老年初治痰涂片阳性肺结核病患者化疗方案选择的对比研究

Comparative study on the chemotherapy of sputum positive pulmonary tuberculosis in malnutrited elderly patients

目的 观察不含吡嗪酰胺 (Z)方案在老年营养不良肺结核病患者治疗中的疗效及副作用。 方法 采用随机配对分组法将 92例老年营养不良肺结核病患者分为试验组 (46例 )和对照组(46例 ) ,两组分别采用 2HR(L)E/ 7HR(L)和 2HR(L)ZE/ 4HR(L)治疗 (H异烟肼 ,R利福平 ,L利福喷丁 ,E乙胺丁醇 )。同期选择初治涂阳肺结核非老年组 40例 ,治疗方案同对照组。 结果 疗程结束后 ,试验组 (9个月后 )、对照组 (6个月后 )、非老年组 (6个月后 )痰菌阴转率分别为 89 1%、80 4%、97 5% (P >0 0 5) ,胸部X线片病灶吸收率分别为 86 9%、82 6%、95 0 % (P >0 0 5) ,肝功能损害发生率分别为 15 2 %、3 9 1%、15 0 % ,对照组肝功能损害发生率显著高于试验组与非老年组 (P <0 0 5) ,停药率分别为 2 2 %、2 1 7%、2 5% ,对照组较试验组及非老年组停药率显著增高 (P <0 0 1) ;1年细菌学复发率分别为 4 8%、2 1 6%、2 7% ,试验组、非老年组低于对照组 (P <0 0 5)。 结论 不含Z初治化疗方案治疗老年痰涂片阳性营养不良肺结核病患者 ,治愈率与常规初治化疗方案相近 ,且发生肝损害率低 ,停药率低 。

Objective To observe and evaluate the effect and side effects of antitubercular drug Pyra zinamide in the senile pulmonary tuberculosis with bacteriological positive. Methods Ninety-two elderly pulmonary tuberculosis patients with sputum smear positive (newly detected) were allocated into the treatment group 〔receiving 2HR(L)E/7HR (L) regimen〕 and the controls 〔2HR (L) ZE/4HR(L)〕. Meanwhile 40 non-aging patients with pulmonary tuberculosis as another control group 〔2HR(L)ZE/4HR(L) 〕 were observed. ResultsThe negative conversion rate of the sputum after chemotherapy was 89 1%, 80 4% , and 97 5% in the treatment, the control group and the non-aging group, respe ctively. The improving rates of chest X-ray was 86 9% in the treatment group, 82 6% in the control group and 95 0% in the non-aging group. Comparing the re sults of three groups, there were no statistically significant differences. The liver damage rate was 15 2% in the treatment, 39 1% in the control, and 15 0% in the non-aging group, respectively, while the treatment withdrawing rate 2 2%, 21 7% and 2 5%, respectively. Comparison showed that the liver damage rate and the drug withdrawing rate of the control group were significantly higher th an that in the treatment and in the non-aging group(P<0 05). One-year bac teriological relapse rate was 4 8%, 21 6%, and 2 7%, respectively, showing l ower in the treament and non-aging groups than that in the control group. Conclusions The curative effect of HR(L) E regimen was the same as that of the HR(L)ZE regi men. Due to its lower rates of side effects, it is worthwhile for clinical usage .