耐多药空洞肺结核的介入治疗

Interventional therapy on cavitary pulmonary MDR-TB

目的 探讨耐多药空洞肺结核介入治疗的意义。方法 采用 36例临床培养的耐药菌株作耐药结核菌抑制试验、临床对照观察的方法。 1 80例耐多药空洞肺结核住院患者随机分成两组 ,均用 3DLOZA/1 8DLOZ化疗方案治疗 ,治疗组 86例配合抗结核药物凝胶介入治疗并完成疗程。结果 提高抗结核药物浓度 ,可有效控制耐药结核菌生长 ,而所需浓度远远低于药物凝胶的含药浓度。临床观察治疗组比对照组痰菌阴转率高 (88.4 %) ,痰菌阴转速度也快 ,空洞闭合率高 (43.0 %) ,空洞闭合速度快 ,疗效较好。单发空洞、干酪空洞的疗效比多发空洞、纤维空洞的疗效较好。未发现与介入药物凝胶有关的不良反应。结论 经纤支镜引导灌注抗结核药物凝胶 ,是治疗耐多药空洞肺结核的有效方法 ,其有净化空洞 ,促使痰菌转阴 ,空洞闭合的作用。并且有安全无创 ,无明显不良反应 ,并发症少的优点 ,值得临床推广使用。

Objective To determine the significance of interventional therapy on cavitary pulmonary MDR-TB.Methods Study the inhibitory effects on 36 cultured drug-resistant TB strains using increased concentration of anti-tuberculosis drugs,and compare the clinical effect of treaditional anti-TB treatment vs.bronchoscope-assisted interventional therapy on cavitary pulmonary MDR-TB.Randomly selected 180 adult hospitalized patients with cavitary pulmonary MDR-TB and received 3DLOZA/18DLOZ treatment.The therapeutic group consists of 86 patients treated with both traditional and the bronchoscope-assisted interventional antituberculosis drug therapy and had completed.Results Increased concentration of antituberculosis can effectively control growth of drug-resistant tuberculosis.However,the dosage needed could be far more less than the concentration of the antituberculosis jelly interventional therapy.For the sputum negative rate,the therapy group (88.4%) was higher than the controlled group (70.0%).The cavitive closing rate was higher in therapy group (43.0%) than the controlled group (20.0%) too.In addition,more clinically improvement had been shown in the therapy group than the controlled group.Upon observation,the therapeutic effect was much better on single,caseous cavity than on multiple,fibrous cavity.There had not been any observed adverse reaction in the process of interventional therapy.Conclusion Super-drug-resistant TB can be more effectively controlled by higher dose of antituberculosis drugs.Bronchoscope-assisted interventional antiphthisic therapy is an safe and effective way to treat refractory cavitary pulmonary MDR-TB,provided the significant effect on cleaning,closing of the cavity as well as turning sputum negative.Worthwhile,the clinical application should be approached extensively.