中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2014年
3期
230-234
,共5页
结核,肺%抗结核药%环丝氨酸%不良反应
結覈,肺%抗結覈藥%環絲氨痠%不良反應
결핵,폐%항결핵약%배사안산%불량반응
Tuberculosis,pulmonary%Antitubercular agents%Cycloserine%Adverse effects
目的 评价含环丝氨酸的标准方案治疗耐多药肺结核(MDR-TB)引起的精神神经等不良反应.方法 选择2012年5至12月杭州市红十字会医院结核病诊疗中心纳入全球第五轮耐多药基金项目的MDR-TB患者82例.所有患者都接受含环丝氨酸的标准MDR-TB治疗方案,观察患者治疗中的不良反应,并采用t检验比较患者不同时期症状自评量表(SCL-90)分值.结果 80.5％(66/82)的患者药物不良反应发生在治疗后的3个月内.最常见的不良反应包括:关节痛(42.7％)、胃肠道反应(40.2％)、中枢神经系统症状(22.0％)和电解质异常(17.1％).9例发生严重的精神神经不良反应(抽搐、抑郁、焦虑、精神分裂和自杀),其中6例入组前有氟喹诺酮类用药史.6例经停环丝氨酸或抗结核药物后,精神症状消失,后更换环丝氨酸继续抗结核治疗.比较患者的SCL-90分值发现,出现症状时的SCL-90总分、抑郁和焦虑因子分值均高于用不含环丝氨酸的治疗方案继续治疗1个月后的分值(=2.241,2.301和5.659,P＜0.05).结论 含环丝氨酸的标准方案治疗MDR-TB出现的严重精神神经不良反应可能主要与环丝氨酸有关.
目的 評價含環絲氨痠的標準方案治療耐多藥肺結覈(MDR-TB)引起的精神神經等不良反應.方法 選擇2012年5至12月杭州市紅十字會醫院結覈病診療中心納入全毬第五輪耐多藥基金項目的MDR-TB患者82例.所有患者都接受含環絲氨痠的標準MDR-TB治療方案,觀察患者治療中的不良反應,併採用t檢驗比較患者不同時期癥狀自評量錶(SCL-90)分值.結果 80.5％(66/82)的患者藥物不良反應髮生在治療後的3箇月內.最常見的不良反應包括:關節痛(42.7％)、胃腸道反應(40.2％)、中樞神經繫統癥狀(22.0％)和電解質異常(17.1％).9例髮生嚴重的精神神經不良反應(抽搐、抑鬱、焦慮、精神分裂和自殺),其中6例入組前有氟喹諾酮類用藥史.6例經停環絲氨痠或抗結覈藥物後,精神癥狀消失,後更換環絲氨痠繼續抗結覈治療.比較患者的SCL-90分值髮現,齣現癥狀時的SCL-90總分、抑鬱和焦慮因子分值均高于用不含環絲氨痠的治療方案繼續治療1箇月後的分值(=2.241,2.301和5.659,P＜0.05).結論 含環絲氨痠的標準方案治療MDR-TB齣現的嚴重精神神經不良反應可能主要與環絲氨痠有關.
목적 평개함배사안산적표준방안치료내다약폐결핵(MDR-TB)인기적정신신경등불량반응.방법 선택2012년5지12월항주시홍십자회의원결핵병진료중심납입전구제오륜내다약기금항목적MDR-TB환자82례.소유환자도접수함배사안산적표준MDR-TB치료방안,관찰환자치료중적불량반응,병채용t검험비교환자불동시기증상자평량표(SCL-90)분치.결과 80.5％(66/82)적환자약물불량반응발생재치료후적3개월내.최상견적불량반응포괄:관절통(42.7％)、위장도반응(40.2％)、중추신경계통증상(22.0％)화전해질이상(17.1％).9례발생엄중적정신신경불량반응(추휵、억욱、초필、정신분렬화자살),기중6례입조전유불규낙동류용약사.6례경정배사안산혹항결핵약물후,정신증상소실,후경환배사안산계속항결핵치료.비교환자적SCL-90분치발현,출현증상시적SCL-90총분、억욱화초필인자분치균고우용불함배사안산적치료방안계속치료1개월후적분치(=2.241,2.301화5.659,P＜0.05).결론 함배사안산적표준방안치료MDR-TB출현적엄중정신신경불량반응가능주요여배사안산유관.
Objective To evaluate neuropsychiatric adverse effects of cycloserine therapy for multidrug resistant pulmonary tuberculosis (MDR-TB).Methods A total of 82 patients with MDR-TB who were enrolled in Global Fund Round Five MDR-TB Control Program were admitted in Center for Diagnosis and Treatment of Tuberculosis,Hangzhou Red Cross Hospital from May to December 2012.All patients received the standard treatment containing cycloserine for MDR-TB.The adverse reactions during the treatment were recorded,and symptom checklist-90 (SCL-90) scores at different time points were compared with t test.Results Adverse reactions were observed in 66 patients (66/82,80.5％) within 3 months after the initial treatment.Common adverse reactions included arthralgia (42.7％),gastrointestinal reactions (40.2％),central nervous system symptoms (22.0％) and electrolytes disturbance (17.1％).Nine patients had severe neuropsychiatric symptoms characterized by convulsions,depression,anxiety,schizophrenia and attempting suicide,6 of whom had used fluoroquinolones before the study.The above symptoms were relieved after stopping cycloserine or antitubercular agents,and cycloserine was replaced in the following treatment.The total SCL-90 score,depression and anxiety scores were significantly higher during onset of symptoms than those one month after the following treatment (t =2.241,2.301 and 5.659,P ＜ 0.05).Conclusion Cycloserine may induce severe neuropsychiatric adverse reactions in patients receiving standard treatment for MDR-TB.
