含克拉霉素化疗方案在耐多药肺结核治疗中的应用价值及近期疗效分析
|
摘要
目的 :探讨含克拉霉素化疗方案治疗耐多药肺结核的临床疗效分析。方法 :选择2012年6月1日～2012年12月31日到我院住院治疗的、确诊登记的72例耐多药肺结核病连续病例为研究对象。采用随机、平行对照研究,以我院院为单位按流水号排序,采取简单随机分组方法,单号为研究组,双号为对照组,每组各36例患者。研究组采用含克拉霉素化疗方案进行治疗,对照组采用标准化疗方案进行治疗。比较两组临床疗效、痰菌转阴情况、病灶吸收情况、空洞闭合情况、不良反应及生存率。结果 :研究组总有效率略高于对照组,但无统计学意义[66.67%(24/36)vs 55.56%(20/36)];研究组在第3、6、9、12、18、24个月时的痰菌转阴率均略高于对照组,但差异无统计学意义;研究组患者病灶吸收总有效率高于对照组[86.11%(31/36)vs 61.11%(22/36)];研究组空洞闭合率略高于对照组,但差异无统计学意义[88.89%(32/36)vs 72.22%(26/36)];研究组不良反应总发生率低于对照组[16.67%(6/36)vs 50%(18/36)];研究组第24个月时生存率高于对照组[77.78%(28/36)vs 55.56%(20/36)]。结论 :在耐多药肺结核患者中使用含克拉霉素化疗方案效果显著,有助于提高痰菌转阴率,改善病灶及空洞情况,提高生存率,同时降低不良反应发生率,疗效确切,值得推广应用。
Objective To study curative efficacy of chemotherapy regimen containing clarithromycin in treatment of Multi-drug resistant tuberculosis. Methods 72 patients of multidrug resistant pulmonary tuberculosis who received therapy from Jun 1, 2012 to Dec 31, 2012 in our hospital. A randomized, parallel-controlled study was conducted in our hospital based on serial numbers. A simple randomization method was used. The single number was study group and the double number was control group with 36 patients in each group. The study group was treated with clarithromycin chemotherapy and the control group was treated with standard chemotherapy regimen. Clinical efficacy, sputum negative conversion, lesion absorption, empty closure, adverse reactions and survival rate were compared between the two groups. Results The total effective rate of the study group was slightly higher than that of the control group, but not statistically significant [67%(24/36) vs 56%(20/36) ]; The sputum negative rate of the study group at 3, 6, 9, 12, 12, 18 and 24 months was slightly higher than that of the control group, but the difference was not statistically significant; The total effective rate of lesion absorption in study group was higher than that in control group[86.11%(31/36) vs 61.11%(22/36) ]; The closure rate of the study group was slightly higher than that of the control group, but the difference was not statistically significant [88.89%(32/36) vs72.22%(26/36) ]; The total incidence of adverse reactions in the study group was lower than that in the control group[16.67%(6/36)vs 50%(18/36)) ]; The study group at 24 months survival rate was higher than the control group[77.78%(28/36) vs 55.56%(20/36) ].Conclusion The treatment of multi-drug resistant pulmonary tuberculosis patients with clarithromycin chemotherapy can significantly improve the rate of sputum negative conversion rate, improve the lesion and cavity, improve the survival rate, reduce the incidence of adverse reactions, and have definite curative effect. It is worth to be popularized and applied.
Objective To study curative efficacy of chemotherapy regimen containing clarithromycin in treatment of Multi-drug resistant tuberculosis. Methods 72 patients of multidrug resistant pulmonary tuberculosis who received therapy from Jun 1, 2012 to Dec 31, 2012 in our hospital. A randomized, parallel-controlled study was conducted in our hospital based on serial numbers. A simple randomization method was used. The single number was study group and the double number was control group with 36 patients in each group. The study group was treated with clarithromycin chemotherapy and the control group was treated with standard chemotherapy regimen. Clinical efficacy, sputum negative conversion, lesion absorption, empty closure, adverse reactions and survival rate were compared between the two groups. Results The total effective rate of the study group was slightly higher than that of the control group, but not statistically significant [67%(24/36) vs 56%(20/36) ]; The sputum negative rate of the study group at 3, 6, 9, 12, 12, 18 and 24 months was slightly higher than that of the control group, but the difference was not statistically significant; The total effective rate of lesion absorption in study group was higher than that in control group[86.11%(31/36) vs 61.11%(22/36) ]; The closure rate of the study group was slightly higher than that of the control group, but the difference was not statistically significant [88.89%(32/36) vs72.22%(26/36) ]; The total incidence of adverse reactions in the study group was lower than that in the control group[16.67%(6/36)vs 50%(18/36)) ]; The study group at 24 months survival rate was higher than the control group[77.78%(28/36) vs 55.56%(20/36) ].Conclusion The treatment of multi-drug resistant pulmonary tuberculosis patients with clarithromycin chemotherapy can significantly improve the rate of sputum negative conversion rate, improve the lesion and cavity, improve the survival rate, reduce the incidence of adverse reactions, and have definite curative effect. It is worth to be popularized and applied.
