含环丝氨酸方案治疗耐多药肺结核出现严重精神症状的临床分析

Clinical analysis of severe psychiatric symptoms in treatment of MDR-TB with standard chemotherapy regimen containing cycloserine

目的评价含环丝氨酸(Cs)的标准方案治疗耐多药肺结核过程中出现严重精神症状的发生情况,为环丝氨酸在耐多药肺结核治疗的临床应用提供参考依据。方法回顾性分析2012年6月1日—2014年6月30日武汉市结核病防治所全球基金耐多药肺结核项目采用含有环丝氨酸标准化治疗方案的113例患者,对其中6例出现严重精神症状的病例进行临床分析。结果 113例耐多药肺结核中6例出现严重精神症状(占5.3%),出现严重精神症状后均停用环丝氨酸,经药物干预后症状缓解,后续治疗予PAS替代,均未再使用环丝氨酸。结论环丝氨酸是较安全的治疗耐多药肺结核的二线抗结核药物,环丝氨酸的不良反应主要是精神症状,出现严重精神症状需及时停药,药物干预,精神症状能在短期内缓解。

Objective To evaluate the occurrence of severe psychiatric symptoms in the treatment of multi-drug resistanttuberculosis（MDR-TB） with standard chemotherapy regimen containing cycloserine（Cs）,so as to provide the reference for theclinical application of cycloserine in the treatment of MDR-TB. Methods The clinical data of 113 MDR-TB patients werecollected and analyzed. They were enrolled in Global Fund MDR-TB Control Program with standardized treatment regimencontaining cycloserine from June 1,2012 to June 30,2014. Results Six out of 113 patients with MDR-TB had severepsychiatric symptoms（5.3%）,and the symptoms were relieved after stopping cycloserine. Cycloserine was replaced by PAS inthe following treatment in all 6 cases after psychiatric symptoms alleviation. Conclusion Cycloserine is a safe drug in thetreatment of MDR-TB. MDR-TB patients treated with cycloserine regimen should be closely monitored in neuropsychiatricside effects for early recognition and treatment. The symptoms may be relieved after stopping cycloserine.