69例妊娠并发肺结核患者的临床治疗

Therapy of pregnancy combined with tuberculosis-69 cases clinical observation

目的 探讨2H-R-E/10H-R及2H-Z-E/10H-R抗结核治疗方案对妊娠并发肺结核患者的有效性、耐受性及对新生儿先天性畸形的影响。方法 纳入1998年9月至2014年12月首都医科大学附属北京胸科医院诊治的妊娠3个月内的初治肺结核患者79例,自妊娠3个月后开始抗结核药物治疗,采用数字表法随机将患者分为A组（40例,予2H-R-E/10H-R方案治疗）和B组（39例,予2H-Z-E/10H-R方案治疗）,治疗过程中退组10例,最终A组35例,B组34例;通过胸部CT扫描表现评价治疗第2、12个月末时两组患者的治疗效果,观察治疗过程中药物不良反应,并随访观察两组患者新生儿发生先天性畸形的情况。采用SPSS 14.0软件进行数据的统计学处理,计数资料采用χ 2检验,以P〈0.05为差异有统计学意义。 结果 69例患者完成治疗疗程,A、B两组患者治疗至2个月末和12个月末的有效率分别为97.1%（34/35）和94.1%（32/34）,无效率分别为2.9%（1/35）和5.9%（2/34）,差异均无统计学意义（Fisher确切概率法,P值均=0.614）。治疗至12个月末时A、B组患者药物不良反应发生率分别为14.3%（5/35）、32.4%（11/34）,差异无统计学意义（χ 2=3.16,P=0.075]。69例患者从妊娠3个月至抗结核药物治疗12个月,未见病情进展;新生儿产后随访5个月,均未发生畸形和结核感染。 结论 2H-R-E/10H-R及2H-Z-E/10H-R抗结核方案治疗妊娠并发肺结核疗效确切,且无差异,患者可耐受,无新生儿先天畸形发生,均可临床应用。

Objective To investigate the effectiveness and tolerance of treatment regimen which are 2H-R-E/10H-R and 2H-Z-E/10H-R for pregnancy combined with tuberculosis patients, as well as the influence of congenital malformation for newborns.Methods Bring 79 pregnancy cases were cured in Beijing Chest Hospital from September 1998 to December 2014 combined with initial treatment pulmonary tuberculosis at first 3months’ gestation into this study, and all cases got antituberculosis therapy after 3months’ gestation. All cases were randomly divided into A group and B group through random number table method. A group was 40 cases and they got 2H-R-E/10H-R. B group was 39 cases and they got 2H-Z-E/10H-R. There were 10 cases quit. Finally, A group was 35 cases and B group was 34 cases. Evaluating treatment effect of patients in two groups at the end of second and twelfth month through CT scan. Adverse drug reaction was evaluated through therapeutic process. Meanwhile, observe the congenital malformation conditions for newborns in two groups. All data were took in statistical treatment through SPSS 14.0 software and the count data was expressed as χ 2 test. Finally, P〈0.05 was considered statistically significant. Results Sixty-nine cases finished treatment course. The effective rate for group A and B at the end of second and twelfth month of treatment were 97.1%（34/35） and 94.1%（32/34） respectively. And the invalid rate were 2.9%（1/35） and 5.9%（2/34） respectively. There was no statistical significance（Fisher exact propability, P=0.614）. The incidence of drug-related adverse reaction at the end of twelfth month of treatment was 14.3%（5/35） and 32.4%（11/34） for group A and B respectively. There was no statistical significance（χ 2=3.16, P=0.075）. There was no aggravation for 69 cases from third month of pregnancy to the end of twelfth month of antituberculosis therapy. Newborns were followed up for 5months and all newborns did not get malformation and tuberculosis infection. Conclusion The curative effect of treatment course which were 2H-R-E/10H-R and 2H-Z-E/10H-R for pregnancy patients combined with tuberculosis was obvious and no difference. Patients could tolerate this treatment course and there was no congenital malformation for newborns. Therefore, all therapeutic schedule could be applied to clinical practice.