提高剂量和延长强化期在菌阳复治肺结核患者中的疗效评价

Curative Effect of Increasing Dose and Prolonging the Intensive Phase in the Retreated Pulmonary Tuberculosis Patients with Positive Bacteria

关键词:  肺结核  再治疗  剂量效应关系  治疗结果  复发  菌阳性

Key words:  pulmonary tuberculosis  retreatment  dose-response relationship  treatment outcome  recurrence  positive bacteria

摘要:

目的 探究提高剂量和延长强化期在菌阳复治肺结核患者中的疗效及影像学评价情况。方法 选择2015年1月—2016年6月于宁波市第二医院肺科就诊的90例非耐药性菌阳复治肺结核患者，随机分为对照组（45例）和实验组（45例），对照组给予2HRZES/6HRE标准复治方案，实验组提高异烟肼和利福平剂量并延长强化期至3个月的3HRZES/6HRE方案，比较2组患者的痰涂片转阴率、临床和影像学疗效、不良反应发生率和完成治疗后的复发率。结果 对照组和实验组的病灶治疗有效率分别为75.55%和91.11%（P<0.05）。对照组和实验组的治疗成功率分别为71.11%和88.89%，治愈率分别为48.89%和71.11%（P<0.05）。对照组和实验组前20周痰涂片转阴率分别为68.89%和84.44%；实验组的中位转阴时间为8周，显著低于对照组的14周，差异有统计学意义（P<0.05）。对照组和实验组在治疗后24周内复发率分别为18.75%和5.00%；实验组复发风险明显低于对照组（P<0.05）。对照组和实验组的不良反应发生率无统计学差异。结论 在菌阳复治肺结核患者的治疗中提高剂量和延长强化期具有较高的临床疗效和安全性，能够明显缩短痰涂片转阴时间，显著降低治疗后复发风险。

Abstract:

OBJECTIVE To investigate the curative effect and imaging evaluation of increasing dose and prolonging the intensive phase in the retreated pulmonary tuberculosis patients with positive bacteria. METHODS Ninety cases of non-resistant bacterial positive pulmonary tuberculosis patients who were treated in Ningbo Second Hospital from January 2015 to June 2016 were collected. All patients were randomly divided into control group (45 cases) and experimental group (45 cases). The control group was given standard 2HRZES/6HRE. The experimental group was given high dose isoniazid and rifampin and 3 months intensive phase. The sputum smear negative conversion rate, clinical and imaging efficacy, adverse reaction rate and the recurrence rate after completion of treatment were compared between 2 groups. RESULTS The effective rates in focus of control group and experimental group were 75.55% and 91.11% respectively (P<0.05). The success rates of treatment in the control group and experimental group were 71.11% and 88.89%, and the cure rates were 48.89% and 71.11%, respectively (P<0.05). The sputum smears negative conversion rates of the control group and the experimental group in the first 20 weeks were 68.89% and 84.44% respectively. The median negative conversion time of the experimental group was 8 weeks, which was significantly lower than that of the control group (14 weeks) (P<0.05). The recurrence rates in control group and experimental group within 24 weeks after treatment were 18.75% and 5.00% respectively. The recurrence risk in experimental group was significantly lower than that in control group (P<0.05). There was no significant difference in adverse reaction rates between 2 groups. CONCLUSION It has high clinical efficacy and safety in increasing the dose and prolonging the intensive phase in the treatment of patients with pulmonary tuberculosis, can significantly shorten the time of sputum smear negative conversion and obviously reduce the recurrence risk after treatment.