目的 评价化疗加介入治疗及个体化方案治疗耐多药肺结核及慢性排菌性肺结核的疗效和安全性.方法 对符合条件的耐多药及慢性排菌性肺结核患者分为4组进行治疗:第1组采用对氨基水杨酸异烟肼、利福喷汀、左旋氧氟沙星、丙硫异烟胺、乙胺丁醇和阿米卡星组成的18个月全身抗痨化疗方案;第2组:采用对氨基水杨酸异烟肼、利福喷汀加3种敏感抗结核药物组成的个体化治疗方案;第3组:在第1组的18个月全身抗痨化疗方案上加经纤支镜下介入治疗;第4组:在第1组的18个月全身抗痨化疗方案上加经肺穿刺下介入治疗.结果 经过18个月的治疗,各组的临床症状改善程度基本接近;各组的痰细菌学阴转率分别为85.7%、87.5%、100%、70%, 其中以第3组痰菌阴转率尤其显著,于6个月时即达到86.7%, 12个月时达93.3%, 18个月时达100%; X线检查示病灶的显效率及有效率均取得了较好的疗效,其中以第4组病灶吸收效果显著,于6个月时有效率即达到100%, 显效率达40%, 12个月时显效率达80%; 各组的空洞关闭率分别为42.8%、36.4%、66.7%、70.0%.结论 本研究所设计的方案对耐多药及慢性排菌性肺结核病均有明确的疗效,加经纤支镜或肺穿刺下介入治疗具有促进痰细菌学阴转、病灶吸收和空洞关闭的作用,且安全性和耐受性良好.%Objective To evaluate the efficacy and safety of chemotherapy regimens combined with interventional therapy or individualized therapy in the treatment of multi - drug resistant pulmonary tuberculosis. Methods During 18 months treatment, patients with multi - drug resistant or long positive sputum bacillus pulmonary tuberculosis were randomly divided into four treatment groups. Group I: pasiniazide, rifapentine, levofloxacin, ethambutol, ethionamide, amikacin were used as the basic 18 - month chemotherapy regimen; Group Ⅱ: the individualized therapy combined pasiniazide, rifapentine and three sensitive anti - tuberculosis drugs; Group Ⅲ: the same chemotherapy regimen as Group Ⅰ, with interventional therapy by broncho - fiberscope; Group Ⅳ: the same chemotherapy regimen as Group Ⅰ , with interventional therapy by injecting anti -tuberculosis drugs into the caves directed by Computed Tomography. Then comparisons were made between the four groups. Results After 18 months' treatment, the four groups improved similarly in terms of clinical symptoms; the sputum negative conversion rate (smear negative, culture negative) was 85.7％, 87.5％, 100％, 70％, and group Ⅲ was significantly better than other groups,its sputum negative conversion rate was 86.7％, 93.3％, 100％ after 6, 12, 18 months respectively; the marked effective rate of chest X-ray in the fourth group was 40 ％ after 6 months, 80％ after 12 months; the cavity closure rates of each group were 42.8％, 36.4％, 66.7％, 70.0％ after 18 months. Conclusions Our study showed chemotherapy regimens combined with interventional therapy were very effective in the sputum negative conversion rate, lesion absorption and the cavity closing for the treatment of multi-drug resistant or long positive sputum bacillus pulmonary tuberculosis, with good safety and tolerance.
展开▼
