利福平注射液治疗初治肺结核强化期疗效观察

目的评价利福平注射液治疗初治肺结核强化期的疗效和安全性。方法对110例初治肺结核患者,分为治疗组和对照组各55例,两组患者除采用异烟肼、链霉素、吡嗪酰胺、乙胺丁醇外,治疗组给予利福平注射液静点,对照组给予复合利福平口服。强化期结束时,治疗组和对照组的痰涂片结核杆菌阴转率分别为：50.9%和36.18%,差异有统计学意义,X线影像学结果表明,两组的病灶率分别为87.27%和52.73%差异有统计学意义（P〈0.05）。结论利福平注射液联合其他抗结核药物治疗初治肺结核,较口服复合利福平疗效显著,其安全性和耐受性良好。     

白介素-2辅助治疗初治菌阳肺结核的疗效观察

目的探讨白介素-2辅助治疗初治菌阳肺结核的疗效。方法将72例初治菌阳肺结核病者随机分为2组,实验组采用白介素-2联用链霉素＋利福平＋异烟肼＋乙胺丁醇／吡嗪酰胺（3HRS（E）Z／6HRZ）方案治疗。对照组单用3HRS（E）Z／6HRZ方案常规治疗。观察痰菌阴转率和空洞病灶愈合的程度。结果实验组患者的空洞病灶各有不同程度的愈合,痰找抗酸杆菌呈阴性;而对照组空洞病灶改变不明显,痰菌阴转率较低。结论白介素-2有较好辅助治疗肺结核作用。     

利福平静注治疗开放性肺结核

在一组用利福平+异烟肼+乙胺丁醇治疗的开放性肺结核,早期先给予利福平静注1～4周,与只给利福平口服相比,疗效明显加快。作者比较了口服和静注利福平治疗开放性肺结核的药物动力学和治疗效果。 18例开放性肺结核,痰菌G_5～G_7。1/3病例的空洞超过2cm。用利福平+异烟肼+乙胺丁醇治疗。最初1～4周利福平静注,然后继之以口服。另一组39例同样用此3种药治疗,但不静注利福平而只口服。全部均为敏感病例。主要比较两组病例的痰菌阴转情况和胸片的变化。部分病例在化疗开始第1、2天及其后每周1次,用Lecaillon氏法连续测定用药后12     

利福喷丁、利福平在初治涂阳肺结核患者治疗中的疗效比较

目的比较利福喷丁和利福平在初治涂阳肺结核患者治疗中的临床疗效和不良反应。方法 94例初治涂阳肺结核患者均服用异烟肼,吡嗪酰胺和乙胺丁醇治疗,随机分为利福喷丁组(n=47例)加用利福喷丁治疗,利福平组(n=47例)加用利福平治疗。观察和比较两组患者痰涂片转阴、空洞闭合、病灶吸收例数和不良反应等情况。结果利福喷丁组痰涂片转阴、空洞闭合和病灶吸收例数均明显高于利福平组(P<0.05);利福喷丁组白细胞下降、肝功能异常、胃肠道反应和皮疹等不良反应发生率均明显低于利福平组(P<0.05)。结论利福喷丁治疗初治涂阳肺结核患者具有高效、低毒等优点,是治疗肺结核的理想药物。     

耐多药肺结核临床治疗方案的研究

目的 观察临床耐多药肺结核的治疗方案.方法 148例耐多药肺结核均对异烟肼、利福平、吡嗪酰胺、乙胺丁醇2种以上耐药,随机分为两组,治疗组用司帕沙星＋丙硫异烟胺＋硫酸卷曲霉素;对照组用力克肺疾＋利福喷丁＋丁胺卡那霉素＋左氧氟沙星治疗.结果 疗程结束时治疗组痰菌阴转率和病灶吸收率分别为81.2%、93.75%,明显高于对照组57.7%、54.37%（P＜0.05）.结论 司帕沙星＋丙硫异烟胺＋硫酸卷曲霉素治疗耐多药肺结核有明显的临床疗效.     

