个体性化疗方案在耐药肺结核患者治疗中的应用研究(1)
【摘要】 目的：对比耐药肺结核三种治疗方案的治疗效果，探讨个体性化疗方案的优越性，为临床治疗耐药肺结核提供参考。方法：收集本疾病预防控制中心2009年1月-2013年1月确诊并完成治疗的150例耐药的肺结核患者。50例患者采用标准化治疗方案[6Z Km (Am，Cm) Lfx (mfx) Cs (PAS，E) Pto/ 18Z Lfx (Mfx) Cs (PAS，E) Pto]，50例采用个体化治疗方案[6ZEMfxCs(Am)Pot/18ZEMfxPtoPas]治疗，50例采用经验性治疗方案(选择1种二线注射剂，卡那霉素或阿米卡星，若其一耐药再选用卷曲霉素。注射剂至少应用6个月，选择2～3种口服二线药，选择顺序为对氨基水杨酸、环丝氨酸、丙硫异烟胺。培养转为阴性后再治疗至少18个月)。分析三种治疗方案对耐药肺结核患者的治疗效果。结果：个体化治疗方案的痰菌阴转率为70.00%，X线检查胸部病灶好转率为70.00%，均明显高于标准化治疗方案(58.00%、50.00%)和经验性治疗方案(34.00%、42.00%)，比较差异均有统计学意义(P<0.05)。结论：个体化治疗方案治疗耐药肺结核效果显著好于标准化治疗方案和经验性治疗方案。
, 百拇医药
【关键词】 耐药肺结核； 标准化治疗方案； 个体化治疗方案； 经验性治疗方案； 效果分析
【Abstract】 Objective：To compare the effect of the three different treatment plans for multi-drug resistant tuberculosis and explore the superiority of individualized treatment so as to provide the reference for the clinical treatment of drug-resistant tuberculosis.Method：150 patients with drug-resistant tuberculosis in our center from January 2009 to January 2013 were selected.Among them，50 patients were given standard treatment [6Z Km (Am，Cm) Lfx (MFX) Cs (PAS，E) Pto/ 18Z Lfx (Mfx) Cs (PAS，E) Pto]，50 patients were given individualized treatment [6ZEMfxCs (Am) Pot/ 18ZEMfxPtoPas] and the other 50 cases were given experienced treatment(one second-line injection was chosen from kanamycin and Amikacin，if the resistance happened，then selected capreomycin.The Injection had to be used for at least 6 months.2-3 oral second-line drugs were chosen，the select order was amino acid，cycloserine and protionamide.The treatment continued for at least 18 months after the cultures turned negative).The therapeutic effect of three therapeutic schemes for patients with drug-resistant tuberculosis were analysed.Result：The sputum negative conversion rate (70.00%) and X-ray improvement rate(70.00%) of the individualized treatment group were significantly higher than that of the standard treatment group(58.00%，50.00%) and the experienced treatment group(34.00%，42.00%)，the differences were statistically significant(P<0.05).Conclusion：For the treatment of drug resistant tuberculosis，the individualized treatment plan is better than the standard and experienced treatment plan.