引文
[1]胡琼伟,徐凌忠,周成超,等.肺结核患者服药依从性现状及影响因素分析[J].中国公共卫生, 2014, 30(04):403-405.
[2]Jan F, Hassan M, Muhammad N, et al. Electrolytes imbalance caused by amikacin in patients receiving multi drug resistance-tuberculosis treatment at Hazara region Kpk, Pakistan[J]. Tuberk Toraks, 2017,65(3):193-201.
[3]张启龙,高隆,杨俊.莫西沙星对多重耐药肺结核患者血清PCT和s TREM-1水平的影响[J].医学临床研究, 2016, 33(12):2295-2298.
[4]刘明,马英莲,刚永桂,等.左氧氟沙星和卷曲霉素联合化疗方案用于耐多药肺结核的临床观察[J].中国药房, 2016, 27(27):3788-3790.
[5]Roh HF, Kim J, Nam SH, et al. Pulmonary resection for patients with multidrug-resistant tuberculosis based on survival outcomes:a systematic review and meta-analysis[J]. Eur J Cardiothorac Surg, 2017, 52(4):673-678.
[6]中华医学会结核病学分会.肺结核诊断和治疗指南[J].中华结核和呼吸杂志.2001, 24(2):70-74.
[7]鹿振辉,张惠勇,耿佩华,等.中医辨证联合化疗治疗耐多药肺结核388例临床观察——多中心随机对照试验[J].中医杂志, 2014,55(17):1469-1474.
[8]Vasconcelos KA, Frota SMMC, Ruffino-Netto A, et al. The importance of audiometric monitoring in patients with multidrug-resistant tuberculosis[J]. Rev Soc Bras Med Trop, 2017, 50(5):646-651.
[9]屈满英,蒋之,封文军,等.抗痨汤治疗耐多药肺结核的临床疗效观察[J].中国现代医学杂志, 2014, 24(32):91-94.
[10] Bouton TC, Phillips PPJ, Mitnick CD, et al. An optimized background regimen design to evaluate the contribution of levofloxacin to multidrugresistant tuberculosis treatment regimens:study protocol for a randomized controlled trial[J]. Trials, 2017, 18(1):563.
[11]易恒仲,孙圣华,杨坤云.含莫西沙星和左氧氟沙星方案治疗耐多药肺结核的前瞻性临床研究[J].医学临床研究, 2010, 27(9):1640-1643.
[12] Kebede A, Demisse D, Assefa M, et al. Performance of MTBDRplus assay in detecting multidrug resistant tuberculosis at hospital level[J].BMC Res Notes, 2017, 10(1):661.
[13]黄葵,蓝珂,李勇,等.老年AIDS合并初治肺结核病人化疗药物强化期不良反应观察[J].中国艾滋病性病, 2015, 21(07):575-577.
[14]陈雪林,石芸,马亮亮,等.利肺片联合化疗治疗老年初治肺结核疗效观察[J].中华中医药杂志, 2015, 30(08):3037-3039.
[15] Scuffell J, Boccia D, Garcia Velarde F, et al. Mental disorders and drug/alcohol use in patients commencing extensively drug-resistant tuberculosis treatment[J]. Public Health Action, 2017, 7(3):237-239.
[16] Jelly I, Peters MDJ. Community-based management of multiple drug resistant tuberculosis in a tertiary hospital in Tanzania:a best practice implementation project[J]. JBI Database System Rev Implement Rep,2017, 15(12):3092-3101.
[17]刚永桂.白及抗痨凝胶辅助化疗药物治疗空洞型肺结核及肺外结核[J].中国实验方剂学杂志, 2015, 21(17):195-198.
[18]梁冰,伍红,苏静怡,等.左氧氟沙星联合抗结核化疗方案治疗复治涂阳肺结核的临床研究[J].实用医学杂志, 2015, 31(18):2981-2984.
[19] Che Y, Song Q, Yang T, et al. Fluoroquinolone resistance in multidrugresistant Mycobacterium tuberculosis independent of fluoroquinolone use[J]. Eur Respir J, 2017, 50(6). pii:1701633.
[20] Mansoori N, Douraghi M, Rajabloo AA, et al. Mycobacterium tuberculosis Complex Drug Resistance in a High Tuberculosis Incidence Area from the WHO Eastern Mediterranean Region[J]. J Pharm Pharm Sci,2017, 20(1):428-434.
