初治涂阳肺结核短化方案研究

２０２例治涂阳肺结核，随机分入甲、乙、丙三组方案，依次为２ＳＨＲＥ／４ＨＲ，２ＳＨＲＺ／４ＨＴ，２ＥＨＲＺ／４ＨＥ。主要采用全程管理下自服药。治疗第２组末，三组痰培养阴性率分别为９０％，９１．７％和９０．９％。疗程结束，除丙组１例未转阴外，余痰涂片及培养全部转阴（包括初期耐药２８例）。随访３年，三组共１３６例，痰菌复阳１０例，甲、乙组间无显著差异（Ｐ＞０．０５），丙组与甲、乙型有显著差异（Ｐ＜０．     

固定剂量复合剂卫非特/卫非宁治疗结核病的临床对照研究

目的全面评价固定剂量复合剂卫非特／卫非宁的抗结核疗效、患者合作情况和在我国应用的前景。方法将３０８例初治菌阳肺结核患者，以２∶１随机对照法分为治疗组（２ＲＩＦＡＴＥＲ／４ＲＩＦＩＮＡＨ，２２７例）和对照组（２ＨＲＺ／４ＨＲ，８１例）进行短程化疗。结果治疗组和对照组２个月痰菌阴转率分别达９１．２％和８６．４％；满疗程痰菌阴转率各为９８．７％和９７．５％；胸部Ｘ线明显改善，治疗组和对照组病灶吸收分别占９５．２％和９３．８％，两组分别有６８．６％和６７．９％空洞闭合；两组药物不良反应发生率均为８．９％；治疗组和对照组自动停药率分别为４．２％和７．８％。结论固定复合剂卫非特／卫非宁是一种安全、高效、易被患者接受、在中国结核病短化中有推广应用前景的抗结核药物。     

多重耐药肺结核26例耐药原因分析

多重耐药肺结核２６例耐药原因分析辽宁省锦州市结核病防治所（１２１００４）郭素坤多重耐药性结核病（ＭＤＲ－ＴＢ）患者对异烟肼、利福平等常规化疗效果差，痰菌不易阴转，传染期长，给临床治疗带来很大困难。为此本文选择采用２ＳＨＲＺ／４ＨＲ或２ＨＲＺＥ／４ＨＲ...     

初治菌阳病例短程化疗对武汉市疫情控制的作用

本文总结武汉城区１９８７～１９９０年新登１１５４例初治菌阳肺结核采用２ＨＲＳＺ／４ＨＲ、２ＨＲＳＺ／４Ｈ＿２Ｒ＿２Ｚ＿２短程化疗方案效果。疗程完成率、规则用药率分别为９９．１％及９８．４％，失访率仅１．４％；痰菌阴转率、治愈率为９６．３％、９５．８％。随着实施短化比例的增高，使菌阳治愈速度加快，Ｐ／Ｉ值由１．１缩小至０．９７，１９８４、１９８９年流行病学断面调查，涂阳患病率以每年８％的速度递降。     

结核性胸膜炎超短程化疗效果观察

本文将１９８８年１２月～１９９３年１２月入院的１２４例结核性胸膜炎随机分为４月超短化组２Ｓ（Ｅ）ＺＲＨ／２ＲＨ方案５９例和６或９月短化组２Ｓ（Ｅ）ＺＲＨ／４ＨＲ方案５９例、２ＳＲＨ／７ＲＨ方案６例进行治疗的对比研究。结果：４月短化组疗效肯定。对完成疗程的５２例随访１～５．５年，无一例复发或出现肺内外结核，达到与６月短化相同的效果。     

初治菌阳病例短程化疗对武汉市疫情控制的作用

本文总结武汉城区１９８７－１９９０年新登１１５４例初治菌阳肺结核采用２ＨＲＳＺ／４ＨＲ、２ＨＲＳＺ／４Ｈ２Ｒ２Ｚ２短程化疗方案效果，疗程完成率，规则用药率分别为９９．１％及９８．４％。失访率仅１．４％；痰菌阴转率，治愈率为９６．３％、９５．８％，随着实施短化比例的增高，使菌阳治愈速度加快，Ｐ／Ｉ值由１。１缩小至０．９７，１９８４、１９８９年流行病学断面调查，涂阳患病率以每年８％的速度递降。     

