CAJ | 학술논문

目的关注并探讨病灶超过一个肺野的初治涂阴肺结核的最佳治疗方案,从而提高整体治愈率,降低涂阴转阳性率,降低复发率.方法将2005年1月1日至2011年6月30日在本站登记的病灶超过一个肺野的428例初治涂阴肺结核患者(重症涂阴除外)随机分为治疗组212例和对照组216例,两组在性别和年龄上差异没有显著性.治疗组在强化期应用四联抗结核药即2HRZS或2HRZE,对照组则在强化期采用三联抗结核药即2HRZ.继续治疗期则均采用4HR的方案.至疗程结束时,X线正侧位片影像下或CT扫描下与治疗前片对比病灶吸收面积达80％以上、边缘清楚,密度增高、呈纤维化或钙化现象,症状改善明显,血沉指数在除外其它原因后下降至正常,治疗过程中痰查抗酸杆菌一直阴性未见阳转的判定为疗效显著.反之,影像学上对比治疗前片病灶吸收不明显或者面积在80％以下,边缘不甚清晰、密度仍旧高低不一或者是仍为硬结病灶,没有纤维化或钙化现象,症状改善不明显,血沉指数至疗程结束时在除外其它干扰因素后仍无法下降至正常,或者治疗过程中痰菌呈现阳转的任一项指标判定为疗效较差.结果治疗组212例患者,疗效显著的184例,疗效显著率占86.8％,疗效较差28例,占13.2％,而对照组216例患者,疗效显著的126例,占58.3％,疗效较差的有90例,占41.7％.结论在病灶超过一个肺野的初治涂阴肺结核患者的治疗问题上,强化期应用四联抗结核药的疗效要远远高于应用三联抗结核药的疗效.
목적 관주병탐토병조초과일개폐야적초치도음폐결핵적최가치료방안,종이제고정체치유솔,강저도음전양성솔,강저복발솔.방법 장2005년1월1일지2011년6월30일재본참등기적병조초과일개폐야적428례초치도음폐결핵환자(중증도음제외)수궤분위치료조212례화대조조216례,량조재성별화년령상차이몰유현저성.치료조재강화기응용사련항결핵약즉2HRZS혹2HRZE,대조조칙재강화기채용삼련항결핵약즉2HRZ.계속치료기칙균채용4HR적방안.지료정결속시,X선정측위편영상하혹CT소묘하여치료전편대비병조흡수면적체80％이상、변연청초,밀도증고、정섬유화혹개화현상,증상개선명현,혈침지수재제외기타원인후하강지정상,치료과정중담사항산간균일직음성미견양전적판정위료효현저.반지,영상학상대비치료전편병조흡수불명현혹자면적재80％이하,변연불심청석、밀도잉구고저불일혹자시잉위경결병조,몰유섬유화혹개화현상,증상개선불명현,혈침지수지료정결속시재제외기타간우인소후잉무법하강지정상,혹자치료과정중담균정현양전적임일항지표판정위료효교차.결과 치료조212례환자,료효현저적184례,료효현저솔점86.8％,료효교차28례,점13.2％,이대조조216례환자,료효현저적126례,점58.3％,료효교차적유90례,점41.7％.결론 재병조초과일개폐야적초치도음폐결핵환자적치료문제상,강화기응용사련항결핵약적료효요원원고우응용삼련항결핵약적료효.
Objective To explore an optimal therapeutic scheme for smear-negative patients with lesionsexceeding a lung field and without previous treatment,and to improve the overall curative rate and reduce the conversion rate of smear negative to positive and the relapse rate.Methods 428 smear-negative patients with lesions exceeding a lung field who had registered in our institute during the period of January 1,2005 to June 30,2011 were randondy divided into study group ( 212 patients )and control group ( 216 patients ),with no specificity in sex and age.The study group received combination therapy with HRZS or HRZE for 2 months during the intensifying period,while the control group received HRZ in the intensify period and then HR for 4 months.The X-ray films or CT scans showing the lesions were absorbed with an area of reaching more than 80％ till the X ray inclined the place move when the treatment was ended,border was clear,density increased,with fibrization or calcification phenomenon,and symptom improvement were obvious,erythrocyte sedimentation rate exponent feminine gender has not always seen that the decision that the sun rotates is that the curative effect was notable in coming down besides after other caused till the middle sputum curing process regularly,checked antiacid bacillus.The sorption curing front move nidus was not obvious or area was 80％ following the films had learned a contrast,the border block of wood was very limit,that density remains the same differs at any rate or was to be hardening nidus still,do not flbrization or calcification phenomenon,symptom improvement was not obvious,the erythrocyte sedimentation rate exponent was that the curative effect was relatively poor till having no way to decline after other disturbs a factor.Results The efficacy was obvious in 184 of 212 ( 86.8 ％ ) patients but was poor in 28 ( 13.2％ ) in the study group; whereas it was obvious in 126 of 216 ( 58.3％ ) patients but was poor in 90 ( 41.7％ ) in the control group.Conclusions In the treatment of smear-negative tuberculosis patients without previous treatment,the efficacy of combination therapy with four first-line antituberculotic agents is much peater than that of the therapy with three agents.