86例复治涂阳肺结核患者的耐药分析

目的 探讨复治涂阳肺结核患者对抗结核药物的耐药特点.方法 回顾性分析86例复治涂阳肺结核患者的单耐药、多耐药及耐多药的情况及治疗转阴率和不良反应.结果 所有患者中,任何形式耐药占100％,多耐药占91.9％,耐多药占65.1％,一线药物耐药顺位为H＞R＞S＞E,二线药物以对左氧氟沙星耐药的比例最高,占37.21％;3个月后痰菌转阴率仅为60.46％,复治病例中耐药比例最高的人群为40～60岁的中老年人,占68.96％;不良反应主要为过敏反应(54.65％)和肝功能异常(8.14％).结论 复治涂阳的肺结核耐药率高,且以中老年人为主,应当重视结核患者耐药性的检测及用药的规律性、足量性.     

葛根素治疗抗结核药物性肝炎临床观察

目的探讨观察葛根素注射液对抗结核药物性肝炎的临床治疗作用。方法将120例抗结核药物性肝炎结核病患者随机分成治疗组和对照组各60例,在接受抗结核治疗的基础上,治疗组在基础治疗中加用注射用葛根素注射液静脉滴注,对照组给予还原型谷胱甘肽进行护肝治疗。结果治疗组和对照组治疗后肝功各项指标均显著改善,与治疗前比较差异均有统计学意义,且两组间各项指标差异无统计学意义。结论葛根素注射液可以有效地治疗抗结核药所致的肝损害,其效果与还原型谷胱甘肽相当。     

微生物来源的抗结核药物国内外生产情况、研发状况及市场动态

由于结核病具有严重的危害性，人类从未停止过与其抗争。微生物来源的抗结核药物作为人类抵御结核病侵袭的重要武器之一，具有很多防治结核的优势。这类药物品种繁多，在临床中有广泛的应用。随着新的致病菌的出现以及结核杆菌耐药率的不断提高，多药耐药结核菌感染的诊治丽临很大的挑战。鉴于经济、政治、科技、文化环境的差异，不同时期和不同国家，其市场情况也有一定变化。本文对当前这类药物国内外生产情况、研发进展及市场动态进行分析研究，并提供相应建议，以期为相关企业制定营销战略决策起导向作用。     

Rifampicin-associated pseudomembranous colitis

We report a case of pseudomembranous colitis that developed in a patient with liver cirrhosis during anti-tuberculosis therapy with rifampicin and isoniazid. The association between rifampicin and pseudomembranous colitis has been controversial; this report, however, supports the association. Colonoscopy performed 3 days after the onset of the pseudomembranous colitis revealed only reddish patches and a few aphthoid lesions, but 4 days later pseudomembranes were apparent. The pseudomembranous colitis was successfully controlled by discontinuation of the anti-tuberculosis agents, along with the administration of lactic acid bacteria, without vancomycin or metronidazole. Possible predisposing factors for the development of pseudomembranous colitis in this patient are also discussed. Received: February 8, 1999 / Accepted: August 27, 1999     

Mortality from adverse drug reactions in adult medical inpatients at four hospitals in South Africa: a cross-sectional survey

Aims

Fatal adverse drug reactions (ADRs) are important causes of death, but data from resource-limited settings are scarce. We determined the proportion of deaths in South African medical inpatients attributable to ADRs, and their preventability, stratified by human immunodeficiency virus (HIV) status.

Methods

We reviewed the folders of all patients who died over a 30 day period in the medical wards of four hospitals. We identified ADR-related deaths (deaths where an ADR was ‘possible’, ‘probable’ or ‘certain’ using WHO-UMC criteria and where the ADR contributed to death). We determined preventability according to previously published criteria.

Results

ADRs contributed to the death of 2.9% of medical admissions and 56 of 357 deaths (16%) were ADR-related. Tenofovir, rifampicin and co-trimoxazole were the most commonly implicated drugs. 43% of ADRs were considered preventable. The following factors were independently associated with ADR-related death: HIV-infected patients on antiretroviral therapy (adjusted odds ratio (aOR) 4.4, 95% confidence interval (CI) 1.6, 12), exposure to more than seven drugs (aOR 2.5, 95% CI 1.3, 4.8) and increasing comorbidity score (aOR 1.3, 95% CI 1.1, 1.7).

Conclusions

In our setting, where HIV and tuberculosis are highly prevalent, fatal in-hospital ADRs were more common than reported in high income settings. Most deaths were attributed to drugs used in managing HIV and tuberculosis. A large proportion of the ADRs were preventable, highlighting the need to strengthen systems for health care worker training and support.     

