关键词: 结核, 肺, 再治疗, 结核, 抗多种药物性, 方案评价, 疗效比较研究

Abstract:

To explore and compare the curative effect of short-term chemotherapy regimen and standard chemotherapy regimen on first-time retreated multidrug-resistant pulmonary tuberculosis (MDR-PTB) patients, a total of 236 cases of first-time retreated MDR-PTB patients admitted to the Outpatient Department of Guangzhou Chest Hospital from March 2009 to March 2014 who had previous tuberculosis history, no basic disease, and no serious complications were enrolled in this study. These patients were diagnosed by the laboratory test and had only received regular first-line anti-tuberculosis drugs for more than one month. All these subjects were randomly divided into two groups, group A and group B, according to their visiting order. Each group had 118 cases. Multidrug screening was performed in both groups, respectively, and altogether 36 cases were diagnosed as MDR-PTB, among which 21 cases of group A received short-term chemotherapy regimen 2-3H-R-Z-E/6H-R-E (short-term group) and 15 cases of group B received multidrug-resistant standard retreatment regimen 6Am-Z-Lfx-PAS(Cs)-Pto/18Z-Lfx-PAS(Cs)-Pto (standard group). We analyzed the short and long-term clinical therapeutic effect of the two groups after treatment, including the sputum negative conversion rate, lesion absorption rate, adverse reactions, and prognosis. The Fisher’s exact probability statistics was used to compare the enumeration data between the two groups. The results showed that after being treated for 9 months the sputum negative conversion rate in the short-term group (85.7%, 18/21) was significantly higher than that in the standard group (46.2%, 6/13) (P=0.017).There was no statistically significant difference in the sputum negative conversion rate (85.7% (18/21) vs 84.6% (11/13), P=0.373), absorption rate of lesions (47.6% (10/21) vs 23.1% (3/13), P=0.109), cavity closure rate (25.0% (3/12) vs 18.2% (2/11), P=0.360), treatment success rate (76.2% (16/21) vs 53.8% (7/13), P=0.122), and treatment failure rate (23.8% (5/21) vs 46.2% (6/13), P=0.122) between the two groups after the termination of treatment. No suspension of treatment due to serious adverse reactions occurred in the two groups. One case in the standard group showed drug-induced hepatitis, the patient was relieved after being treated with hepatoprotective agents. Five cases in the standard group showed increased serum uric acid, since there was no symptom of joint pain, so no relevant treatment was performed in these patients. Four cases in the short-term group showed increased serum uric acid, while only one case was relieved after symptomatic treatment of joint pain, and two patients who showed gastrointestinal response were relieved after adjusting the frequency of medication. Our results indicated that the short-term clinical efficacy of short-term retreatment chemotherapy regimen was better than multidrug-resistant standard chemotherapy regimen in treating the first-time retreated MDR-PTB patients, but the long-term efficacy was not statistically significant. It is suggested that for the first-time retreated MDR-PTB patients the short-term retreatment chemotherapy regimen is a preferred choice, since the short-term retreatment chemotherapy regimen is short course with cheap and accessible drugs and no increased serious adverse reactions.

Key words: Tuberculosis, pulmonary, Retreatment, Tuberculosis, multidrug-resistant, Regimen eva-luation, Comparative effectiveness research