异烟肼、利福平不同剂型对肺结核病患者的临床疗效
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摘要
目的比较不同剂型异烟肼、利福平治疗肺结核的有效性及安全性,指导临床合理用药。方法对2016年5月至2017年6月昆明市第三人民医院住院的128例初治肺结核患者随机分为注射异烟肼、利福平组和口服异烟肼、利福平组,其中注射组65例,口服组63例,治疗方案统一采用规范2HREZ/4HR。观察不同剂型在肺结核患者治疗中临床疗效及副反应有无差异性。结果注射组痰菌阴转率高于口服组,但治疗1月末和2月末2组痰菌阴转率均差异无统计学意义(χ2=1.422,2.652;P>0.05);治疗2月末的注射组和口服组病灶显吸率分别为57.1%,33.3%,差异有统计学意义(χ2=7.025,P=0.008<0.01);治疗2月末的注射组和口服组的空洞闭合率分别为55.0%和29.4%,2组差异无统计学意义(χ2=2.451,P=0.117>0.05);2组治疗1月和2月后的病灶和空洞变化无效率均差异无统计学意义(P>0.05);注射组的胃肠道反应发生率3.4%,明显低于口服组的12.7%,注射组肝功能损害的发生率12.3%,高于口服组7.9%,但2组不良反应各指标比较差异无统计学意义(P>0.05);注射组总不良反应发生率为23.1%,口服组总不良反应发生率为30.2%,2组比较差异无统计学意义(χ2=0.823,P>0.05)。结论注射组异烟肼、利福平治疗肺结核疗效高于口服组,安全性相似。
Objective To compare the effectivity and safety of isoniazide and rifampicin with different dosage forms in the treatment of pulmonary tuberculosis and to guide clinical rational drug use. Me thods 128 initially treated patients with pulmonary tuberculosis admitted into the Third People's Hospital of Kunming City from May2016 to June 2017 were randomly divided into isoniazid-injection group and isoniazid oral-administration group,65 patients in the injection group and 63 in the oral administration group. The standard 2 HREZ#4 HR was uniformly adopted in the therapeutic schedules. The existence of differences in the clinical effectiveness and side effects of different dosage forms in the treatment of pulmonary tuberculosis were observed. Re s ult The negative rate of sputum necrosis in the injection group was higher than that in the oral administration group, but there was no statistic difference in the negative rates of sputum necrosis in the two groups after one-month and two-month treatment(x2=1.422,2.652; all P > 0.05);Inhalation rate in the injection group and the oral administration group after 2 months of treatment were 57.1% and 33.3% respectively,and there were statistic differences(χ2= 7.025,P =0.008 < 0.01). The cavity closure rates in the injection group and the oral administration group after 2 months of treatment were 55.0% and 29.4% respectively,and there were no statistic differences between the two groups(χ2= 2.451,P = 0.117 > 0.05); there was no difference in the ineffectiveness rate in the changes of nidus and cavities between the two groups after two months of treatment(P > 0.05); The incidence of gastrointestinal reactions of3.4% in the injection group was significantly lower than that of 12.7% in the oral administration group. The incidence of hepatic impairment in the injection group was 12.3%,higher than that of 7.9% in the oral administration group,but there was no statistic difference in the comparison between adverse reaction indicators in the two groups(P>0.5);The total incidence of adverse reactions in the injection group was 23.1%,and that in the oral administration group was 30.2%. There was no statistic difference of the comparison between that of the two groups(χ2= 0.823,P> 0.05). Conclus ion The effectiveness of isoniazid and rifampicin in the treatment of pulmonary tuberculosis in the injection group was higher than that in the oral administration group,and the safety was similar.
