含利奈唑胺化疗方案治疗术后耐多药脊柱结核患者的效果分析

目的 评价含利奈唑胺化疗方案治疗术后耐多药脊柱结核患者的临床疗效及安全性。方法 收集2013年5月至2017年4月北京胸科医院骨科收治的16例耐多药脊柱结核患者,手术后经不含利奈唑胺方案行抗结核药物治疗6个月后无效,后改为含利奈唑胺方案行抗结核药物治疗。通过对比抗结核药物治疗方案调整前后的化疗成功率、植骨融合率、疼痛视觉模拟评分(visual analogue scale, VAS)变化情况,以及与利奈唑胺相关的不良反应发生情况,评价含利奈唑胺方案治疗耐多药脊柱结核的临床疗效及安全性。结果 含利奈唑胺方案抗结核药物治疗的成功率为75.0%(12/16),治疗失败率为25.0%(4/16);植骨融合率为81.3%(13/16);使用含利奈唑胺方案抗结核药物治疗前VAS得分平均为(5.8±1.4)分;使用含利奈唑胺方案后VAS得分平均为(2.3±1.5)分,差异有统计学意义(t=6.546,P=0.000);12例患者椎体感染及椎旁脓肿逐渐吸收。与利奈唑胺相关的不良反应发生率为56.3%(9/16),胃肠道反应的发生率31.3%(5/16),末梢神经炎的发生率43.8%(7/16),贫血的发生率37.5%(6/16),头晕的发生率12.5%(2/16),皮疹的发生率6.3%(1/16)。减少利奈唑胺剂量后,与利奈唑胺相关的药物不良反应严重程度减轻。结论 含利奈唑胺方案治疗耐多药脊柱结核的临床疗效确切,但与利奈唑胺剂量相关的药物不良反应的发生率较高。

Clinical efficacy of linezolid in the treatment of postoperative patients with multidrug-resistant spinal tuberculosis

Objective To evaluate the clinical efficacy and safety of linezolid in the treatment of postoperative patients with multidrug-resistant spinal tuberculosis. Methods From May 2013 to April 2017,16 multidrug-resistant spinal tuberculosis patients admitted to the orthopedics department, Beijing Chest Hospital were selected. After the operation, the anti-tuberculosis drugs treatment for 6 months without linezolid were ineffective, and then the patients changed to the linezolid-containing regimen for anti-tuberculosis treatment. Evaluating the clinical efficacy and safety of linezolid-containing regimen in the treatment of postoperative multidrug-resistant spinal tuberculosis by comparing the success rate of treatment, the rate of bone graft fusion, the change of visual analogue scale (VAS) and the occurrence of adverse effects related to linezolid before and after the adjustment of anti-tuberculosis treatment regimen. Results The success rate of the treatment with linezolid-containing regimen was 75.0% (12/16), the failure rate was 25.0% (4/16), and the bone graft fusion rate was 81.3% (13/16). The average VAS score for the treatment without linezolid was(5.8±1.4) points, compared with the average VAS score of the linezolid-containing regimen was (2.3±1.5), and the difference was statistically significant (t=6.546,P=0.000). The vertebral infection and paravertebral abscess of 12 patients were gradually absorbed. The incidence of adverse reactions associated with linezolid was 56.3% (9/16) totally. The incidence of gastrointestinal adverse reactions, peripheral neuritis, anemia, dizziness, rash was 31.3% (5/16), 43.8% (7/16), 37.5% (6/16), 12.5% (2/16), and 6.3% (1/16), respectively. The severity of adverse reactions was reduced after reducing the dose of linezolid. Conclusion The clinical efficacy of the linezolid-containing regimen in the treatment of multidrug-resistant spinal tuberculosis is definite, but there is a high incidence of adverse effects related to the dose of linezolid.