中药结核丸联合异烟肼利福平吡嗪酰胺乙胺丁醇应用于肺结核的临床分析

目的探讨中药结核丸联合异烟肼、利福平、吡嗪酰胺、乙胺丁醇几种药物治疗肺结核的疗效。方法选取2014年9月~2015年9月我院收治的肺结核患者98例作为研究对象,随机分为对照组和研究组,各49例。对照组采用异烟肼、利福平、吡嗪酰胺、乙胺丁醇四种药物进行治疗,研究组在对照组的基础上添加中药结核丸进行治疗,观察两组患者治疗的总有效率。结果研究组患者的总有效率明显高于对照组,差异有统计学意义(P0.05)。结论中药结核丸联合异烟肼利福平吡嗪酰胺乙胺丁醇应用于肺结核的疗效显著,值得推广应用。     

蛹虫草菌粉胶囊佐治空洞型初治菌阳肺结核的疗效观察

目的观察和评价蛹虫草菌粉胶囊佐治空洞型初治菌阳肺结核的疗效。方法选取空洞型初治菌阳肺结核患者140例,随机分为2组。试验组（化疗＋服用2个月蛹虫草菌粉胶囊）70例,化疗方案3HRZE/6HR（H为异烟肼、R为利福平、Z为吡嗪酰胺、E为乙胺丁醇,连用3个月,H、R连用6个月）。对照组70例,单按3HRZE/6HR方案化疗。结果试验组和对照组在疗程满1个月结核中毒症状缓解率分别为95.7%、85.7%（P〈0.05）。疗程满3个月痰菌阴转率分别为92.9%、77.1%（P〈0.01）,空洞治疗有效率分别为87.1%、72.9%（P〈0.05）,药物性肝损伤发生率分别为7.14%、18.6%（P〈0.05）。结论蛹虫草菌粉胶囊有较好的佐治空洞型初治菌阳肺结核作用;临床效果好,值得推广。     

利福平注射液治疗初治菌阳肺结核病人的临床观察

目的评价化疗并用利福平注射液与利福平胶囊治疗初治菌阳肺结核的疗效。方法将80例初治菌阳肺结核患者随机分为2组，治疗组（40例）、对照组（40例）强化期分别用HZE加利福平注射液和HEZ加利福平胶囊方案治疗；观察强化期1、2个月末痰菌阴转、肺部病灶吸收及毒副反应情况。结果1、2个月末痰菌阴转率：治疗组分别为82．5％和97．5％，对照组分别为65．0％和85．0％；胸部X线改善显效率：治疗组分别为17．5％和40．0％，对照组分别为10．0％和25．0％；空洞闭合缩小率：分别为41．7％和22．7％。毒副反应：治疗组和对照组肝功能损害发生率分别为22．1％和25．2％，胃肠反应发生率分别为20．0％和45．0％。结论利福平注射液起效快、效果佳、副反应少，在控制症状、缩短排菌时间、降低传染性、减少副反应及抢救重症结核上有很好的效果，值得临床推广。     

利福平注射液对初治菌阳肺结核病人的疗效观察

目的观察利福平注射液治疗初治菌阳肺结核的疗效及安全性。方法 100例初治菌阳肺结核患者随机分为治疗组（50例）与对照组（50例）,强化期分别采用HZE＋利福平注射液治疗和HZE＋口服利福平胶囊方案治疗;观察强化期1、2个月末痰菌阴转、肺部病灶吸收及毒副反应情况。结果 1、2个月末痰菌阴转率,治疗组分别为78%、96%,对照组分别为62%、82%;1、2个月末胸部X线影像学检查显效率,治疗组分别为22%、48%,对照组分别为12%、30%;治疗组与对照组2个月末空洞闭合、缩小率分别为40%、23%,肝功能异常发生率分别为24%、20%,胃肠道反应发生率分别为22%、48%。结论利福平注射液治疗具有局部药物浓度高,作用快,副作用小的特点,其治愈率高,有较好的临床应用价值。     

