高剂量异烟肼与延长强化期对结核性脑膜炎的疗效研究

目的 探讨提高结核性脑膜炎的疗效.方法 将60例结核性脑膜炎随机分为两组,各30例；治疗组:异烟肼剂量强化期为16～20 mg/kg/d,巩固期0.6/d;对照组:异烟肼剂量全程均为0.3/d;总疗程均为18月,观察两组治疗3、9、18个月时的疗效、后遗症以及药物不良反应等.结果 抗结核治疗3个月时,治疗组显效率为40.0％,优于对照组的16.7％,差异有统计学意义(x2=4.022,P＜0.05);9个月时,治疗组显效率为63.3％,明显优于对照组的26.7％,差异有统计学意义(x2=8.148,P＜0.01);18个月时,治疗组显效率为70.0％,对照组的为33.3％；治疗组死亡率为3.3％,对照组为30.0％；治疗组无明显后遗症发生,而对照组为23.3％,两组比较差异均有统计意义(均P＜0.05)；治疗组无严重药物不良反应发生.结论 高剂量异烟肼和延长强化期可以显著提高结核性脑膜炎的疗效,明显降低其死亡率及致残率,且无严重药物不良反应发生,可在临床上推广应用.

Efficacy of high doses isoniazid and extension of intensified peried in tuberculous meningitis

OBJECTIVE To study how to improve the curative effect of tuberculous meningitis.METHODS A total of 60 cases of tuberculous meningitis were randomly divided into two groups,the treatment group and the control group with 30 cases each.In the treatment group,scheme for 6~9HR(Re)EZ/9~12HR(Re)E,including isoniazid dose strengthen period for 16 to 20 mg/kg/d,consolidate period 0.6/d.In the control group,scheme for the 3HR(Re)EZ/15HR(Re)E,including isoniazid dose the whole which was 0.3/d.The total period of treatment was 18 months.Efficacy and adverse drug reactions,sequela etc was compared in two groups.RESULTS Antitubercular treatment for 3 months,the efficacy in the treatment group was higher than that in the control group,the difference was statistically significant(χ2=4.022,P<0.05).Treatment for 9 months,the treatment group got much better than control group,the difference was statistically significant(χ2=8.148,P<0.01).Treatment for 18 months,the treatment group got much better than control group,the difference was statistically significant(χ2=8.077,P<0.01).The mortality rate(3.3%) of the treatment group was significantly lower than that of the control group(30.0%),the difference was statistically significant(χ2=5.88,P<0.05).No obvious complications were found in the treatment group,but 23.3% of the control were found with complications,two groups showed statistically significant difference(χ2=5.822,P<0.05).No serious adverse drug reaction was found in the treatment group.CONCLUSION Application of high dose isoniazid and extend the extension period can improve the curative effect of tuberculous meningitis,decrease mortality and morbidity,and there is no serious adverse drug reaction.