Objective To compare the effectivity and safety of isoniazide and rifampicin with different dosage forms in the treatment of pulmonary tuberculosis and to guide clinical rational drug use. Me thods 128 initially treated patients with pulmonary tuberculosis admitted into the Third People's Hospital of Kunming City from May2016 to June 2017 were randomly divided into isoniazid-injection group and isoniazid oral-administration group,65 patients in the injection group and 63 in the oral administration group. The standard 2 HREZ#4 HR was uniformly adopted in the therapeutic schedules. The existence of differences in the clinical effectiveness and side effects of different dosage forms in the treatment of pulmonary tuberculosis were observed. Re s ult The negative rate of sputum necrosis in the injection group was higher than that in the oral administration group, but there was no statistic difference in the negative rates of sputum necrosis in the two groups after one-month and two-month treatment(x2=1.422,2.652; all P > 0.05);Inhalation rate in the injection group and the oral administration group after 2 months of treatment were 57.1% and 33.3% respectively,and there were statistic differences(χ2= 7.025,P =0.008 < 0.01). The cavity closure rates in the injection group and the oral administration group after 2 months of treatment were 55.0% and 29.4% respectively,and there were no statistic differences between the two groups(χ2= 2.451,P = 0.117 > 0.05); there was no difference in the ineffectiveness rate in the changes of nidus and cavities between the two groups after two months of treatment(P > 0.05); The incidence of gastrointestinal reactions of3.4% in the injection group was significantly lower than that of 12.7% in the oral administration group. The incidence of hepatic impairment in the injection group was 12.3%,higher than that of 7.9% in the oral administration group,but there was no statistic difference in the comparison between adverse reaction indicators in the two groups(P>0.5);The total incidence of adverse reactions in the injection group was 23.1%,and that in the oral administration group was 30.2%. There was no statistic difference of the comparison between that of the two groups(χ2= 0.823,P> 0.05). Conclus ion The effectiveness of isoniazid and rifampicin in the treatment of pulmonary tuberculosis in the injection group was higher than that in the oral administration group,and the safety was similar.
引文
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[7]陈羽,刘映,工静,等.抗结核病药物治疗老年肺结核的不良反应及影响闪素[J].中国老年学杂志,2015,35(8):2079-2081.
[8]陈爽,杨海鹏,陈娟,等.不同剂型利福平对比治疗肺结核疗效和安全性的Meta分析[J].中国药房,2015,26(15):2097-2099.
[9]梁珍,汗胤,刘轶群,等.注射用利福平治疗糖尿病合并肺结核451例临床疗效观察[J].中国药业,2014,23(4):28-30.
[10]席秀娥,王明永,万勇敢,等.注射用利福平治疗复治涂阳肺结核的近期疗效观察[J].临床肺科杂志,2015,20(6):977-980.
[11]张锡林.利福平注射液治疗初治菌阳肺结核病人的临床观察[J].临床肺科杂志,2008,13(2):140-141.
[12]杨莹,黄雪惠,彭湘仙.利福平注射液和参麦注射液治疗肺结核的近期效果观察[J].中国热带,2015,15(8):1017-1019.
[13]蔡波,薛雯雯.马小勇.不同剂型利福平治疗肺结核伴糖尿病患者的效果及对血糖的影响[J].医学综述,2016,22(12):2428-2430.
[2]中华人民共和国卫生部.中华人民共和国卫生行业标准肺结核诊断标准(WS288-2008)[M].北京:人民卫生出版社,2008:1-3.
[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,2005:64-86.
[4]中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].肝脏,2015,20(10):750-767.
[5]李亮,李琦.结核病治疗学[M].北京:人民卫生出版社,2013:22-25.
[6]于利.利福喷丁与利福平治疗肺结核的效果比较[J].中国当代医药,2016,23(13):154-156.
[7]陈羽,刘映,工静,等.抗结核病药物治疗老年肺结核的不良反应及影响闪素[J].中国老年学杂志,2015,35(8):2079-2081.
[8]陈爽,杨海鹏,陈娟,等.不同剂型利福平对比治疗肺结核疗效和安全性的Meta分析[J].中国药房,2015,26(15):2097-2099.
[9]梁珍,汗胤,刘轶群,等.注射用利福平治疗糖尿病合并肺结核451例临床疗效观察[J].中国药业,2014,23(4):28-30.
[10]席秀娥,王明永,万勇敢,等.注射用利福平治疗复治涂阳肺结核的近期疗效观察[J].临床肺科杂志,2015,20(6):977-980.
[11]张锡林.利福平注射液治疗初治菌阳肺结核病人的临床观察[J].临床肺科杂志,2008,13(2):140-141.
[12]杨莹,黄雪惠,彭湘仙.利福平注射液和参麦注射液治疗肺结核的近期效果观察[J].中国热带,2015,15(8):1017-1019.
[13]蔡波,薛雯雯.马小勇.不同剂型利福平治疗肺结核伴糖尿病患者的效果及对血糖的影响[J].医学综述,2016,22(12):2428-2430.