CT引导下空洞内注药在耐多药肺结核患者治疗中的作用

The role of the CT-guided cavity injection of anti - tuberculosis drugs in the treatment of multi- drug-resistent pulmonary tuberculosis

目的探讨CT引导下空洞内注药在耐多药肺结核综合治疗中的作用。方法对2004年4月-2006年4月我所心肺功能正常、伴肺部空洞的50例耐多药肺结核患者，在含帕司烟肼、左旋氧氟沙星、乙胺丁醇、丙硫异烟胺、阿米卡星和吡嗪酰胺治疗方案的基础上，进行介入治疗，介入治疗后继续化疗至18个月。结果介入治疗后3个月痰抗酸菌涂片同时结核分支杆菌培养阴性率为60．0％（30／50），治疗18个月达84％（42／50）。X线影像学检查结果显示，介入治疗后3个月病灶吸收显效率为52．0％（26／50），有效率为92．0％（46／50），治疗18个月显效率达82．0％（41／50），有效率为96．0％（48／50），经介入治疗3个月后空洞闭合率为20％（10／50），治疗18个月达50．0％（25／50）。治疗结束时发热、咯血、咳痰、乏力、呼吸困难等症状消失率达72％～93％。结论CT引导下空洞内注药对耐多药肺结核具有加速细菌转阴、病灶吸收和空洞闭合的作用，可促进症状改善，提高患者的生活质量。

Objective To evaluate the role of the CT-guided cavity injection of anti - tuberculosis drugs in the comprehensive treatment of MDR-TB. Method Admitted in WuhanTubereulosis Prevention And Treatment Institute fromApril 2004 to April 2006,50 MDR-TB patients with lung cavities who had normol eardiopulmonary functions recieved interventional treatment on the basis of the chemotherapy regimen which comprised Pasiniazide, levofloxacin, ethylamine, Protionamide, amikacin, and pyrazinamide, and which was continued for 18 months. Results After the interventional treatment, the negative rate of both AFB smears and Mycobaeterium tuberculosis culture of sputum was 60.0% （30/50） at the end of 3 months,and up to 84% （42/50） at the end of the 18 monthstreatment. X ray imaging results showed that the rate of lesion absorption was 52.0% （26/50） ,and the effective rate was 92.0% （46/50） at the end of 3 months after interventionai treatment,whereas the rate of lesion absorption was 82.0% （41/50） and the effective rate was 96.0% （48/50） at the end of the 18 months- treatment. The closure rate of lung cavities was 20% （10/50） at the end of 3 months after interventional treatment, and was 50.0% （25/50） at the end of the 18 monthstreatment. The rate of symptom （ such as fever, hemoptysis, sputum, fatigue, difficulty in breathing） disapearance was up to 72-93% at the end of the treatment. Conclusions CT-guided cavity injection of anti - tuberculosis drugs in multi-drug resistant pulmonary tuberculosis accelerates bacteria clearance,lesion absorption and cavity closure, and promotes improvement of symptoms ,thereby improves patients＇ quality of life.