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异烟肼联合阿米卡星支气管镜下注药治疗疑似耐多药肺结核的临床观察
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| 篇名： | 异烟肼联合阿米卡星支气管镜下注药治疗疑似耐多药肺结核的临床观察 |
| TITLE： | |
| 摘要： | 目的：观察异烟肼联合阿米卡星支气管镜下注药治疗疑似耐多药肺结核的疗效和安全性。方法： 108例疑似耐多药肺结核患者随机分为对照组（54例）和观察组（54例）。对照组患者给予对氨基水杨酸异烟肼片0.5 g，口服，每日2次+利福喷丁胶囊0.45 g，口服，每周2次+吡嗪酰胺片1.5 g，口服，每日1次+丙硫异烟胺肠溶片0.2 g，口服，每日3次+硫酸阿米卡星注射液4 ml加入0.9％氯化钠注射液250 ml中静脉滴注，每日1次，同时给予异烟肼注射液2 ml+硫酸阿米卡星注射液2 ml加入0.9％氯化钠注射液5 ml中充分混合后雾化吸入，每日2次，均连用18个月；观察组患者在对照组治疗的基础上给予异烟肼注射液2 ml+硫酸阿米卡星注射液2 ml加入0.9％氯化钠注射液10 ml中于支气管镜下注药，注药完成后于患侧方向静卧60 min，每2周1次，3次为1个疗程，共3～5个疗程。观察两组患者痰菌阴转情况、病灶吸收情况、空洞闭合情况，治疗前后T细胞亚群（CD4+、CD8+、CD4+/CD8+）水平及不良反应发生情况。结果：治疗3、6、18个月后，观察组患者痰菌阴转率、病灶总吸收率、空洞闭合率均显著高于对照组同期，且随时间延长逐渐升高，差异均有统计学意义（P＜0.05）。治疗后，两组患者CD4+、CD4+/CD8+水平均显著高于同组治疗前，且观察组高于对照组，CD8+水平均显著低于同组治疗前，且观察组低于对照组，差异均有统计学意义（P＜0.05）。两组患者不良反应发生率比较差异无统计学意义（P＞0.05）。结论：在常规治疗的基础上加用异烟肼联合阿米卡星支气管镜下注药治疗疑似耐多药肺结核，可有效促使痰菌阴转及病灶吸收，促进免疫功能恢复，且不增加不良反应发生率。 |
| ABSTRACT： | OBJECTIVE： To observe the efficacy and safety of isoniazid combined with amikacin by injection under bronchoscopy in the treatment of suspected multi-drug resistant tuberculosis. METHODS： 108 patients with suspected multi-drug resistant tuberculosis were randomlt divided into control group （54 cases） and observation group （54 cases）. Control group received Isoniazid aminosalicylate tablet， orally， twice a day + Rifapentine capsule 0.45 g， orally， twice a day， orally， twice a week+Pyrazinamide tablet 1.5 g， orally， once a day+Protionamide enteric-coated tablet 0.2 g， orally， 3 times a day+Amikacin sulfate injection 4 ml， adding into 0.9％ Sodium chloride injection 250ml， intravenous infusion， once a day， for 12 months； it was also combined with Isoniazid injection 2 ml+Amikacin sulfate injection 2 ml， adding into 0.9％ Sodium chloride injection 5 ml， inhalation after thorough mixing， twice a day， both were treated for 18 months. Observation group was additionally received Isoniazid injection 2 ml + Amikacin sulfate injection 2 ml， adding into 0.9％ Sodium chloride injection 10 ml， injecting under bronchoscopy， then laying on the affected side for 60 min； once every 2 weeks， 3-times was a course， it lasted 3-5 courses. The negative conversion rate of sputum bacteria， absorption of lesions and tuberculosis void closure， T cell subsets （CD4+，CD8+，CD4+/CD8+） levels before and after treatment and the incidence of adverse reactions in 2 groups were observed. RESULTS： After 3， 6， 18 months of treatment， the negative conversion rate of sputum bacteria， absorption rate of lesions and void closure rate in observation group were significantly higher than the control group， and they increased over time， with statistical significances （P＜0.05）. After treatment， CD4+， CD4+/CD8+ in both groups were significantly higher than before， and observation group was higher than control group， while CD8+ was significantly lower than before， and observation group was lower than control group， with statistical significances （P＜0.05）. And there was no significant difference in the incidence adverse reactions in 2 groups （P＞0.05）. CONCLUSIONS： Based on the conventional treatment， isoniazid combined with amikacin by injection under bronchoscopy can effectively improve the negative conversion rate of sputum bacteria and absorption of lesions in the treatment of suspected multi-drug resistant tuberculosis and promote recovery of immune functions， does not increase the incidence of adverse reactions. |
| 期刊： | 2016年第27卷第36期 |
| 作者： | 李艳静，常占平，王玉华，刘恩利 |
| AUTHORS： | LI Yanjing，CHANG Zhanping，WANG Yuhua，LIU Enli |
| 关键字： | 支气管镜；异烟肼；阿米卡星；耐多药肺结核；疗效；安全性 |
| KEYWORDS： | Bronchoscopy； Isoniazid； Amikacin； Multi-drug resistant tuberculosis； Efficacy； Safety |
| 阅读数： | 459 次 |
| 本月下载数： | 2 次 |
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