初治痰菌阳性肺结核疗程结束时空洞或结核球内细菌学分析

目的对初治痰菌阳性肺结核病例短程化疗结束后痰菌阴转，但肺内仍存在结核球或空洞病灶的病例，经皮肺穿刺取材进行细菌学检查，评价短程化疗的疗效。方法2002年1月至2004年5月，选择初治痰菌阳性肺结核83例，患者均经过常规抗结核药物（异烟肼、利福平、乙胺丁醇、吡嗪酰胺）短程化疗，疗程末痰涂片及痰培养均为阴性，但肺部X线表现仍存在空洞或结核球，在疗程结束后1个月内，在CT引导下经皮肺穿刺对空洞壁或空洞内容物或结核球取材，进行细菌学检查，并对检查结果进行分析。结果对活检组织均进行涂片及培养检查，痰菌阴转病例中仅75例（90．4％）获得的组织标本阴性结果，8例（9.6％）获得阳性结果（其中3例为涂片阳性、培养阳性；5例为涂片阴性、培养阳性）。药敏试验结果1例对异烟肼、利福平耐药，其余7例为敏感菌株。24个月的随访结果有6例痰菌阳转。结论初治痰菌阳性空洞、结核球肺结核病例的短程化疗后，组织标本细菌学检查阳性结果的8例病例中在2年内有6例出现痰细菌学复发，提示目前普遍采用的肺结核疗效判断标准（痰菌阴转）值得商榷。     

肺泰胶囊辅助治疗初治涂阳肺结核的疗效及安全性研究

目的研究肺泰胶囊辅助治疗初治涂阳肺结核的疗效及安全性。方法采用前瞻性对照研究对2006年6月—2007年6月期间符合入选标准的初治涂阳肺结核120例,治疗组标化方案联合肺泰胶囊,对照组单用标化方案。记录治疗前、疗程2个月末、6个月末的疗效指数、X线胸片、痰菌、空洞的变化及不良反应。结果 (1)治疗组及对照组分别有57例、55例完成该试验;(2)治疗组在疗程2个月末、6个月末的疗效指数高于对照组,t值分别为2.13、2.32,P0.05;治疗组的X线胸片病灶吸收率、痰菌阴转率、6个月末的空洞闭合率均高于对照组,P值均0.05;(3)口服肺泰胶囊的不良反应发生率仅5.3%(3/57)。结论肺泰胶囊可有效缓解肺结核病人的临床症状,可辅助标化方案提高病灶的吸收率、空洞的闭合率及痰菌的阴转率,且长期口服安全性较高。     

含白细胞介素2治疗方案或可促进初治药物敏感肺结核患者早期痰培养阴转

目的：评价白细胞介素-2（IL-2）治疗初治药物敏感肺结核的有效性和安全性。方法：采用前瞻性、随机、对照、多中心临床研究方法,自2017年12月至2019年6月,于我国15个省（市）的17个研究中心连续纳入确诊的初治药物敏感肺结核患者作为研究对象,最终纳入1264例。采用计算机生成的随机化序列进行分组,619例被分配到...     

微卡辅助治疗复治涂阳肺结核的临床效果

目的评价微卡（母牛分枝杆菌菌苗）作为免疫调节剂辅助治疗复治涂阳肺结核的疗效。方法将80例复治涂阳肺结核病人随机分为治疗组40例及对照组40例，两组化疗方案相同3SHRZE／6HR，治疗组肌肉注射微卡，每半月1次，共9个月，观察药物不良反应。结果疗程结束时，治疗组痰菌阴转率为92．5％，明显高于对照组77．5％（P〈0．01）；治疗组病灶吸收，空洞关闭率分别为97．5％和91．7％均明显高于对照组85．0％和78．3％（P〈0．01），有统计学意义。结论微卡是一种新型免疫调节剂，可提高复治涂阳肺结核的疗效，值得推广。     

Formulation,characterization and evaluation of inhalable effervescent dry powder of Rifampicin nanoparticles

