CAJ | 학술논문

目的探讨复治涂阳肺结核患者化学治疗新方案的疗效和安全性.方法选取2013年7月至2014年3月在温州市中心医院确诊的初次复治涂阳肺结核患者88例,随机分为超短疗程组(58例)和标准疗程组(30例).超短疗程组采用5MfxRfb(Rft PaZE方案(Mfx:莫西沙星,Rfb:利福布汀,Rft:利福喷丁,Pa:对氨基水杨酸异烟肼,Z:吡嗪酰胺,E:乙胺丁醇),标准疗程组采用2SHREZ/6HRE或3HREZ/6 HRE方案(S:链霉素,H:异烟肼,R.利福平).观察患者的临床症状、体征,第2个月末及疗程结束时痰涂片、痰培养转阴率,肺部病灶吸收及空洞闭合等情况.采用t检验或x2检验进行数据分析.结果因各种原因未完成治疗10例,共78例肺结核患者完成治疗(超短疗程组50例,标准疗程组28例).疗程结束时,两组患者症状体征疗效指数比较差异无统计学意义(x2=0.836,P＞0.05).治疗第2个月末,超短疗程组痰涂片、痰培养转阴率分别为76.00％(38/50)和72.00％ (36/50),标准疗程组分别为71.43％(20/28)和67.86％(19/28),两组比较差异无统计学意义(x2 =0.197和0.148,P＞0.05);疗程结束时,超短疗程组痰涂片及痰培养转阴率均为92.00％(46/50),标准疗程组均为85.71％(24/28),差异亦无统计学意义(x2=0.239,P＞0.05).治疗结束时,超短疗程组胸部CT显示病灶显著吸收33例,吸收12例,不变4例,恶化1例;标准疗程组显著吸收8例,吸收13例,不变5例,恶化2例.两组病灶变化差异有统计学意义(x2=10.582,P＜0.05),但空洞变化差异无统计学意义(x2=1.825,P＞0.05).总体转归方面,超短疗程组治愈44例,完成疗程5例,失败1例;标准疗程治愈24例,完全疗程2例,失败2例,两组比较差异无统计学意义(x2=1.468,P＞0.05).两组不良反应发生率分别为32.00％ (16/50)和32.14％ (9/28),差异无统计学意义(x2=0.001,P＞0.05).结论超短疗程治疗方案对初次复治涂阳肺结核是安全有效的.
목적 탐토복치도양폐결핵환자화학치료신방안적료효화안전성.방법 선취2013년7월지2014년3월재온주시중심의원학진적초차복치도양폐결핵환자88례,수궤분위초단료정조(58례)화표준료정조(30례).초단료정조채용5MfxRfb(Rft PaZE방안(Mfx:막서사성,Rfb:리복포정,Rft:리복분정,Pa:대안기수양산이연정,Z:필진선알,E:을알정순),표준료정조채용2SHREZ/6HRE혹3HREZ/6 HRE방안(S:련매소,H:이연정,R.리복평).관찰환자적림상증상、체정,제2개월말급료정결속시담도편、담배양전음솔,폐부병조흡수급공동폐합등정황.채용t검험혹x2검험진행수거분석.결과 인각충원인미완성치료10례,공78례폐결핵환자완성치료(초단료정조50례,표준료정조28례).료정결속시,량조환자증상체정료효지수비교차이무통계학의의(x2=0.836,P＞0.05).치료제2개월말,초단료정조담도편、담배양전음솔분별위76.00％(38/50)화72.00％ (36/50),표준료정조분별위71.43％(20/28)화67.86％(19/28),량조비교차이무통계학의의(x2 =0.197화0.148,P＞0.05);료정결속시,초단료정조담도편급담배양전음솔균위92.00％(46/50),표준료정조균위85.71％(24/28),차이역무통계학의의(x2=0.239,P＞0.05).치료결속시,초단료정조흉부CT현시병조현저흡수33례,흡수12례,불변4례,악화1례;표준료정조현저흡수8례,흡수13례,불변5례,악화2례.량조병조변화차이유통계학의의(x2=10.582,P＜0.05),단공동변화차이무통계학의의(x2=1.825,P＞0.05).총체전귀방면,초단료정조치유44례,완성료정5례,실패1례;표준료정치유24례,완전료정2례,실패2례,량조비교차이무통계학의의(x2=1.468,P＞0.05).량조불량반응발생솔분별위32.00％ (16/50)화32.14％ (9/28),차이무통계학의의(x2=0.001,P＞0.05).결론 초단료정치료방안대초차복치도양폐결핵시안전유효적.
Objective To assess the clinical efficacy and safety of a novel chemotherapy regimen for retreatment of smear-positive pulmonary tuberculosis.Methods A total of 88 cases of recurrent smearpositive pulmonary tuberculosis for the first time were enrolled from Wenzhou Central Hospital during July 2013 and March 2014.All subjects were randomly divided into ultra-short course group (58 cases) and standard course group (30 cases).Patients in ultra-short course group were given 5MfxRfb (Rfi) PaZE regimen (Mfx:moxifloxacin,Rfb:rifabutin,Rft:rifapentine,Pa:isoniazid aminosalicylate,Z:pyrazinamide,E:ethambutol),and those in standard course group were given 2SHREZ/6HRE or 3HREZ/ 6HRE regimen (S:streptomycin,H:isoniazid,R:rifampicin).Clinical symptoms and signs,negative conversion rates of sputum smear or culture at the end of the second month and the end of the course,absorption of pulmonary lesions and cavity closure were observed.t test or chi-square test was used for data analysis.Results There were 10 patients withdrew from the study,and the rest 78 patients completed whole treatments (50 cases in ultra-short course group and 28 cases in standard course group).No significant difference was observed in the improvements of clinical symptoms and signs between two groups at the end of the treatment (x2 =0.836,P ＞ 0.05).Negative conversion rates of sputum smear and culture at the end of the second month were 76.00％ (38/50) and 72.00％ (36/50) in ultra-short course group,while in standard course group were 71.43％ (20/28) and 67.86％ (19/28),and there was no significant difference between two groups (x2 =0.197 and 0.148,P ＞ 0.05).At the end of the treatment,negative conversion rates of both sputum smear and culture in ultra-short course group were 92.00％ (46/50),while those in the standard course group were 92.00％ (46/50) (x2 =0.239,P ＞ 0.05).In ultra-short course group,marked lesion absorption was observed in 33 cases at the end of the treatment,absorption in 12 cases,deterioration in 1 case,and no significant change was observed in 4 cases.While in the standard course group,marked lesion absorption was observed in 8 cases at the end of the treatment,absorption in 13 cases,deterioration in 2 cases,and no siguificant change was observed in 5 cases.There was significant difference in the absorption of pulmonary lesions between two groups (x2 =10.582,P ＜ 0.05),but no significant difference in cavity closure was observed (x2 =1.825,P ＞ 0.05).In ultra-short course group,clinical cure was obtained in 44 patients,5 patients completed full course of treatments but did not meet the criterial for cure,and 1 patient failed in the treatment.While in standard course group,clinical cure was obtained in 24 patients,2 patients completed full course of treatments but did not meet the criterial for cure,and 2 patients failed in the treatment.The clinical outcomes in two groups were of significant difference (x2 =1.468,P ＞0.05).Adverse effects during treatment were observed in 16 (32.00％) patients in ultrashort course group and 9 (32.14％) patients in standard course group,and the difference was not significant (x2 =0.001,P ＞ 0.05).Conclusion Ultra short course regimen is effective and safe for retreatment of smear-positive pulmonary tuberculosis.