利奈唑胺联合抗结核治疗对结核性脑膜脑炎患者肝功能及脑脊液腺苷脱氨酶水平的影响

Effects of linezolid combined with anti-tuberculosis therapy on liver function and cerebrospinal fluid adenosine deaminase level in patients with tuberculous meningoencephalitis

目的探究利奈唑胺联合抗结核治疗对结核性脑膜脑炎(TBM)患者肝功能及脑脊液腺苷脱氨酶(ADA)水平的影响。方法选取2015年6月至2020年6月安徽省胸科医院收治的102例TBM患者,按照随机数字表法分为观察组(50例)和对照组(52例),对照组进行常规抗结核治疗,观察组在对照组基础上联合利奈唑胺治疗。治疗3个月后比较2组临床总有效率、肝功能[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素、γ谷氨酰转肽酶(GGT)]、脑脊液指标[白细胞计数(WBC)、葡萄糖、蛋白质、ADA]水平及不良反应发生情况。结果观察组总有效率高于对照组[96.0%(48/50)比82.7%(43/52)],差异有统计学意义(P<0.05)。治疗后2组ALT、AST、总胆红素、GGT水平均较治疗前有所升高(均P<0.05),但组间比较差异均无统计学意义(均P>0.05)。治疗后2组脑脊液WBC、蛋白质及ADA水平均较治疗前下降,葡萄糖水平均较治疗前升高,且观察组WBC、蛋白质、ADA水平低于对照组[ADA:(4.3±1.1)U/L比(4.8±1.1)U/L],葡萄糖水平高于对照组,差异均有统计学意义(均P<0.05)。2组药物性肝损伤、视力下降、胃肠道症状、外周神经疼痛的发生率差异均无统计学意义(均P>0.05)。结论利奈唑胺联合常规抗结核治疗TBM更能有效降低患者脑脊液ADA水平,提高临床疗效,且不额外增加肝功能损伤。

Objective To investigate the effects of linezolid combined with anti-tuberculosis therapy on liver function and cerebrospinal fluid adenosine deaminase(ADA)in patients with tuberculous meningoencephalitis(TBM).Methods From June 2015 to June 2020,102 TBM patients admitted to Anhui Chest Hospital were selected and randomly divided into the observation group(50 cases)and the control group(52 cases).The control group was treated with conventional anti-tuberculosis therapy,and the observation group was treated with linezolid on the basis of the control group.After 3 months of treatment,the total clinical effective rate,liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),γ-glutamyl transpeptidase(GGT)],cerebrospinal fluid indicators[white blood cell count(WBC),glucose,protein,ADA]levels and adverse reactions were compared between the two groups.Results The total clinical effective rate in the observation group was higher than that in the control group[96.0%(48/50)vs 82.7%(43/52)](P<0.05).After treatment,the levels of ALT,AST,TBIL,and GGT were increased in both groups(all P<0.05),but there were no significant differences between the two groups(all P>0.05).After treatment,the levels of cerebrospinal fluid WBC,protein,and ADA in both groups were decreased,while the glucose levels in both groups were increased,the WBC,protein and ADA levels in the observation group were lower than those in the control group[ADA:(4.3±1.1)U/L vs(4.8±1.1)U/L],and the glucose level in the observation group was higher than that in the control group(all P<0.05).There were no significant differences in the incidences of drug-induced liver injury,vision loss,gastrointestinal symptoms,and peripheral nerve pain between two groups(all P>0.05).Conclusion Linezolid combined with conventional anti-tuberculosis therapy can effectively reduce of cerebrospinal fluid ADA level in TBM patients,improve clinical efficacy,and do not increase additional liver function damage.