BackgroundDry powder inhaler is a popular approach to pulmonary drug delivery to treat tuberculosis. Spray dried Nanoparticles using lactose carrier is extensively used for pulmonary drug delivery. Though lactose nanoparticles show deep lung deposition, they fail to uniformly disperse nanoparticles in its original form in alveoli. Rifampicin is one of the first line drugs in tuberculosis treatment. Lung targeted drug delivery system is an approach to reduce dose related side effects of rifampicin. Inhalable nanoparticles also help to target alveolar macrophages, thus improving treatment efficiency.MethodologyThis study focuses on rifampicin nanosuspension formulation and optimization using nano-precipitation method followed by characterizing effervescent DPI of rifampicin nanoparticles with effervescent pair (citric acid and sodium bicarbonate). Preliminary studies showed suitability of 4:5 solvent: antisolvent ratio and lecithin (1%) as stabilizer. The drug and stabilizer concentration in nanoparticles was successfully optimized using 3 1 2 factorial design using DESIGN EXPERT software. The rifampicin nanoparticles were further converted to spray dried powder using effervescent carrier.ResultThe effervescent pair formulation was monodisperse and had a particle size of 1.5 microns (polydispersity index 0.289), thus showing better redispersibility than lactose nanoparticles. The mass median aerodynamic diameter and fine particle diameter of both spray dried formulations were similar and suitable for deep lung deposition.ConclusionThese findings are suggestive that effervescent technique can be successfully employed to improve redispersibility of rifampicin nanoparticles.     

Treatment outcome of relapse and defaulter pulmonary tuberculosis patients.

SETTING: Tuberculosis clinic in a referral hospital. OBJECTIVE: To evaluate the effect of risk factors on the outcome of retreatment in relapse and defaulter pulmonary tuberculosis patients. DESIGN: A total of 57 retreatment tuberculosis patients treated and monitored in our centre between January 1997 and June 1999 were evaluated with respect to treatment outcome. Factors which have on effect on treatment outcome were investigated. RESULTS: Of 57 patients, 37 (64.9%) were classified as relapse cases and 20 (35.1%) as defaulters. The treatment success rate was 71.9% (68.4% cure rate and 3.5% completion rate). Failure was encountered in 22.8%. Twenty-six patients (45.6%) exhibited resistance to at least one drug, namely rifampicin. The multidrug-resistance (MDR) rate was 18.5%. Treatment success rates were 100% and 50%, respectively, in patients in whom susceptibility to all drugs and resistance to at least one drug were detected. Successful outcome was possible in 68.8% of patients with any rifampicin resistance and in 20% of patients with MDR tuberculosis. Retreatment resulted in failure in 80% and 100%, respectively, of patients whose sputum cultures remained positive at the end of the second and third months. CONCLUSION: Drug resistance proved the most important factor affecting treatment outcome. Success rates in retreatment of patients with any rifampicin resistance or MDR tuberculosis are low. Conversion to negative sputum results at the end of the second and third months of retreatment seems to be a significant parameter for a successful outcome.     

纤维支气管镜注入利福平治疗支气管结核临床疗效分析

目的 探讨经纤维支气管镜注入利福平治疗支气管结核的临床疗效.方法 将本院治疗的86例支气管结核患者随机分入对照组与观察组,对照组患者接受单纯口服抗结核药物治疗,观察组患者在口服化疗药物同时接受由纤维支气管镜注入利福平注射液治疗,比较两组临床疗效及痰菌转阴率.结果 观察组治疗总有效率显著高于对照组,差别具有统计学意义（100% vs 75.0%,P〈0.05）;观察组治疗后1月,2月,6月及12月痰菌阴转率显著高于对照组（P〈0.05）.结论 经纤维支气管镜注入利福平治疗支气管结核可显著提高临床疗效,促进痰菌阴转.     

