伴有肝功能异常的肺结核的化学治疗

Chemotherapy regimen for the pulmonary tuberculosis patients complicated with abnormal hepatic function

目的 临床常见肺结核伴有肝功能异常而导致治疗困难 ,为此探索选用肝毒性最小的化疗方案。方法 采用 2 [左旋氧氟沙星 (LOFX)·帕星肼 (PSNZ)·乙胺丁醇 (E)·链霉素 (S)或阿米卡星 (AMK) ]/12～ 16 [LOFX·PSNZ·E]方案治疗伴有肝功能异常的菌阳肺结核 2 0例 ,自身对照 ,动态观察痰菌、X线胸片及肝功能变化。结果 2 0例皆较顺利地完成了预定疗程 ,肝功能好转或恢复正常 ,痰菌涂片均在 2个月内阴转 ,原来X线胸片所见显著好转 (12 /2 0 ) ,无恶化者 ,仅 1例残留空洞 ,痰菌培养仍阳性 ,该菌株对异烟肼 (H)、利福平 (R)、PSNZ皆耐药。结论 (1)对处于乙型肝炎活动期或有乙型肝炎病史者选用抗结核药需要慎重。 (2 )

Objective To evaluate a chemotherapy method of minimal hepatic toxicity for the pulmonary tuberculosis patients complicated with abnormal hepatic function.Methods Twenty patients of smear and cultural positive pulmonary tuberculosis,complicated with abnormal hepatic function,were treated with 2[LOFX.PSNZ.E.S(or AMK)]/12 16[LOFX.PSNZ.E] chemotherapy regimens to observe the changes of smear and cultural results,X ray and hepatic functions before and after chemotherapy(self control).Results All the 20 patients were treated smoothly with the chemotherapy regimens and their hepatic function were improved or recovered to normal with negative smear in 2 months after the chemotherapy.The X ray resolutions were found clearly in 12 of 20 cases and there was not one case with worse X ray when the chemotherapy regimens finished.There was only one case having residual pulmonary cavity,and the smear and cultural was still positive with the organism resistant to H.R.PSNZ after the chemotherapy.Conclusions (1)The antituberculosis drugs for treating the pulmonary tuberculosis patient in the period of hepatitis activity or with hepatitis history must be choosen carefully;(2)the chemotherapy regimen with LOFX.PSNZ is suitable for the pulmonary tuberculosis patients with abnormal hepatic function in this series.