含贝达喹啉方案治疗12例青少年利福平耐药肺结核患者的疗效分析

Analysis of the efficacy of regimen containing bedaquiline in the treatment of twelve adolescent rifampicin-resistant pulmonary tuberculosis patients

目的:回顾性分析贝达喹啉联合常规抗结核药物治疗12例青少年利福平耐药肺结核患者的疗效。方法:收集2020年4月至2021年1月于北京胸科医院就诊且使用含贝达喹啉方案治疗的12例18周岁以下青少年耐药肺结核患者作为研究对象,其中,单耐利福平结核病(RR-TB)患者3例,耐多药结核病(MDR-TB)患者5例,准广泛耐药结核病(pre-XDR-TB)患者4例。分析治疗24周后患者的痰培养阴转率和病灶吸收好转情况以评估治疗的有效性,分析心电图QTc的变化等药物不良反应发生情况以评估安全性。结果:12例患者均完成了24周的治疗疗程且均实现痰培养阴转,胸部CT扫描显示8例显效、4例有效,6例存在肺部空洞的患者中4例空洞缩小或空洞数量减少、2例空洞闭合。药物不良反应包括1例QT间期延长、3例周围神经病、2例视神经受损、1例头胀痛、1例手抖、1例耳鸣、2例贫血、3例胃肠道反应、3例氨基转移酶升高、2例高尿酸血症,12例患者均未停用贝达喹啉。结论:含贝达喹啉的组合方案治疗青少年耐药肺结核患者24周时的结核分枝杆菌培养阴转率较高,患者耐受性相对良好。

Objective:To retrospectively analyze the efficacy of regimen containing bedaquiline in the treatment of 12 adolescent drug-resistant pulmonary tuberculosis(TB)patients.Methods:From April 2020 to January 2021,12 adolescent patients under 18 years old with drug-resistant TB who used bedaquiline regimen in Beijing Chest Hospital were enrolled,of them,3 with rifampicin-resistant(RR),5 with multidrug-resistant(MDR),and 4 with pre-extensively drug-resistant(pre-XDR).TB culture conversion rate and lesions absorption after 24 weeks were analyzed to assess the treatment efficacy.The adverse effects such as changes of QTc in ECG were recorded to assess the treatment safety.Results:All the 12 cases completed the 24-week treatment and the culture achieved negative conversion.Chest CT scan showed significant effect in 8 cases and effective in 4 cases.Among 6 patients with lung cavities,cavity in the lung became smaller or the number reduced in 4 cases,and 2 showed cavity closure.Adverse effects included prolonged QT interval(n=1),peripheral neuropathy(n=3),damaged optic nerve(n=2),headache(n=1),shaking hands(n=1),tinnitus(n=1),anemia(n=2),gastrointestinal reaction(n=3),elevated transaminase(n=3),and hyperuricemia(n=2),however,all of the patients did not stop using bedaquiline.Conclusion:The negative conversion rates of culture in adolescent patients with drug-resistant TB was relatively high after receiving 24 weeks regimen containing bedaquiline,and the tolerance was relatively good.