注射用利福平冻干粉针剂治疗结核性胸膜炎的临床疗效

目的 探讨注射用利福平冻干粉针剂(维夫欣)治疗结核性胸膜炎的疗效.方法 选择结核性胸膜炎患者80例,随机分成治疗组和对照组(每组40例),全部病例均采用规范的全身抗结核、胸穿抽液及激素治疗;治疗组应用注射用利福平冻干粉针剂与对照组应用利福平胶囊口服比较,观察两组临床疗效、胸水吸收时间及药物不良反应等.结果 治疗组和对照组总有效率分别为87.5％和52.5％,两组疗效差异有统计学意义(P＜0.05).两组胸水吸收时间分别为12.2±1.6天、20.3±3.2天;P＜0.05.治疗组利福平相关不良反应:治疗组4例;对照组15例(其中胃肠道反应5例,肝损害7例,粒细胞减少2例,过敏1例).两组安全性差异有统计学意义(P＜0.05).结论 射用利福平冻干粉针剂治疗结核性胸膜炎能够提高疗效;其胃肠道和肝损害等不良反应发生率低于对照组,应用安全.     

2型糖尿病合并肺结核患者治疗方案的选择与评估

目的探讨2型糖尿病合并肺结核应用胰岛素加口服二甲双胍联合抗结核治疗的临床疗效。方法对216例2型糖尿病合并肺结核病人随机分成三组,三组患者均在有效控制血糖的基础上,规律抗结核治疗。A组单纯口服二甲双胍0.5/次,3次/d,B组单纯应用胰岛素。C组应用胰岛素加口服二甲双胍,胰岛素剂量12～60 U不等,根据FGB检测随时调整剂量。抗结核治疗方案为3HRZE(S)/9HR。结果肺结核疗效:治疗3月末、6月末及疗程结束病灶吸收率、空洞闭合率、痰菌阴转率:B组68.5%、83.6%、97.3%;C组78.1%、90%、98.6%。均高于A组41.1%、56.2%、68.5%;B、C组与A组比较均有显著差异(P<0.01)。结论应用胰岛素加口服降糖药疗效好于胰岛素组,胰岛素组好于口服降糖药组;控制血糖是治疗糖尿病合并肺结核的关键。     

Rifampicin reduces plasma concentrations of moxifloxacin in patients with tuberculosis.

BACKGROUND: The long duration of the current tuberculosis (TB) treatment is demanding and warrants the development of new drugs. Moxifloxacin shows promising results and may be combined with rifampicin to shorten the duration of TB treatment. Rifampicin induces the phase II metabolic enzymes that are involved in the biotransformation of moxifloxacin. Therefore, the interaction between rifampicin and moxifloxacin should be investigated. PATIENTS AND METHODS: Nineteen Indonesian patients with pulmonary TB who were in the last month of their TB treatment completed a 1-arm, 2-period, fixed-order pharmacokinetic study. In phase 1 of the study, they received 400 mg of moxifloxacin every day for 5 days in addition to 450 mg of rifampicin and 600 mg of isoniazid 3 times per week. In phase 2 of the study, after a 1-month washout period, patients received moxifloxacin for another 5 days (without rifampicin and isoniazid). A 24-h pharmacokinetic curve for moxifloxacin was recorded on the last day of both study periods, and its pharmacokinetic parameters were evaluated for an interaction with rifampicin, using a bioequivalence approach. RESULTS: Coadministration of moxifloxacin with rifampicin and isoniazid resulted in an almost uniform decrease in moxifloxacin exposure (in 18 of 19 patients). The geometric means for the ratio of phase 1 area under the curve to phase 2 area under the curve and for the ratio of phase 1 peak plasma concentration to phase 2 peak plasma concentration were 0.69 (90% confidence interval, 0.65-0.74) and 0.68 (90% confidence interval, 0.64-0.73), respectively. The median time to reach peak plasma concentration for moxifloxacin was prolonged from 1 h to 2.5 h when combined with rifampicin and isoniazid (P=.003). CONCLUSIONS: Coadministration of moxifloxacin with intermittently administered rifampicin and isoniazid results in reduced moxifloxacin plasma concentrations, which is most likely the result of induced glucuronidation or sulphation by rifampicin. Further studies are warranted to evaluate the impact of the interaction on the outcome of TB treatment.