2种化疗方案治疗老年初治肺结核的疗效和安全性研究

The efficacy and safety of two chemotherapy regimens in the initial treatment of elderly patients with pulmonary tuberculosis

目的比较2种结核化疗方案治疗老年初治肺结核的疗效及安全性。方法将符合纳入标准的130例老年初治涂阳肺结核患者随机分为试验组和对照组。试验组给予2HLEV/4HL治疗,对照组给予2HRZE/4HR治疗,比较2组疗效和安全性。结果化疗2月和6月末,试验组和对照组痰菌阴转率差异均无统计学意义;化疗6个月疗程结束时病灶变化(显吸、吸收、不变或恶化)和空洞变化(闭合、缩小、不变或增大)组间差异均无统计学意义。试验组不良反应发生率是28.3%,小于对照组的57.9%(P=0.001);2组不良反应均以胃肠道反应和肝损伤最多见,试验组胃肠道反应、肝损伤及高尿酸血症发生率均小于对照组(P均<0.05)。结论 2种结核化疗方案疗效无差异,但2HLEV/4HL的不良反应发生率低,对老年初治肺结核患者是更安全的化疗方案。

Objective To compare the efficacy and safety of two different chemotherapy regimens in the initial treatment of elderly patients with pulmonary tuberculosis. Methods One hundred and thirty initially-treated elderly patients with smear-positive pulmonary tuberculosis who met the inclusion criteria were randomly and equally divided into the experimental group and the control group. Patients in the experimental group received 2HLEV/4 HL treatment and those in the control group were given 2HRZE/4HR. The differences of efficacy and safety between the two groups were compared. Results There were no statistically significant differences between the two groups in sputum negative conversion rates at the end of 2-month and 6-month treatment（P 〉 0.05）; and the differences of the focus change and the pulmonary cavity change between groups at the end of chemotherapy were not statistically signifieant（P 〉 0.05）. The incidence of adverse reactions in the experimental group was 28.3%, which was lower than those in the control group of 57.9%（P=0.001）; The most reported adverse reactions in both groups were gastrointestinal reaction and liver injury, and the incidences of gastrointestinal reaction, liver injury, and hyperuricemia in the experimental group were lower than those in the control group （P 〈 0.05）. Conclusions There is no difference in the efficacy, between the two tuberculosis chemotherapy regimens, but the adverse effects of the 2HLEV/4 HL treatment are lower, making it a safer chemotherapy for initially-treated elderly patients with pulmonary tuberculosis.