Efficacy and Safety of Combined Bedaquiline and Delamanid Use among Patients with Multidrug-Resistant Tuberculosis in Beijing,China

Objectives The combined use of bedaquiline and delamanid(BDQ-DLM)is limited by an increased risk of prolonging the QTc interval.We retrospectively evaluated patients who received DLM/BDQcontaining regimens at a TB-specialized hospital.We aimed to present clinical efficacy and safety data for Chinese patients.Methods This case-control study included patients with multidrug-resistant tuberculosis(MDR-TB)treated with BDQ alone or BDQ plus DLM.Results A total of 96 patients were included in this analysis:64 in the BDQ group and 32 in the BDQ+DLM group.Among the 96 patients with positive sputum culture at the initiation of BDQ alone or BDQ combined with DLM,46 patients(71.9%)in the BDQ group and 29(90.6%)in the BDQ-DLM group achieved sputum culture conversion during treatment.The rate of sputum culture conversion did not differ between the two groups.The time to sputum culture conversion was significantly shorter in the BDQ-DLM group than in the BDQ group.The most frequent adverse event was QTc interval prolongation;however,the frequency of adverse events did not differ between the groups.Conclusion In conclusion,our results demonstrate that the combined use of BDQ and DLM is efficacious and tolerable in Chinese patients infected with MDR-TB.Patients in the BDQ-DLM group achieved sputum culture conversion sooner than those in the BDQ group.

405例肺癌合并肺结核患者临床特征及驱动基因检测分析

背景与目的随着肺癌研究进展,靶向治疗、免疫检查点抑制剂等新的治疗方法已经开始应用于肺癌患者,因此需要进一步了解合并肺结核的肺癌患者的临床及实验室特点,从而为此类患者的临床治疗提供新的思路。本研究目的是分析肺癌合并肺结核患者的临床特征、驱动基因检测结果及其之间关系。方法回顾性分析我院2014年1月-2019年12月收治的405例肺癌合并肺结核患者,应用统计学方法分析其临床特征与驱动基因状态之间的关系。结果405例肺癌合并肺结核患者中男性占77.3%,有吸烟史患者占85.3%,病理类型以肺腺癌为主,当胸部影像学有空洞改变时以鳞癌为主要类型。214例患者进行驱动基因检测,表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变率为35.9%,其中41.8%为外显子19缺失突变,50.9%为外显子21 L858R突变。当胸部影像有空洞改变时,EGFR突变率显著降低(16.1%)。间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)融合基因检测阳性率为2.5%,原癌基因1酪氨酸激酶(c-ros oncogene 1 receptorkinase,ROS1)突变率为1.9%,肉瘤病毒致癌基因同源物B1(V-raf murine sarcoma viral oncogene homolog B1,BRAF)基因突变率为1.1%,克尔斯滕大鼠肉瘤病毒致癌基因同源物(Kirsten Rat Sarcoma Viral Oncogene Homolog,KRAS)基因突变率为10.1%。女性肺癌合并肺结核患者基因突变率为50.0%,男性为27.9%。结论肺癌合并肺结核患者以有吸烟史的男性患者为主,病理类型以腺癌为主。基因突变阳性率与单纯肺癌无明显差异,但是当胸部影像有空洞表现时,基因突变率显著降低。