初治肺结核212例耐药性测定

２１２例初治菌阳肺结核对８种抗结核药物的耐药性测定结果，１４２例耐药，耐药率６６．９％。耐Ｓ、Ｈ、Ｒ、Ｅ者分别为４９．５％，４９．０％，２７．８％及１２．７％，其高、低浓度耐药顺序基本相同。耐１～３种药依次为１５．６％，２７．４％，１４．６％；耐４种药以上为９；４％。同时耐ＨＲ２２．６％，耐ＨＲＳ１９．３％，耐ＨＲＥ７．５％，是导致化疗失败的主要原因。     

五个月短程化疗及六个月全程间歇方案治疗菌阳肺结核的临床对照研究

目的考核利福喷丁（Ｌ）的疗效；缩短疗程或全程间歇以减少用药次数；观察全程应用吡嗪酰胺（Ｚ）对疗效及毒副反应的影响。方法以利福平（Ｒ）为对照，采用５个月疗程方案（Ⅰ组２ＳＨＲＺ／３Ｒ２Ｈ２Ｚ２，Ⅱ组２ＳＨＲＺ／３Ｌ１Ｈ２Ｚ２）、６个月全间歇方案（Ⅲ组２Ｓ３Ｈ３Ｒ３Ｚ３／４Ｌ１Ｈ２Ｚ２，Ⅳ组２Ｓ３Ｈ３Ｒ３Ｚ３／４Ｌ１Ｈ２Ｅ２），观察Ｚ的全程应用结果，巩固期以乙胺丁醇（Ｅ）为对照。３６６例初治菌阳肺结核随机分入以上４组。结果（１）３３９例完成疗程者中３２９例治疗成功，满疗程时痰菌阴转率Ⅰ～Ⅳ组分别为９７０％、９４１％、１０００％、９７２％。Ｘ线病灶有效率依序为９６０％、９７６％、１０００％和９４４％。５个月组与６个月组空洞关闭率分别为７７％及７６％。各组相互比较均无显著性差异（Ｐ＞０．０５），未见严重副作用。（２）３０５例完成３年随访，Ⅰ、Ⅱ、Ⅲ、Ⅳ组细菌学加Ｘ线复发分别为２、３、６和３例。结论本研究结果进一步证明Ｌ是长效、高效、安全、便于督导的新药；巩固期用Ｚ无必要；现有基本药物合理联用有可能缩短疗程为５个月，值得进一步研究。     

肺结核球及干酪病灶的活血化瘀治疗

本文报告我院１９９０￣１９９５年间采用２ＨＲＺＳ（Ｅ）／４ＨＲＥ（Ｚ）化疗方案并用复方丹参活血化瘀治疗肺结核球及大块干酪病灶５６例与单纯化疗５２例的结果，分析表明：化疗＋活血化瘀的６个月综合疗效：有效率（显效＋有效）为９６．４％，单纯化疗组则为７６．９％，二者经卡方检验Ｐ〈０．０５，具有差异性。经２￣５年的随访，活血化瘀组有１２例（２１．４％）达到临床治愈，无一例复发。单纯化疗组有６例行外科手术治     

药物副反应

药物副反应吡嗪酰胺致多发性关节囊血性积液１例邓宝库鞍钢结核病防治所１１４００１病人女７９岁。因胸闷、气短、咳嗽、痰带血丝１月，于１９８６年４月２６日就诊本所，诊为左侧浸润型肺结核（痰菌阳性）。ＥＳＲ２０ｍｍ／１ｈ，肝功正常。予以２ＳＨＲＺ／７ＨＲＥ方...     

Assessment of a combined preparation of isoniazid, rifampicin and pyrazinamide (Rifater) in the initial phase of chemotherapy in three 6-month regimens for smear-positive pulmonary tuberculosis: a five-year follow-up report.

