耐多药肺结核患者采用抗结核药品治疗的不良反应发生情况分析

Analysis of adverse reactions of anti-tuberculosis drugs in patients with multi-drug resistant tuberculosis

目的分析耐多药结核病(MDR-TB)患者采用抗结核药品治疗的药品不良反应(ADR)发生情况,并评价其对治疗的影响。方法205例MDR-TB患者,进行不良反应分类及评估。观察分析205例患者治疗转归情况、不良反应发生情况及其对治疗的影响。结果205例MDR-TB患者:治愈138例(67.32%),完成治疗18例(8.78%),失败27例(13.17%),丢失22例(10.73%),死亡0例。205例MDR-TB患者中有98例患者发生至少1种药品不良反应,治疗6 d内感全身痛、恶心、胃肠道反应,最长者达到124 d,不良反应发生率较高的依次为高尿酸血症85例(86.73%);药物性肝损伤15例(15.31%);胃肠道反应13例(13.27%);药物性皮疹12例(12.24%);血液系统损伤6例(6.12%),其中4例(4.08%)白细胞减少、2例(2.04%)血小板减少;耳毒性和前庭功能障碍2例(2.04%)。发生不良反应98例MDR-TB患者中有65例(66.33%)予以护胃、保肝和健康宣教等对症处理后维持原方案继续治疗停药,31例(31.63%)调整药物剂量和更换药品完成疗程停药,只有2例(2.04%)因全身过敏及胃肠道反应严重拒绝试药而停止治疗。结论在对MDR-TB患者治疗时经常会出现各类不良反应,但临床上一般都是可以较好处理,出现药品不良反应对治疗无明显的影响,通过及时监测药物不良反应及对症处理,仍能够保证患者的治疗顺利进行。

Objective To analyze the occurrence of adverse drug reactions(ADR)in patients with multi-drug resistant tuberculosis(MDR-TB)and evaluate its effect on treatment.Methods 205 patients with MDR-TB were classified and evaluated for adverse reactions.The treatment outcome,occurrence of adverse reactions and their influence on treatment of 205 patients were observed and analyzed.Results 205 MDR-TB patients:138 cases(67.32%)were cured,18 cases(8.78%)were completed,27 cases(13.17%)failed,22 cases(10.73%)were lost,and 0 case died.Among 205 MDR-TB patients,98 patients had at least1 adverse drug reaction,with generalized pain,nausea,and gastrointestinal reactions within 6 d of treatment,with the longest reaching of 124 d.The higher incidence of adverse reactions was,in order,hyperuricemia in 85 cases(86.73%);drug-induced liver injury in 15 cases(15.31%);gastrointestinal reactions in 13 cases(13.27%);drug-induced rash in 12 cases(12.24%);hematological injury in 6 cases(6.12%),including 4 cases(4.08%)of leukopenia,2 cases(2.04%)of thrombocytopenia,and 2 cases(2.04%)of ototoxicity and vestibular dysfunction.Of the 98 patients with MDR-TB who experienced adverse reactions,65 cases(66.33%)were treated with symptomatic treatment such as gastric protection,liver protection and health education and then discontinued by maintaining the original regimen,31 cases(31.63%)completed the course of treatment by adjusting the drug dose and changing the drug,and then discontinued the treatment,only 2 cases(2.04%)refused the treatment due to drug allergy;only 2 cases(2.04%)discontinued the treatment due to systemic allergy and serious gastrointestinal reactions by refusing to test the drug.Conclusion Although various kinds of adverse reactions often occur in the treatment of patients with MDR-TB,they can generally be better handled clinically.The occurrence of adverse drug reactions does not have a significant impact on treatment,and timely monitoring of adverse drug reactions and symptomatic treatment can still ensure the smooth progress of patient treatment.