环丝氨酸在耐多药结核病化学治疗中应用价值的探讨

doi:10.3969/j.issn.1000-6621.2018.02.011

摘要/Abstract

摘要： 目的

评估环丝氨酸在耐多药结核病化学治疗中的应用价值,为进一步优化中国耐多药结核病化学治疗方案提供依据。

方法

收集2014—2016年杭州市红十字会医院及温州市中心医院共143例耐多药结核病患者的治疗转归等临床资料,所有患者的治疗符合《世界卫生组织耐药结核病治疗指南(2016年更新版)》中含环丝氨酸的标准治疗方案,总结患者治疗结果、痰菌阴转、药物不良反应发生等情况。

结果

143例患者经过含环丝氨酸的标准治疗方案后,总体治疗成功率达到69.2%(99/143);81.1%(116/143)的患者在强化期内实现痰菌阴转。13例患者出现环丝氨酸相关的药物不良反应(9.1%,13/143),包括头晕、头痛7例,四肢麻木3例,肢体抽搐2例,情绪低落1例;所有不良反应在药物减量或者加用对症药物后均缓解。

结论

含环丝氨酸的标准治疗方案对耐多药结核病患者进行治疗后,患者总体治疗成功率较高,药物耐受性较好,值得在临床上推广应用。

关键词: 环丝氨酸, 结核, 肺, 结核, 抗多种药物性, 治疗结果

Abstract: Objective

To evaluate the application of cycloserine in the treatment of multidrug-resistant tuberculosis (MDR-TB) and to provide a basis for further optimization of the chemotherapy for MDR-TB patients in China.

Methods

The clinical data, including treatment outcomes, of 143 MDR-TB patients in Hangzhou Red Cross Hospital and Wenzhou Central Hospital from 2014 to 2016 were collected. All patients received cycloserine-containing standard treatment according to the World Health Organization Treatment Guidelines for Drug-resistant Tuberculosis, 2016 Update. The data such as treatment outcome, sputum negative conversion rate, and adverse events associated with drug were summarized.

Results

Among the 143 patients treated with cycloserine-containing regimen, the overall treatment success rate achieved 69.2% (99/143). 81.1% (116/143) of patients had sputum culture conversion in the intensive phase. A total of 13 cases (9.1%, 13/143) reported adverse events that were considered to be related with cycloserine, including 7 cases who complained of dizziness or headache, 3 cases of limb numbness, 2 cases of limb twitch and 1 case of depression. All adverse events were relieved by dose reduction or symptomatic treatment.

Conclusion

Cycloserine-containing standard therapy has high overall success rate and well tolerance for MDR-TB patients, which is worth to be applied in clinical.

Key words: Cycloserine, Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Treatment outcome

李杨,王飞,吴琍敏,朱敏,何贵清,孙峰,王晓萌,张文宏. 环丝氨酸在耐多药结核病化学治疗中应用价值的探讨[J]. 中国防痨杂志, 2018, 40(2): 168-172. doi: 10.3969/j.issn.1000-6621.2018.02.011

Yang LI,Fei WANG,Li-min WU,Min ZHU,Gui-qing HE,Feng SUN,Xiao-meng WANG,Wen-hong. ZHANG. Investigation on application of cycloserine in chemotherapy for multidrug-resistant tuberculosis[J]. Chinese Journal of Antituberculosis, 2018, 40(2): 168-172. doi: 10.3969/j.issn.1000-6621.2018.02.011

图/表 3

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参考文献 18

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初始治疗方案	例数	构成比(%)
吡嗪酰胺+阿米卡星+左氧氟沙星+环丝氨酸+丙硫异烟胺	46	32.2
吡嗪酰胺+阿米卡星+莫西沙星+环丝氨酸+丙硫异烟胺	27	18.9
吡嗪酰胺+卷曲霉素+左氧氟沙星+环丝氨酸+丙硫异烟胺	22	15.4
吡嗪酰胺+卷曲霉素+莫西沙星+环丝氨酸+丙硫异烟胺	16	11.2
吡嗪酰胺+卡那霉素+左氧氟沙星+环丝氨酸+丙硫异烟胺	14	9.8
吡嗪酰胺+卡那霉素+莫西沙星+环丝氨酸+丙硫异烟胺	8	5.5
阿米卡星+左氧氟沙星+环丝氨酸+丙硫异烟胺+高剂量异烟肼	1	0.7
阿米卡星+莫西沙星+环丝氨酸+丙硫异烟胺+乙胺丁醇	1	0.7
吡嗪酰胺+左氧氟沙星+环丝氨酸+丙硫异烟胺+对氨基水杨酸	1	0.7
吡嗪酰胺+莫西沙星+环丝氨酸+丙硫异烟胺+对氨基水杨酸	1	0.7
卷曲霉素+莫西沙星+环丝氨酸+丙硫异烟胺+乙胺丁醇	1	0.7
吡嗪酰胺+卷曲霉素+左氧氟沙星+环丝氨酸+乙胺丁醇	2	1.4
吡嗪酰胺+卷曲霉素+莫西沙星+环丝氨酸+对氨基水杨酸	2	1.4
吡嗪酰胺+卡那霉素+左氧氟沙星+环丝氨酸+丙硫异烟胺	1	0.7
合计	143	100.0

治疗时间	痰菌阴转例数	比率(%)
1个月末	59	41.3
2个月末	85	59.4
3个月末	96	67.1
4个月末	106	74.1
5个月末	111	77.6
6个月末	116	81.1
8个月末	119	83.2
10个月末	119	83.2
12个月末	120	83.9
14个月末	120	83.9
16个月末	121	84.6
18个月末	122	85.3
20个月末	122	85.3
22个月末	124	86.7
24个月末	126	88.1

不良反应事件	发生例次	发生率(%)
高尿酸血症	61	42.7
关节疼痛	41	28.7
药物性肝损伤	31	21.7
低钾血症	28	19.6
恶心、呕吐	19	13.3
听力下降	11	7.7
尿蛋白增加	8	5.6
耳鸣	7	4.9
头晕、头痛	7	4.9
皮肤瘙痒	7	4.9
四肢麻木	6	4.2
贫血	6	4.2
肾功能异常	6	4.2
视物模糊	5	3.5
乏力	4	2.8
甲状腺功能减退	4	2.8
癫痫	3	2.1
肢体抽搐	2	1.4
失眠	2	1.4
情绪低落	1	0.7