抗结核药血药浓度监测及临床疗效与安全性分析

目的:建立测定抗结核药血药浓度的方法,并观察其临床疗效与安全性。方法:选择我院2007年8月-2010年12月164例结核病住院患者,采用高效液相色谱(HPLC)法分别测定患者连续服药1个月后异烟肼、利福平、吡嗪酰胺的血药浓度,分析不同血药浓度的临床疗效及肝损害情况。结果:异烟肼、利福平、吡嗪酰胺的血药浓度高于正常浓度范围者分别占9.1%、12.8%、24.4%,低于正常浓度范围者分别占54.3%、9.8%、6.7%。临床疗效以完全改善和明显改善者居多,占92.1%。药物性肝损害多发生在用药后1个月内,以老年人多见。49例肝损害患者中血药浓度高于正常者占73.5%。结论:HPLC法可用于抗结核药血药浓度监测,其结果是临床调整用药剂量的重要依据,对结核病患者合理用药具有重要意义。

Blood Concentration Monitoring of Anti-tuberculosis Drugs and Analysis of Their Clinical Efficacy and Safety

OBJECTIVE ： To establish a method for the determination of the blood concentration of anti-tuberculosis drugs, and to observe the clinical efficacy and safety of the drugs. METHODS： 164 tuberculosis inpatients were collected from our hospital from Aug. 2007 to Dec. 2010. HPLC method was used to detect the blood concentration of isoniazid, rifampicin and pyrazinamide in patients after 1 month of treatment. Clinical efficacy and hepatic injury of different blood concentrations were analyzed. RE- SULTS： The blood concentration of isoniazid, rifampicin and pyrazinamide beyond normal limits in patients accotmted for 9.1%, 12.8% and 24.4%, respectively. Whereas, lower than normal limits ocuppied 54.3%, 9.8% and 6.7%, respectively. In most cases, the anti-tuberculosis therapy could cure the disease or obviously lighten the clinical symptoms of patients, about 92.1%. The drug-induced hepatic injury often occurred in the elderly within 1 month after medication. The blood concentration beyond normal limits was 73.5% in 49 patients with drug-induced hepatic injury. CONCLUSION： HPLC method can be used for blood concentration monitoring of anti-tuberculosis agents, and the results provide important basis for the adjustment of drug dosage in the clinic, which is valuable for rational use of drugs in tuberculosis patients.