, 百拇医药
【Key words】 Drug resistant tuberculosis； Standard treatment plan； Experienced treatment plan； Individualized treatment plan； Efficacy analysis
First-author’s address：Disease Prevention and Control Center of Qihe County，Qihe 251100，China
doi：10.3969/j.issn.1674-4985.2015.17.055
肺结核是一种历史悠久、传染性极强的呼吸系统疾病，其主要的致病菌是结核分枝杆菌。本病是营养相关性疾病，在发展中国家广泛存在[1]。根据我国第四次肺结核流行病学调查显示，我国有近半数的人口感染过结核杆菌，其中，活动性肺结核患者450万，涂阳患者150万，发病人数在世界仅次于印度居第2位[2-3]。由于本病是一种营养相关性疾病，患者感染后，机体抵抗力下降，而且出现治疗效果不满意的情况[4]。然而随着化学药物的广泛应用或者滥用，耐药的结核病对结核病控制产生了严重的威胁。耐药的肺结核病是指从患者分离出的结核菌至少耐异烟肼及利福平或两种以上抗结核药物的结核病，使得以这两种药物为核心的标准化方案失去了疗效[5]。耐药肺结核病人病程长，痰菌不易阴转，传染性强，易导致原发耐药病人的产生，给结核病的控制带来极大的困难，因此，如何防治耐药结核病已经成为临床上亟待解决的问题。目前的治疗方案类型主要包括个体化方案、经验性方案(Empirical therapy，ET )、标准化方案(Standardization therapy，ST)[6]。个体化治疗(individualized drug therapy，IDT)是以每个患者的信息为基础决定治疗方针，为探讨个体化治疗方案与其他治疗方案在耐药肺结核治疗中的作用，笔者回顾性分析了2009年1月-2013年1月在本疾病预防控制中心接受治疗的150例耐药肺结核病患者资料发现，个体化治疗方案较标准化治疗方案、经验治疗方案在痰菌阴转、胸部影像吸收方面均取得了较好的疗效。现报告如下。, http://www.100md.com(张绿洲)
, 百拇医药
【关键词】 耐药肺结核； 标准化治疗方案； 个体化治疗方案； 经验性治疗方案； 效果分析
【Abstract】 Objective：To compare the effect of the three different treatment plans for multi-drug resistant tuberculosis and explore the superiority of individualized treatment so as to provide the reference for the clinical treatment of drug-resistant tuberculosis.Method：150 patients with drug-resistant tuberculosis in our center from January 2009 to January 2013 were selected.Among them，50 patients were given standard treatment [6Z Km (Am，Cm) Lfx (MFX) Cs (PAS，E) Pto/ 18Z Lfx (Mfx) Cs (PAS，E) Pto]，50 patients were given individualized treatment [6ZEMfxCs (Am) Pot/ 18ZEMfxPtoPas] and the other 50 cases were given experienced treatment(one second-line injection was chosen from kanamycin and Amikacin，if the resistance happened，then selected capreomycin.The Injection had to be used for at least 6 months.2-3 oral second-line drugs were chosen，the select order was amino acid，cycloserine and protionamide.The treatment continued for at least 18 months after the cultures turned negative).The therapeutic effect of three therapeutic schemes for patients with drug-resistant tuberculosis were analysed.Result：The sputum negative conversion rate (70.00%) and X-ray improvement rate(70.00%) of the individualized treatment group were significantly higher than that of the standard treatment group(58.00%，50.00%) and the experienced treatment group(34.00%，42.00%)，the differences were statistically significant(P<0.05).Conclusion：For the treatment of drug resistant tuberculosis，the individualized treatment plan is better than the standard and experienced treatment plan.
, 百拇医药
【Key words】 Drug resistant tuberculosis； Standard treatment plan； Experienced treatment plan； Individualized treatment plan； Efficacy analysis
First-author’s address：Disease Prevention and Control Center of Qihe County，Qihe 251100，China
doi：10.3969/j.issn.1674-4985.2015.17.055
肺结核是一种历史悠久、传染性极强的呼吸系统疾病，其主要的致病菌是结核分枝杆菌。本病是营养相关性疾病，在发展中国家广泛存在[1]。根据我国第四次肺结核流行病学调查显示，我国有近半数的人口感染过结核杆菌，其中，活动性肺结核患者450万，涂阳患者150万，发病人数在世界仅次于印度居第2位[2-3]。由于本病是一种营养相关性疾病，患者感染后，机体抵抗力下降，而且出现治疗效果不满意的情况[4]。然而随着化学药物的广泛应用或者滥用，耐药的结核病对结核病控制产生了严重的威胁。耐药的肺结核病是指从患者分离出的结核菌至少耐异烟肼及利福平或两种以上抗结核药物的结核病，使得以这两种药物为核心的标准化方案失去了疗效[5]。耐药肺结核病人病程长，痰菌不易阴转，传染性强，易导致原发耐药病人的产生，给结核病的控制带来极大的困难，因此，如何防治耐药结核病已经成为临床上亟待解决的问题。目前的治疗方案类型主要包括个体化方案、经验性方案(Empirical therapy，ET )、标准化方案(Standardization therapy，ST)[6]。个体化治疗(individualized drug therapy，IDT)是以每个患者的信息为基础决定治疗方针，为探讨个体化治疗方案与其他治疗方案在耐药肺结核治疗中的作用，笔者回顾性分析了2009年1月-2013年1月在本疾病预防控制中心接受治疗的150例耐药肺结核病患者资料发现，个体化治疗方案较标准化治疗方案、经验治疗方案在痰菌阴转、胸部影像吸收方面均取得了较好的疗效。现报告如下。, http://www.100md.com(张绿洲)