)(χ~2=13. 657,P <0. 05)。观察组患者药物不良反应发生率为7. 8%(5/65),低于对照组的10. 9%(7/65)(χ~2=0. 095,P> 0. 05)。结论对MDR-TB患者应用含环丝氨酸联合胸腺肽方案治疗有助于进一步提高临床疗效,并可促进痰结核杆菌转阴,有利于病灶吸收及病灶空洞闭合,且用药安全性较高。
Objective To explore the efficacy and safety of cycloserine-containing thymosin regimen in the treatment of multidrug-resistant tuberculosis( MDR-TB). Methods The clinical data of 130 patients with MDR-TB admitted to Xi'an Chest Hospital from September2013 to August 2016 were retrospectively analyzed. According to different treatment methods,they were divided into observation group and control group,with 65 cases in each group. The control group was treated with conventional multi-drug-resistant tuberculosis standard treatment regimen. The observation group was treated with cycloserine-containing thymosin peptide regimen,and both groups were treated for 24 months. The clinical efficacy of the two groups of patients,the conversion rate of Mycobacterium tuberculosis and the adverse drug reactions in different periods were compared. Results The negative conversion rates of Mycobacterium tuberculosis in the observation group were 66. 2%( 43/65),78. 5%( 51/65),and 92. 3%( 60/65) at 6,12,and 24 months after treatment,respectively,which were higher than those of the control group,38. 5%( 25/65),43. 1%( 28/65),and 63. 1%( 41/65) with statistically significant difference( χ2= 6. 224,9. 681,13. 657,P < 0. 05). The treatment success rate of the observation group was 92. 3%( 60/65),which was higher than that of the control group( 63. 1%,41/65)( χ2= 13. 657,P< 0. 05). The incidence of adverse drug reactions in the observation group was 7. 8%( 5/65),which was lower than that in the control group( 10. 9%( 7/65)( χ2= 0. 095,P > 0. 05). Conclusion The application of cycloserine-containing thymosin in patients with MDR-TB can further improve the clinical efficacy,and can promote the conversion of tubercle bacilli,facilitate the absorption of lesions and the closure of lesions,and the safety of medication is high.
Objective To explore the efficacy and safety of cycloserine-containing thymosin regimen in the treatment of multidrug-resistant tuberculosis( MDR-TB). Methods The clinical data of 130 patients with MDR-TB admitted to Xi'an Chest Hospital from September2013 to August 2016 were retrospectively analyzed. According to different treatment methods,they were divided into observation group and control group,with 65 cases in each group. The control group was treated with conventional multi-drug-resistant tuberculosis standard treatment regimen. The observation group was treated with cycloserine-containing thymosin peptide regimen,and both groups were treated for 24 months. The clinical efficacy of the two groups of patients,the conversion rate of Mycobacterium tuberculosis and the adverse drug reactions in different periods were compared. Results The negative conversion rates of Mycobacterium tuberculosis in the observation group were 66. 2%( 43/65),78. 5%( 51/65),and 92. 3%( 60/65) at 6,12,and 24 months after treatment,respectively,which were higher than those of the control group,38. 5%( 25/65),43. 1%( 28/65),and 63. 1%( 41/65) with statistically significant difference( χ2= 6. 224,9. 681,13. 657,P < 0. 05). The treatment success rate of the observation group was 92. 3%( 60/65),which was higher than that of the control group( 63. 1%,41/65)( χ2= 13. 657,P< 0. 05). The incidence of adverse drug reactions in the observation group was 7. 8%( 5/65),which was lower than that in the control group( 10. 9%( 7/65)( χ2= 0. 095,P > 0. 05). Conclusion The application of cycloserine-containing thymosin in patients with MDR-TB can further improve the clinical efficacy,and can promote the conversion of tubercle bacilli,facilitate the absorption of lesions and the closure of lesions,and the safety of medication is high.
引文
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[12]翁加豪,杨仪,陈伟生,等.依替米星联合胸腺肽肠溶片治疗耐多药肺结核对疗效改善、肺功能及生活质量的影响[J].黑龙江医学,2016,40(12):1134-1136.
[13]徐江涛,胡晓虹,王豫闽.胸腺肽联合抗结核药物治疗耐多药肺结核的临床效果评价[J].中国当代医药,2018,25(8):142-144,148.
[2]中国防痨协会.耐药结核病化学治疗指南(2015)[J].中国防痨杂志,2015,37(5):421-469.
[3]中华医学会.临床诊疗指南:结核病分册[M].北京:人民卫生出版社,2005:15-16.
[4]何贵清,施伎蝉,吴联朋,等.耐多药肺结核患者基线菌株二线抗结核药物耐药情况分析[J].中国现代医生,2018,56(15):84-87.
[5]周美兰,符志军,张和武,等.武汉市359例耐多药肺结核患者治疗效果分析[J].中国热带医学,2017,17(3):248-252.
[6]吕振东.研究免疫调节剂胸腺肽联合抗结核药物治疗耐多药肺结核的效果[J].中国保健营养,2016,26(11):214-215.
[7]覃舒扬.莫西沙星与左氧氟沙星联合HRZE化疗方案用于多耐药性肺结核中的临床对比研究[J].临床和实验医学杂志,2014,13(12):1003-1006.
[8]林武振.环丝氨酸联合胸腺肽对耐多药肺结核患者痰菌阴转及细胞免疫功能的影响[J].现代诊断与治疗,2017,28(22):4234-4236.
[9]张国红.环丝氨酸联合胸腺肽对耐多药肺结核患者痰菌阴转率及血清T细胞亚群、γ-干扰素水平的影响[J].中国实用医刊,2017,44(23):93-95.
[10]吴小霞,辛朝雄,杨俭,等.环丝氨酸联合胸腺肽干预耐多药肺结核研究[J].热带医学杂志,2017,17(7):936-939,944.
[11]辛朝雄,吴小霞,杨俭,等.含环丝氨酸联合胸腺肽方案治疗耐多药肺结核的效果[J].广东医学,2016,37(17):2646-2651.
[12]翁加豪,杨仪,陈伟生,等.依替米星联合胸腺肽肠溶片治疗耐多药肺结核对疗效改善、肺功能及生活质量的影响[J].黑龙江医学,2016,40(12):1134-1136.
[13]徐江涛,胡晓虹,王豫闽.胸腺肽联合抗结核药物治疗耐多药肺结核的临床效果评价[J].中国当代医药,2018,25(8):142-144,148.