利福喷汀替代利福平治疗129例老年初治涂阳肺结核的临床观察

目的观察利福喷汀对老年肺结核的有效性及安全性。方法选取老年初治涂阳肺结核患者129例，分为治疗组（2HL₂ZE/4HL₂）、对照组（2HRZE/4HR），观察痰菌阴转率、X线好转率、1年复发率及药物不良反应。结果治疗组3个月、疗程结束痰菌阴转率分别为87.1%、98.4%，对照组分别为85.2%、96.3%，2组疗效比较差异无统计学意义（χ²₁=0.09，χ²₂=0.02，P＞0.05）；X线有效率分别为了90.3%、87.0%、（P＞0.05）；空洞闭合率分别为36.7%、32.6%（P＞0.05）；1年随访痰菌复发率分别为6.4%、7.4%（P＞0.05）。在不良反应方面，治疗组和对照组胃肠道反应分别为19.4%、38.9%，两组差异有统计学意义（χ²=5.41 P＜0.05），肝功能损害分别为4.8%、24.1%，两组差异有统计学意义（χ²=7.44 P＜0.01）。结论利福喷汀替代利福平治疗老年初治涂阳肺结核取得满意疗效，不良反应少，值得临床应用。

Clinical observation of Rifapentine as an alternative to Rifampin in 129 elderly patients with new smear-positive pulmonary tuberculosis

Objective To observe the efficacy and safety of Rifapentine to patients with new smear-positive pulmonary tuberculosis. Methods 129 elderly patients with new smear-positive pulmonary tuberculosis were enrolled and randomized into the treatment group (2HL2ZE/4HL2) and the control group(2HRZE/4HR). We observed the sputum negative conversion rate, chest X-ray improvement rate, one-year relapse rate and the side effects of anti-tuberculosis drugs. Results The sputum negative conversion rates in the treatment group were 87.19% at 3 months, and 98.4% at the end of therapeutic course, while those of the control group were 85.2% and 96.3% respectively. The difference in the sputum negative conversion rates between the two groups were not statistically signifieant(χ12 =0.09, χ22 = 0. 02, P>0.05). The improvement rates of chest X-ray were 90. 3% and 87.0% respectively without significant difference(P>0.05). The cavity closure rate were 36.7% in the treatment group, and 32.6% in the control group without statistical differ-ence between two groups(P>0.05). One-year bacteriological relapse rate were 6.4% and 7.4% re-spectively without significant difference (P > 0. 05). The gastroinsterstinal reaction rate were 19.4% in the treatment group and 38. 9% in the control group with statistically significant differ-ence(χ2=5.41 P<0. 05) ,and the rate of liver function damage were 4. 8% in the treatment group and 24. 1% in control group with statistically significant difference(χ2 = 7.44 P<0. 01). Conclu-sions The treatment efficacy of regimen including Rifapentine was the same as that of regimen in-cluding Rifampin to elderly patients with new smear-positive pulmonary tuberculosis. The side effects rate of Rifapentine was very lower than that of Rifampin. It could be recommended to use widely further.