资阳市抗结核药物固定剂量复合制剂每日疗法临床效果分析

目的评价抗结核药物固定剂量复合制剂（FDC）每日疗法的临床应用效果,为结核病防治规划中FDC的推广应用提供参考依据。方法选取资阳市4个县（区）2011-07/2012-03期间,符合纳入＂重大新药创制＂科技重大专项结核病治疗新剂型研究课题条件的800例肺结核病患者,对其基本情况、依从性调查、不良反应监测记录、治疗和转归情况进行分析。结果纳入的800例患者,其中男性556例（69.5%;平均年龄42.16±21.082岁。初治涂阴肺结核占67%,初治涂阳肺结核占33%。用药后出现的不良反应（ADRs）为201例,ADRs发生率为25.12%,所有发生的不良反应中以胃肠道系统（41.22%）和神经系统（29.77%）最为常见。肝损害的发生率为7.63%。男性（23.02%）与女性（29.92%）ADRs发生率有统计学差异（χ^2=4.29,P〈0.05）;〈60岁组（17.21%）ADRs发生率明显低于≥60岁组（28.07%）（χ^2=11.24,P〈0.05）。治愈255例,完成治疗518例,结核死亡1例,非结核死亡5例,丢失3例。合计治疗完成773例,占96.63%,治愈率达到96.59%,完成治疗率是96.64%。结论服用FDC的患者ADRs总体发生率和肝功能损害发生率均与板式组合药相似,且能提高患者治愈率,可推广使用。     

甘草酸二胺肠溶胶囊预防抗结核药物性肝损的研究

目的 比较研究甘草酸二胺肠溶胶囊对抗结核药物性肝损( ATDH).方法 将80例确诊初发肺结核患者随机分为实验组、对照组和空白组,分别施用甘草酸二胺肠溶胶囊、双环醇片和不用保肝药,观察180天标准抗结核治疗过程中的ATDH发生情况及检测相关指标.结果 实验组ATDH发生率25％,出现ATDH时间为101.20±23.70天;对照组ATDH发生率34.3％,出现ATDH时间为34.42±6.072天;空白组发生率44％,出现ATDH时间50.91±12.03天.实验组ATDH出现时间显著延后(P =0.007).结论 甘草酸二胺肠溶胶囊可延后ATDH的发生时间,降低其严重程度,并缓解抗结核期间炎性过敏反应.     

结核分枝杆菌临床分离株耐药性与耐药基因突变关系的研究

目的分析临床分离结核分枝杆菌耐药性与耐药基因突变的关系。方法用绝对浓度法和基因测序技术检测临床分离的22株结核分枝杆菌对异烟肼(INH)、利福平(RFP)、链霉素(SM)、卡那霉素(KM)、氧氟沙星(OFLX)、对氨基水杨酸(PAS)耐药性和相应耐药基因kat G、rpo B、rpsl、rrs、gyr A、thy A的突变。结果 22株结核分枝杆菌中耐药菌株占45.5%。INH耐药率为18.2%,RFP耐药率为27.3%,SM耐药率9.1%,KM耐药率为18.2%,OFLX的耐药率为13.6%,PAS耐药率为4.5%。敏感菌株中均未检测到耐药基因突变。耐药菌株中除2株外均检测到相应耐药基因突变。结论结核分枝杆菌对抗结核药物耐药性与相关耐药基因突变密切相关。     

Use of Drug-Susceptibility Testing for Management of Drug-Resistant Tuberculosis,Thailand, 2004–2008

In 2004, routine use of culture and drug-susceptibility testing (DST) was implemented for persons in 5 Thailand provinces with a diagnosis of tuberculosis (TB). To determine if DST results were being used to guide treatment, we conducted a retrospective chart review for patients with rifampin-resistant or multidrug-resistant (MDR) TB during 2004–2008. A total of 208 patients were identified. Median time from clinical sample collection to physician review of DST results was 114 days. Only 5.8% of patients with MDR TB were empirically prescribed an appropriate regimen; an additional 31.3% received an appropriate regimen after DST results were reviewed. Most patients with rifampin -resistant or MDR TB had successful treatment outcomes. Patients with HIV co-infection and patients who were unmarried or had received category II treatment before DST results were reviewed had less successful outcomes. Overall, review of available DST results was delayed, and results were rarely used to improve treatment.     

胸腔镜在肺结核球手术治疗中的应用分析简

目的 探讨电视胸腔镜手术（VATS）在肺结核球手术治疗中的应用价值和效果.方法 对22例行胸腔镜手术肺结核球患者的围术期手术资料进行分析,同时对同期行常规开胸手术60例肺结核球患者作为对照组进行分析.结果 电视胸腔镜手术组术中死亡率为零,只有1例患者出现术后并发症,为伤口愈合不良,治疗后恢复.胸腔镜手术组在手术时间及术中出血量方面与开胸手术组无明显差异,但术后带管时间明显短于开胸手术组,并提示有统计学差异（P〈0.05）.结论 VATS是一种安全,有效的处理肺结核球的手术方式,且对于所有孤立性肺结节患者均可提供可靠诊断.对于胸部不明病变的鉴别诊断,结核球的诊断需保持警惕.