应用含丙硫异烟胺和对氨基水杨酸方案治疗耐多药肺结核致甲状腺功能减退分析

Analysis of the clinical characteristics of hypothyroidism caused by anti-MDR-TB regimen containing prothionamide(Pto) and p-aminosalicylic acid granule(PAS)

目的分析含丙硫异烟胺(Pto)和对氨基水杨酸(PAS)方案治疗耐多药肺结核(MDR-TB)致甲状腺功能减退(甲减)的发生情况,探讨应用Pto和PAS导致药物性甲减的处理方法和措施。方法对2008年8月1日至2010年4月1日武汉市第五轮中国全球基金耐多药结核病防治项目确诊的106例MDR-TB患者,采取含Pto和PAS的标准方案6PZA Km(Cm)Lfx(Mfx)Pto PAS/18PZA Lfx(Mfx)Pto PAS进行治疗,疗程中监测甲状腺功能,共32例出现甲减。分析32例发生甲减[19例进行左旋甲状腺素(L-T4)替代治疗,13例未进行L-T4替代治疗]和74例未发生甲减患者的治疗转归情况。结果治疗106例MDR-TB患者,发生甲减32例(30.2%,32/106);31例患者抗结核疗程结束,停用Pto及PAS后甲状腺功能恢复正常,1例患者治疗过程中因呼吸功能衰竭死亡。甲减患者与未发生甲减患者MDR-TB治愈率分别为68.8%(22/32)和68.9%(51/74),差异无统计学意义(χ2=0.19,P=0.66);甲减患者中L-T4替代治疗者与未替代治疗者MDR-TB治愈率分别为68.4%(13/19)和76.9%(10/13),差异无统计学意义(χ2=0.28,P=0.60)。结论应用含Pto及PAS方案治疗MDR-TB,甲减的发生率较高;使用L-T4替代治疗能控制甲减;停用Pto及PAS后甲状腺功能可以恢复正常。

Objective To investigate the incidence and the clinical characteristics induced by chemotherapy regimen containing prothionamide （Pto） and p-aminosalicylic acid granule （PAS） in anti-multi drug-resistant tuber- culosis （MDR-TB）treatment and to develop preventive measures and treatment methods for hypothyroidism induced by Pto and PAS. Methods We analyzed 106 cases with MDR-TB who received standard chemotherapy regimen containing Pto and PAS（6 PZA Km（Cm） Lfx （Mfx） Pto PAS/18 PZA Lfx（Mfx） Pto PAS） from the research pro- ject supported by the 5th round of the global funds projects during August 1, 2008 and April 1,2010 in Wuhan city. Thirty two cases experienced hypothyroidism were monitored by thyroid functions during treatment. The treatment out- comes were analyzed in 106 cases. There were 32 cases with hypothyroidism treated with levothyrocine（L-T4 ） in 19 cases and without levothyrocine in 13 cases and 74 cases without hypothyroidism. Results There were 32 cases experien- ced hypothyroidism in 106 cases. Thirty one cases with hypothyroidism were recovered after treatment and 1 cases died due to respiratory failure. The cure rates for MDR-TB with and without hypothyroidism were 68.8% （22/32）and 68.9%（51/74） respectively. The difference was insignificant statistically（x2 = 0. 19, P = 0.66）. The cure rates for MDR-TB with hypothyroidism treated with L-T4 and without L-T4 were 68.4 % （13/19）and 76.9 %（10/13） respec- tively. The difference was insignificant statistically （x2 =0.28, P=0. 60）. Conclusion The incidence of hypothy- roidism tends to increase in MDR-TB patients treated with chemotherapy regimen containing Pto and PAS. Hypot- hyroidism can be controlled by taking the drug of L-T4. The thyroid functions can be recovered after chemotherapy teatment.