[21]张海,何欣.中药结核丸辅助正规化疗对老年肺结核患者临床症状及免疫力的改善作用[J].中国地方病防治杂志, 2017, 32(01):92.
[2]Jan F, Hassan M, Muhammad N, et al. Electrolytes imbalance caused by amikacin in patients receiving multi drug resistance-tuberculosis treatment at Hazara region Kpk, Pakistan[J]. Tuberk Toraks, 2017,65(3):193-201.
[3]张启龙,高隆,杨俊.莫西沙星对多重耐药肺结核患者血清PCT和s TREM-1水平的影响[J].医学临床研究, 2016, 33(12):2295-2298.
[4]刘明,马英莲,刚永桂,等.左氧氟沙星和卷曲霉素联合化疗方案用于耐多药肺结核的临床观察[J].中国药房, 2016, 27(27):3788-3790.
[5]Roh HF, Kim J, Nam SH, et al. Pulmonary resection for patients with multidrug-resistant tuberculosis based on survival outcomes:a systematic review and meta-analysis[J]. Eur J Cardiothorac Surg, 2017, 52(4):673-678.
[6]中华医学会结核病学分会.肺结核诊断和治疗指南[J].中华结核和呼吸杂志.2001, 24(2):70-74.
[7]鹿振辉,张惠勇,耿佩华,等.中医辨证联合化疗治疗耐多药肺结核388例临床观察——多中心随机对照试验[J].中医杂志, 2014,55(17):1469-1474.
[8]Vasconcelos KA, Frota SMMC, Ruffino-Netto A, et al. The importance of audiometric monitoring in patients with multidrug-resistant tuberculosis[J]. Rev Soc Bras Med Trop, 2017, 50(5):646-651.
[9]屈满英,蒋之,封文军,等.抗痨汤治疗耐多药肺结核的临床疗效观察[J].中国现代医学杂志, 2014, 24(32):91-94.
[10] Bouton TC, Phillips PPJ, Mitnick CD, et al. An optimized background regimen design to evaluate the contribution of levofloxacin to multidrugresistant tuberculosis treatment regimens:study protocol for a randomized controlled trial[J]. Trials, 2017, 18(1):563.
[11]易恒仲,孙圣华,杨坤云.含莫西沙星和左氧氟沙星方案治疗耐多药肺结核的前瞻性临床研究[J].医学临床研究, 2010, 27(9):1640-1643.
[12] Kebede A, Demisse D, Assefa M, et al. Performance of MTBDRplus assay in detecting multidrug resistant tuberculosis at hospital level[J].BMC Res Notes, 2017, 10(1):661.
[13]黄葵,蓝珂,李勇,等.老年AIDS合并初治肺结核病人化疗药物强化期不良反应观察[J].中国艾滋病性病, 2015, 21(07):575-577.
[14]陈雪林,石芸,马亮亮,等.利肺片联合化疗治疗老年初治肺结核疗效观察[J].中华中医药杂志, 2015, 30(08):3037-3039.
[15] Scuffell J, Boccia D, Garcia Velarde F, et al. Mental disorders and drug/alcohol use in patients commencing extensively drug-resistant tuberculosis treatment[J]. Public Health Action, 2017, 7(3):237-239.
[16] Jelly I, Peters MDJ. Community-based management of multiple drug resistant tuberculosis in a tertiary hospital in Tanzania:a best practice implementation project[J]. JBI Database System Rev Implement Rep,2017, 15(12):3092-3101.
[17]刚永桂.白及抗痨凝胶辅助化疗药物治疗空洞型肺结核及肺外结核[J].中国实验方剂学杂志, 2015, 21(17):195-198.
[18]梁冰,伍红,苏静怡,等.左氧氟沙星联合抗结核化疗方案治疗复治涂阳肺结核的临床研究[J].实用医学杂志, 2015, 31(18):2981-2984.
[19] Che Y, Song Q, Yang T, et al. Fluoroquinolone resistance in multidrugresistant Mycobacterium tuberculosis independent of fluoroquinolone use[J]. Eur Respir J, 2017, 50(6). pii:1701633.
[20] Mansoori N, Douraghi M, Rajabloo AA, et al. Mycobacterium tuberculosis Complex Drug Resistance in a High Tuberculosis Incidence Area from the WHO Eastern Mediterranean Region[J]. J Pharm Pharm Sci,2017, 20(1):428-434.
[21]张海,何欣.中药结核丸辅助正规化疗对老年肺结核患者临床症状及免疫力的改善作用[J].中国地方病防治杂志, 2017, 32(01):92.