异烟肼抑菌商数在预测肺结核治疗预后中的作用

Effect of Inhibitory Quotient of Isoniazid on Prediction of Prognosis of Pulmonary Tuberculosis

目的探索抑菌商数在预测肺结核治疗效果中的作用。方法筛选27名初治涂阳敏感但治疗1周后症状改善不佳的肺结核患者,在患者口服异烟肼后2 h采血,HPLC法测定异烟肼血药浓度(Cmax),用显色法检测结核菌MIC,以Cmax/MIC计算相应患者的抑菌商数(IQ)值,观察IQ值与临床治疗效果的相关性。结果 27名患者的稳态血药浓度中低于治疗浓度范围的有15例(55.6%),在正常治疗浓度范围的有10例(37.0%),高于治疗范围的有2例(7.4%);IQ值<9的有8例(29.6%),IQ值>9的有19例(70.4%);痰菌转阴率为57.89%。所有患者完成疗程后均有较高的症状好转率(>80%)和病灶吸收率(>60%)。结论从结果看,IQ能很好指示治疗预后,当治疗效果不佳时,对患者及时进行血药浓度检测并根据PK/PD调整剂量非常必要。

Objective To explore the effect of inhibitory quotient(IQ)on prediction of the outcome of tuberculosis treatment.Methods Overall 27 patients with pulmonary tuberculosis who underwent poor improvement within 1 week after treatment were screened.Blood samples were collected 2 hours after the patients took isoniazid.HPLC were conducted to determine the level of isoniazid(Cmax).Minimum inhibitory concentration(MIC)of mycobacterium tuberculosis was measured with the color-developing method.IQ was calculated by dividing Cmax by MIC.Relevance between IQ and clinical treatment effect was analysed.Results Of all the 27 patients,15 cases'Cmax was lower than the normal treatment level(55.5%),and that of 10 was at the normal level(37.0%),while another 2 patients'Cmax were higher than the norm(7.4%).As for the IQ,8 patients were below 9(29.6%),while the rest 19 patients were above 9(70.4%).The negative conversion rate of sputum bacteria was 57.89%.All patients had high improvement rate(>80%)and foci absorption rate(>60%).Conclusion IQ can predict prognosis well.If poor treatment effect occurs,it is necessary to detect the Cmax and adjust dosage according to PK/PD.