环丝氨酸联合抗结核药物对耐多药肺结核患者在肺功能、痰菌阴转率、X-pert MTBRIF以及肺CT的影响研究

Effect of Cycloserine Combined with Antituberculosis Drugs on Pulmonary Function,Sputum Negative Conversion Rate,X-Pert Mtbrif and Pulmonary CT in Patients with Multi-drug Resistant Pulmonary Tuberculosis

目的探讨环丝氨酸联合抗结核药物对耐多药肺结核患者肺功能、痰菌阴转率及X-pert MTBRIF的影响。方法回顾性选取我院2017年7月至2019年6月收治的224例耐多药肺结核患者的病例资料,依据治疗方案不同分为对照组与观察组各112例,对照组患者给予常规抗结核药物方案(丙硫异烟胺+盐酸乙胺丁醇+利奈唑胺+吡嗪酰胺)治疗;观察组患者在对照组基础上联合环丝氨酸胶囊(250mg/次,2次/日),对比两组患者治疗前后肺功能、不同阶段痰菌阴转率及治疗后X-pert MTBRIF检测结果,评价临床治疗效果。结果治疗前两组患者FVC、FEV1%、FEV1/FVC等呼吸功能指标差异无统计学意义(P>0.05),治疗后FVC、FEV1%、FEV1/FVC均高于治疗前,呼吸功能改善显著,且观察组患者各指标较对照组升高显著(P<0.05);LPA检测阳性率与X-pert MTB/RIF检测结果差异无统计学意义,P>0.05;观察组患者治疗1个月后X-pert MTB/RIF与线性探针技术(LPA)患者阳性率均低于对照组(P<0.05);两组患者治疗后1周痰转阴率差异无统计学意义(P>0.05);观察组患者治疗后1个月、3个月患者痰转阴率均低于对照组,差异有统计学意义(P<0.05);观察组患者治疗后有效率92.0%(103/112)显著高于对照组76.8%(86/112)(P<0.05);两组患者不良反应发生率无明显差异(P>0.05)。观察组患者治疗后胸部CT效果明显优于对照组。结论环丝氨酸联合常规抗结核药物治疗耐多药肺结核可显著改善患者肺功能,提高患者痰菌转阴率,治疗后患者痰标本结核杆菌含量减少,且未增加治疗后不良反应,临床治疗显著,更适用于耐多药结核患者应用。

Objective to investigate the effect of cycloserine combined with antituberculosis drugs on pulmonary function,sputum negative conversion rate,and X-Pert mtbrif in patients with multi-drug resistant pulmona ry tuberculosis.Methods The data of 224 MDR-TB patients in our hospital from July 2017 to June 2019 were retrospectively selected and divided into a control group and observation group with 112 cases in each group according to different treatment schemes.The patients in the control group were treated with a conventional antituberculosis drug regimen(propofol+ethambutol hydrochloride+linezolid+pyrazinamide).The patients in the observation group were given cycloserine capsules(250 mg/time,2 times/day)based on the control group.Pulmonary function,sputum negative conversion rate at different stages and X-Pert mtbrif test results before and after treatment were compared between the two groups to evaluate the clinical treatment effect.Results There was no significa nt difference in FVC,FEV1%,FEV1/FVC between the two groups before treatment(P>0.05).After treatment,FVC,FEV1%,FEV1/FVC were higher than before treatment,respiratory function improved significantly,and the indexes of the observation group were significantly higher than those of the control group,P<0.05.There was no significant difference between LPA and X-Pert MTB/RIF(P>0.05).The positive rates of X-Pert MTB/RIF and LPA in the observation group were lower than those in the control group(P<0.05).There was no significa nt difference in sputum negative conversion rate between the two groups at 1 week after treatment,P>0.05.the sputum negative conversion rate of observation group at 1 month and 3 months after treatment was lower than that of the control group,the difference was statistically significant(P<0.05).The effective rate of the observation group was 92.0%(103/112),which was significantly higher than 76.8%(86/112)of the control group,P<0.05;there was no substantially difference in the incidence of adverse reactions between the two groups,P>0.05.After treatment,the chest CT effect of the observation group was significantly better than that of the control group.Conclusion Cycloserine combined with conventional anti-tuberculosis drugs in the treatment of MDR-TB can substantially improve the pulmonary function of patients,increase the negative conversion rate of sputum bacteria,reduce the content of Mycobacterium tuberculosis in sputum samples of patients after treatment,and do not increase the adverse reactions after treatment.The clinical treatment is significant,which is more suitable for the application of MDR-TB patients.