利奈唑胺治疗儿童重症结核性脑膜炎的疗效和安全性研究

Efficacy and safety of linezolid in the treatment of children with severe tuberculous meningitis

目的探讨利奈唑胺治疗儿童重症结核性脑膜炎的疗效和安全性,为儿童重症结核性脑膜炎的提供有效的药物方案。方法回顾性分析2017年1月—2020年12月在广州市胸科医院儿科住院的诊断重症结核性脑膜炎40例患儿资料,按随机方法,将重症结核性脑膜炎患儿分为观察组20例和对照组20例,对照组采用常规抗结核治疗方案,观察组在常规抗结核治疗的基础上,加用利奈唑胺。分析比较两组患儿治疗前后格拉斯哥(GCS)评分、脑脊液指标(包括白细胞计数、葡萄糖、蛋白定量、氯化物)和体温恢复情况,同时记录不良反应发生情况。结果两组治疗后GCS评分以及脑脊液各项指标水平均有改善,且治疗4周时,观察组GCS评分(13.35±1.96)分以及脑脊液白细胞计数(28.61±23.46)×10^(6)/L、蛋白定量(466.33±158.35)mg/L明显低于对照组,观察组的葡萄糖(2.75±0.42)mmol/L、氯化物(144.94±31.89)mmol/L明显高于对照组,差异有统计学意义(P<0.05)。两组不良反应均在调整药物后好转,无严重不良反应发生。结论利奈唑胺具有抗结核作用,在结核性脑膜炎早期加用利奈唑胺可以有效改善儿童重症结核性脑膜炎患者的GCS评分、脑脊液指标恢复情况,能显著改善儿童重症结核性脑膜炎的病情,同时不良反应发生率低。

Objective To investigate the efficacy and safety of linezolid in the treatment of children with severe tuberculous meningitis.Methods The data of 40 children with severe tuberculous meningitis diagnosed in The Department of Pediatric,Guangzhou Chest Hospital from January 2017 to December 2020 were retrospectively analyzed.According to the medication situation,the children with severe tuberculous meningitis were divided into study group(20 cases)and control group(20 cases).The control group was treated with conventional anti tuberculosis treatment,and the study group was treated with linezolid on the basis of conventional anti tuberculosis treatment.The Glasgow score(GCS)and cerebrospinal fluid indexes(including white blood cell count,glucose,protein,chloride),body temperature recovery,and adverse reactions were analyzed and compared between the two groups before and after treatment.Results After treatment,the GCS score and cerebrospinal fluid index levels of the two groups were improved,and after 4 weeks of treatment,the GCS score of the study group was(13.35±1.96)and cerebrospinal fluid leukocyte count(28.61±23.46)×10^(6)/L,protein quantitation(466.33±158.35)mg/L,which was significantly lower than that of the control group.The glucose of the study group was(2.75±0.42)mmol/L,chloride(144.94±31.89)mmol/L,which was significantly higher than that of the control group,the difference was statistically significant(P<0.05).The adverse reactions of the two groups were improved after adjusting the drugs,and no serious adverse reactions occurred.Conclusions Linezolid has anti tuberculosis effect.In the early stage of tuberculous meningitis,linezolid can effectively improve the GCS score,cerebrospinal fluid index recovery of children with severe tuberculous meningitis,and can significantly improve the condition of children with severe tuberculous meningitis,with low incidence of adverse reactions.