SETTING: Singapore Tuberculosis Service. OBJECTIVE: To assess the acceptability, efficacy and relapse rate of a combined formulation of three drugs--isoniazid, rifampicin and pyrazinamide (Rifater)--given in the initial phase of chemotherapy in three 6-month regimens (2SHRZ/4H3R3, 1SHRZ/5H3R3 and 2HRZ/4H3R3) under direct observation for all patients. DESIGN: A randomised, controlled, unblinded study comparing a group of patients treated with Rifater and another given the three component drugs as separate formulations. RESULTS: The 310 patients admitted to the study were divided into two groups of 155 patients. The frequency of side effects was similar in both groups. Of 271 patients with drug-sensitive strains who had completed treatment without interruption, sputum cultures converted in all patients. At the end of 5 years, there were 15 relapses: three (2.2%) in the separate drugs group and 12 (9.3%) in the Rifater group. Exclusion of two cases in the Rifater group, one with silicotuberculosis and another with no bacteriological confirmation of diagnosis, gave a relapse rate of 7.9% (P = 0.03 for the comparison of relapse rates in the two groups). CONCLUSION: A combined formulation of three drugs given daily in the initial phase of 6-month short-course therapy, followed by intermittent treatment with isoniazid and rifampicin given three times a week under direct observation for all patients, appears to be less effective than treatment with the component drugs given as separate formulations.     

124例尘肺结核化疗疗效观察

目的　探讨尘肺结核菌阳患者使用不同疗程化疗的近远期疗效。方法 观察10年间的菌阳尘肺结核124例化疗效果。按不同疗程分为12月组 (3HRZS/9HRE)、18月组 (3HRZS/6HRZ/9HRE)、24月组 (3HRZS/9HRZ/12HRE)方案,全程督导治疗结束随访5年。考核标准以痰菌为主。结果 12月组、18月组、24月组方案化疗结束痰菌阴转率达到99.2%,随访期间痰菌复阳率分别为17.4%、3.8%、1.4%。结论 对18月组、24月组方案的远期疗效满意。18月组方案适用于Ⅰ～Ⅱ期尘肺结核,24月组方案适用于Ⅲ期尘肺结核。     

218例尘肺结核分期化疗方案的临床研究

目的探讨尘肺结核菌阳初治患者根据尘肺分期使用不同疗程化疗方案的近远期疗效。方法按尘肺分期及病灶范围分为4组（A₁、A₂、B₁、B₂）给予不同的化疗方案,全程督导治疗结束并随访5年。考核痰菌的阴转率、复阳率,并进行各组间比较。结果4组病例化疗疗程结束痰菌阴转率达到100%,随访5年期间痰菌复阳率分别为17.4%、4.3%、22.5%、5.0%。结论A₂组方案3HRZS(E)/6HRZ/9HRE适用于Ⅰ～Ⅱ期尘肺结核,B₂组方案3HRZS(E)/9HRZ/12HRE适用于Ⅲ期尘肺结核,对该组方案的远期疗效满意。     

Short-course chemotherapy of pulmonary tuberculosis in pneumoconiotic patients

This is the first prospective clinical trial recorded to date of short-course chemotherapy in pulmonary tuberculosis complicated by pneumoconiosis. Forty-eight anthrasillicotic and 11 silicotic patients with previously untreated pulmonary tuberculosis completed 9-month, short-course chemotherapy regimens: 2 months of daily streptomycin, isoniazid, rifampicin, and pyrazinamide followed by daily isoniazid and rifampicin for 7 months (2SHRZ/7HR). There were 3 treatment failures (5%). The remaining 56 patients (95%) all had their sputum converted within 4 months (mean, 1.5 months). Bacteriologic relapses were noted in 3 patients (5%) after 18 to 40 months of follow-up (mean, 28.4 months). The relapses occurred within 7 months after chemotherapy was stopped. There were 2 deaths from nontuberculosis causes during the follow-up period. Fifty-one patients (90%) remained bacteriologically sterile for 28.4 +/- 6.1 months. These results suggest that the 2SHRZ/7HR regimen is satisfactory in treating anthrasilicotic or silicotic patients with pulmonary tuberculosis, though antituberculosis chemotherapy seemed less effective in patients with pneumoconiosis than in those without pneumoconiosis.     

