CAJ | 학술논문

目的探讨含头孢西丁的治疗方案对高度耐药的快速生长型非结核分枝杆菌(NTM)肺疾病患者的疗效和安全性.方法回顾性分析2007年1-12月经上海市肺科医院确诊的快速生长型NTM肺疾病患者16例,其中男7例,女9例,年龄32～74岁,平均(56±10)岁,既往治疗时间为6～48个月,平均(15±11)个月,而痰菌未阴转.化疗方案包括头孢西丁、第3代以上氟喹诺酮、大环内酯类、磺胺甲噁唑等,其中头孢西丁在强化期使用,疗程为3个月,总疗程1.5年以上,观察患者的痰菌阴转率、影像学表现及不良反应.结果 16例中5例无既往慢性疾病史,有支气管扩张症史5例,COPD史2例,结核病史3例,慢性白血病骨髓移植术后1例.治疗前主要症状为咳嗽、咳痰,影像学表现均为多发斑片状、小结节状阴影合并空洞形成.菌株对抗结核药物高度耐药,16例中耐链霉素15例,耐异烟肼16例,耐利福平14例,耐乙胺丁醇13例;15例中耐阿米卡星14例,耐卷曲霉素15例,耐氧氟沙星14例.治疗后患者的临床症状均缓解,8例在治疗半年内痰菌阴转并维持至疗程结束,另外8例的痰菌未能阴转.疗程结束时6例病灶吸收,其中4例为显著吸收,2例为吸收;10例病灶无变化;4例空洞闭合,2例空洞缩小,10例空洞无改变.治疗痊愈率为8/16.未出现因头孢西丁引起的不良反应.结论含头孢西丁化疗方案对高耐药性的快速生长型NTM肺疾病有一定疗效,在无条件行菌种鉴定和药敏检测的前提下,可联合其他药物组成经验性化疗方案.
목적 탐토함두포서정적치료방안대고도내약적쾌속생장형비결핵분지간균(NTM)폐질병환자적료효화안전성.방법 회고성분석2007년1-12월경상해시폐과의원학진적쾌속생장형NTM폐질병환자16례,기중남7례,녀9례,년령32～74세,평균(56±10)세,기왕치료시간위6～48개월,평균(15±11)개월,이담균미음전.화료방안포괄두포서정、제3대이상불규낙동、대배내지류、광알갑오서등,기중두포서정재강화기사용,료정위3개월,총료정1.5년이상,관찰환자적담균음전솔、영상학표현급불량반응.결과 16례중5례무기왕만성질병사,유지기관확장증사5례,COPD사2례,결핵병사3례,만성백혈병골수이식술후1례.치료전주요증상위해수、해담,영상학표현균위다발반편상、소결절상음영합병공동형성.균주대항결핵약물고도내약,16례중내련매소15례,내이연정16례,내리복평14례,내을알정순13례;15례중내아미잡성14례,내권곡매소15례,내양불사성14례.치료후환자적림상증상균완해,8례재치료반년내담균음전병유지지료정결속,령외8례적담균미능음전.료정결속시6례병조흡수,기중4례위현저흡수,2례위흡수;10례병조무변화;4례공동폐합,2례공동축소,10례공동무개변.치료전유솔위8/16.미출현인두포서정인기적불량반응.결론 함두포서정화료방안대고내약성적쾌속생장형NTM폐질병유일정료효,재무조건행균충감정화약민검측적전제하,가연합기타약물조성경험성화료방안.
Objective To evaluate the therapeutic effect and safety of the regimen containing cefoxitin on highly drug-resistant rapidly growing nontuberculous mycobacterial (RGM) pulmonary disease.Methods From January to December 2007, 16 patients with RGM pulmonary disease, who had been treated for 6 -48 months, average ( 15 ± 11 ) months but still sputum positive, were included in the study and treated with a new regimen containing cefoxitin, fluoroquinolone, macrolid, and SMZco.Cefoxitin was used in the first 3 months and the total duration of therapy was 18 months.Sputum conversion rate, radiology change and side effects were observed before and after the therapy.Results Underlying chronic diseases including COPD ( n = 2), tuberculosis ( n = 3 ), bone-marrow transplantation due to chronic leukemia ( n =1 ) and bronchiectasis ( n = 5), were present in 11 patients.Main symptoms before therapy were cough and expectoration.There were multi-focal patchy, small nodular shadows with cavities on CT scans.The 16 clinical strains were highly resistant to anti-tuberculous drugs: 15/16 to streptomycin, 16/16 to isoniazid,14/16 to rifampin, 13/16 to ethambutol, 14/15 to amikacin, 15/15 to capreomycin and 14/15 to ofloxacin.After treatment, the clinical symptoms improved in all patients.Eight of the 16 patients became sputum negative by 6 months which lasted to the end of the therapy, while another 8 patients remained sputum positive.Six patients showed radiological improvement.No one experienced side effects induced by cefoxitin.The total cure rate was 8/16.Conclusion The regimen containing cefoxitin has certain effect on highly drug-resistant nontuberculous mycobacterial pulmonary disease, especially for RGM.