标准抗结核治疗方案对耐多药肺结核患者肾功能的影响分析

Analysis of the effect of standard anti-TB treatment regimen on renal function in patients with MDR-TB

目的分析耐多药肺结核(MDR-TB)患者采用标准抗结核方案治疗过程中药物对肾功能的损伤程度,并评价其对治疗的影响。方法采用回顾性调查的方法,收集2018年1月至2019年12月在深圳市慢性病防治中心结核病科治疗的125例MDR-TB患者的临床资料和检验数据,分析患者血清肌酐、尿素及尿蛋白等检测指标的变化情况,应用R软件(3.6.2版本)进行统计处理并绘图。结果125例患者治疗方案中包括阿米卡星等注射剂占81.6%(102/125),不包括注射剂为18.4%(23/125)。102例包含注射剂方案出现肾功能异常24例,23例不包含注射剂出现肾功能异常8例(χ^(2)=1.506,P=0.220)。在治疗过程中,25.6%(32/125)的患者出现不同类型肾功能检测指标异常:单纯尿素升高患者占8.0%(10/125),单纯血肌酐升高患者占5.6%(7/125),单纯尿蛋白阳性者3.2%(4/125),尿素合并血肌酐升高者5.6%(7/125),尿素升高合并尿蛋白阳性者1.6%(2/125),血肌酐升高合并尿蛋白阳性者0.8%(1/125),三者均异常者0.8%(1/125)。尿蛋白出现阳性时间早于尿素、血肌酐升高时间。参考RIFLE诊断分级标准,有2.4%(3/125)患者出现肾功能损害。结论标准抗结核方案在治疗MDR-TB过程中对患者的肾功能影响较小,患者肾功能异常多为一过性轻微异常,阿米卡星等注射剂也并未造成患者肾功能损伤显著增加。在治疗过程中及时监测尿常规、肾功能,特别是尿蛋白,及早发现异常、妥善处理,能有效避免严重的肾损伤发生,保证治疗方案的有效实施。

Objective To explore the extent of drug damage to renal function during the treatment of MDR-TB patients with a standard anti-TB regimen,and evaluate its impact on the treatment.Method The clinical data and test data of 125 MDR-TB patients treated in the Tuberculosis Department of Shenzhen Chronic Disease Prevention and Treatment Center from January 1,2018 to December 31,2019 were collected retrospectively,and the changes of serum creatinine,urea nitrogen and urine protein were analyzed.R software(version 3.6.2)was used for statistical processing and drawing.Result Among 125 patients,81.6%(102/125)included injections such as amikacin in their treatment regimen,and 18.4%(23/125)did not.There were 24 patients with abnormal renal function in 102 patients with injection regimen,and 8 patients with abnormal renal function in 23 patients without injection regimen.The value ofχ^(2) was 1.506,P=0.220.During the course of treatment,25.6%(32/125)patients showed abnormal renal function indicators of different types:8.0%(10/125)patients with increased urea alone,5.6%(7/125)patients with increased serum creatinine alone,3.2%(4/125)patients with positive urine protein alone,and 5.6%(7/125)patients with increased urea combined with increased serum creatinine,1.6%(2/125)patients with increased urea combined with positive urinary protein,patients with elevated serum creatinine combined with positive urinary protein were 0.8%(1/125),and those with all three abnormalities were 0.8%(1/125).The positive time of urine protein is earlier than that of urea and creatinine.According to RIFLE’s diagnostic scale,2.4%(3/125)of patients had renal impairment.Conclusion The Standard anti-tuberculosis regimen had little effect on patients’renal function during the treatment of MDR-TB,and most of the patients had transient mild abnormalities.Amikacin injection did not cause significant increase in renal injury.In the course of treatment,timely monitoring of routine urine and renal function,especially urinary protein,early detection of abnormalities and proper treatment can effectively avoid the occurrence of serious kidney injury and ensure the effective implementation of treatment regimen.