含贝达喹啉方案治疗青少年耐药肺结核疗效分析

Analysis of the efficacy of bedaquinoline-containing regimen in adolescents with resistant pulmonary tuberculosis

目的回顾性分析含贝达喹啉方案治疗青少年耐药肺结核的有效性和安全性,为青少年耐药肺结核治疗提供依据。方法收集2022年1月至2023年10月在重庆市公共卫生医疗救治中心诊断为耐药肺结核,且年龄在14~18周岁的青少年作为研究对象,共计21例耐药肺结核患者纳入本研究。其中耐利福平肺结核2例,耐多药肺结核11例,准广泛耐药肺结核8例。分析患者使用贝达喹啉治疗期间临床症状改善情况、痰培养阴转率和病灶吸收好转情况以评估治疗的有效性,同时分析治疗期间发生的药物不良反应并评估其等级和治疗方案的安全性。结果1例患者完成12周贝达喹啉治疗,18例患者完成了24周贝达喹啉治疗,2例完成36周贝达喹啉治疗,90.5%(19/21)患者实现24周痰培养阴转,100%(21/21)患者实现28周痰培养阴转,最快阴转时间为治疗后4周,中位阴转时间为8周。治疗12周临床症状完全缓解率达100%。肺部病灶吸收情况显示显效和/或有效率100%。治疗成功率为100%。药物不良反应共计20例次,其中2例心电图表现为QTc间期延长、10例药物性肝损害、2例周围神经病变、2例视神经炎、2例胃肠道反应、1例骨髓抑制(轻度贫血)、1例药物过敏性皮炎。90%的药物不良反应为轻度,QTc间期延长发生率为9.52%。结论含贝达喹啉方案治疗青少年耐药肺结核临床症状改善快,阴转时间短,病灶吸收情况良好,治疗成功率高,QTc间期延长发生率较低,3级以上不良事件发生率低,安全性较高。

Objective To retrospectively assess the efficacy of bedaquiline in combination with conventional anti-tuberculosis(TB)drugs in treating 21 adolescent patients with drug-resistant pulmonary tuberculosis.Provide a basis for the treatment of drug-resistant pulmonary tuberculosis in adolescents.Method A total of 21 adolescent patients under the age of 18 with drug-resistant pulmonary tuberculosis who were treated with the bedaquiline-containing regimen at Chongqing Public Health Medical Center between January 2021 and October 2023 were enrolled,including two patients with rifampicin-resistant tuberculosis(RR-TB),11 patients with multidrug-resistant tuberculosis(MDR-TB),and 8 patient with pre-extensively drug-resistant tuberculosis(pre-XDR-TB).The effectiveness of treatment was evaluated by analyzing the resolution of clinical symptoms,sputum culture conversion rate,and improvement in lesion absorption 24 weeks after treatment,as well as by analyzing the occurrence of adverse drug reactions such as changes in the QTc interval on electrocardiograms to assess safety.Result One patient completed a 12-week course of bedaquiline-containing treatment,whereas 18 patients finished a 24-week course and two finished a 28-week course.with a clinical symptom relief rate of 100%.Sputum culture conversion was achieved at 24 weeks in 90.5%(19/21)of patients and at 36 weeks in 100%(21/21)of patients,with the fastest time being at the end of 4 weeks of treatment and the median time being 8 weeks.Chest CT scans showed significant improvement in 10 cases and effectiveness in 11 cases.The treatment success rate was 100%。Adverse drug reactions included two cases of QTc interval prolongation,ten cases of drug-induced liver injury,six cases of hyperuricemia,two cases of peripheral neuropathy,two cases of optic neuritis,two cases of gastrointestinal reactions,one case of myelosuppression(mild anemia),and one case of drug-induced dermatitis.The majority of adverse drug reactions were mild(90%).The prevalence of QTc prolongation was 9.52%.Conclusion In the treatment of drug-resistant pulmonary tuberculosis in adolescents with bedaquinoline-containing regimen,the clinical symptoms were improved quickly,the time of negative conversion was short,the foci were absorbed well,the treatment success rate was high,and the incidence of QTC interval was low,the rate of grade 3 or above adverse events was low and the safety was high.