利奈唑胺治疗耐多药结核病疗效研究

Clinical efficacy study on using Linezolid to treat multi-drug resistant tuberculosis

目的观察利奈唑胺(Lzd)治疗耐多药结核病(MDR-TB)的临床疗效和安全性。方法收集2012年1月至2014年09月我院诊治的MDR-TB患者38例,将患者分为治疗组和对照组,其中治疗组19例,对照组19例。治疗组患者前6个月选用利奈唑胺(Lzd)、阿米卡星(Amk)、左氧氟沙星(Lfx)、吡嗉酰胺(PZA)、丙硫异烟胺(Pto)或乙胺丁醇(EMB)、对氨基水杨酸异烟肼(Pa)联合治疗,后6个月继续予Lfx、PZA、Pto(EMB)、Pa巩固期治疗;对照组用药除不含Lzd外,其余用药与治疗组一致。对比观察两组患者的痰菌阴转率、CT病灶吸收率、结核空洞好转率和不良反应(ADR)发生率。结果 12个月治疗观察期结束后治疗组痰菌阴转率、CT病灶吸收率及结核空洞好转率分别为89.47%、89.47%和87.50%,均高于对照组的57.89%、57.89%、53.33%,差异有统计学意义(P均<0.05);治疗组与对照组ADR发生率分别为47.37%、21.05%,差异无统计学意义(P>0.05),治疗组ADR发生率稍高,但并未出现特别严重的ADR发生,患者均能坚持治疗。结论加用Lzd治疗MDR-TB可加速痰菌转阴,促进病灶吸收,加快空洞闭合,且不良反应较轻,患者多能耐受,获得了较好的临床疗效。

Objective To evaluate the clinical efficacy and safety of linezolid in treatment of MDR-TB. Methods Collection of diagnosis and treatment of-39 MDR-TB patients in our hospital since January, 2012 to September, 2014. the patients were divided into two groups,the treatment group （n=19） and the control group （n=1g）. Executive 6 months Lzd,Lfx,PZA,Pto,Pa,Amk/6 months Lfx, PZA,Pto, Pa in treatment group, Executive 6 months Lfx,PZA, Pto,Pa,Amk/6 months Lfx, PZA,Pto, Pa in control group. Observe two groups of patients with sputum negative conversion rate,focus absorption rate of CT,Tuberculosis Cavity improvement rate and adverse reaction incidence rate （ADR）. Results Mter 12 months of treatment,the sputum negative conversion rate of CT group,focus absorption and cavity improvement rate were 89.47%, 89.47% and 87.5%,they were higher than the control group＇s 42.8%, 50% ,45.4%,the difference was statistically significant. The treatment group and the control group the incidence of ADR were 47.37% ,21.05% ,there was no significant difference.. Conclusions Using linezolid to treat MDR-TB can improve clinical symptoms, accelerate sputum negative conversion. It has better clinical curative effect with adverse reaction but well tolerance.