TB/HIV双重感染患者抗结核治疗药物不良反应分析

Study on adverse drug response of anti-TB treatment in patients living with TB/HIV co-infection

目的了解TB/HIV双重感染患者抗结核治疗过程中不良反应发生频度及相关影响因素。方法以2007—2008年3个省共6个县,新发现TB/HIV双重感染患者为观察对象,观察这些患者抗结核治疗期间不良反应发生情况。结果共观察332例患者,不良反应总体发生率81.6%,其中胃肠道44.2%,肝脏13.3%,皮肤过敏反应11.4%,血液系统24.4%,神经系统18.7%,骨关节3.6%,肾、视力、耳等其他反应4.2%,68.1%不良反应发生在服用抗结核药品后30 d以内,66.8%持续时间在15 d以上,病死患者87.9%死于抗结核治疗强化期。涂阳肺结核患者、低体质量患者、静脉吸毒患者、抗病毒治疗时间较晚患者重度不良反应发生率较高。结论 TB/HIV双重感染患者抗结核治疗不良反应发生率较单纯结核高,不良反应持续时间更长,应重视双重感染患者抗结核治疗期间不良反应监测,尤其是抗结核治疗强化期,涂阳肺结核、低体质量、静脉吸毒、抗病毒治疗时间较晚患者是重点对象。

Objective To understand the frequency and related impact factors of adverse drug response during TB treatment course in people living with TB/HIV co-infection.Method Adverse drug response of newly discovered TB/HIV patients in 6 counties of 3 provinces was observed.Result A total of 332 TB/HIV patients were observed.The overall incidence of adverse response was 81.6%.Of which,44.2% in gastrointestinal tract,13.3% in liver,11.4% of skin allergies,24.4% of the blood system,18.7% of nervous system,3.6% of bones and joints,4.2%of kidneys,vision,ears and other reaction,68.1% of adverse response happened within 30 days of anti-TB treatment,66.8% lasted for more than 15 days,87.9% of patients died of illness happened in intensive periods of anti-TB treatment.Smear-positive tuberculosis,low-weight,intravenous drug abuse,late initiation of antiviral treatment are impact factors of severe adverse drug response.Conclusion Patients living with TB/HIV co-infection has higher incidence and longer duration of adverse drug response than pure TB patients.Therefore,adverse response should be monitored,especially in intensive TB treatment period.Patients with smear positive pulmonary tuberculosis,low weight,intravenous drug abuse,late initiation of anti-viral treatment are the focus population;Anti-viral treatment should be initiated early for patients living with TB/HIV co-infection.