北京市昌平区初治涂阳肺结核病人短程督导化疗的近、远期效果

目的　观察初治涂阳肺结核短程化学治疗的近期及远期疗效。方法 回顾性分析、调查昌平区1992—1994年155例经6个月短程化学治疗的疗效及1、2、10年的随访结果 。结果 治疗结束时,痰菌阴转率、肺部病变吸收好转率各为96.8%和97.0%,治疗结束后1、2、10年的随访未见复发病人。结论 全程督导下短化具有很好的近、远期效果。     

不固定化疗期短程化疗研究初探

目的研究从现行６个月短化方案进一步缩短化疗期的疗效。方法改进初治涂阳患者６个月固定化疗期，采用涂片检查并以痰菌转阴后连续３个月阴性为治愈停药标准。结果２９０例涂阳肺结核经２ＳＨＲＺ／ｘＨＲ治疗，６个月时痰菌阴转率９８．３％，２８３例阴转治愈，平均化疗期４．７个月，２年随访率９４．３％，细菌学复发率１．９％。结论采用痰涂片检查，并以痰菌转阴后连续３个月阴性为阴转治愈标准，可将化疗期平均缩至４．７个月，且治愈率高，２年细菌学复发率低，为进一步缩短化疗期进行了有意义的探索。     

Controlled clinical trial of 4 short-course regimens of chemotherapy (three 6-month and one 8-month) for pulmonary tuberculosis: Final report

The bacteriological relapse rates up to 30 months after the start of chemotherapy have been compared for 4 daily short-course regimens for pulmonary tuberculosis. All 4 had the same initial 2-month intensive phase of streptomycin, isoniazid, rifampicin and pyrazinamide (SHRZ) followed by isoniazid plus rifampicin for 4 months (4HR), or isoniazid plus pyrazinamide for 4 months (4HZ), or isoniazid alone for 4 months (4H), or isoniazid alone for 6 months (6H).In patients with fully sensitive strains pretreatment, the 6-month regimen with rifampicin throughout (4HR) was highly effective, only 2% of 166 patients relapsing bacteriologically in 24 months of follow-up after stopping chemotherapy. This regimen was significantly better than the 4H regimen which had a relapse rate of 10% in 156 patients (P<0.02) and the 4HZ regimen which had a relapse rate of 8% in 164 patients (P=0.05). The 6H regimen was also highly effective, only 3% of the 123 patients relapsing, compared with 10% of the 156 on the 4H regimen (P=0.06). The relapse rate of the regimen with pyrazinamide throughout (4HZ), was not significantly different from that of either of the regimens with isoniazid alone in the continuation phase. All except 3 (1 4HR, 1 4HZ, 1 4H) of the 36 relapses were with fully drug-sensitive strains.In patients with strains resistant to isoniazid alone pretreatment none of the 23 on the 4HR or 4HZ regimens had an unfavourable bacteriological status at the end of chemotherapy compared with 8 of the 17 patients (P<0.005) on 4H or 6H regimens. Of the patients assessed, 3 of 20 receiving rifampicin or pyrazinamide throughout relapsed compared with 2 of 8 who did not.     

初治涂阳肺结核不固定化疗期短程化疗远期疗效观察

目的　在6个月固定化疗期全程每日给药化疗方案的基础上,观察进一步缩短化疗期的远期疗效。方法 采用2HRZS(E)/XH₃R₃化疗方案治疗初治涂阳肺结核,经涂片检查痰菌阴转后连续3个月阴性为治疗停药标准,并注意抓好研究过程中的环节质量控制。结果 符合选例标准95例,92例完成规则治疗,累计痰菌阴转率为98.9%,91例治愈,平均化疗期为5.1个月,2年随访率为91.2%,细菌学复发率为2.3%。结论 本研究与国内6个月标准短化相比,其复发率相近。说明本方案治愈率高,可缩短治疗期。     

结核病控制项目中初治涂阳重症肺结核的认定和方案选择

目的 对结核病控制项目中重症肺结核进行不同方案的治愈率和复发率的比较分析.方法对Ⅰ组3 HREZ/6HRE、Ⅱ组3H2R2E2Z2/6H2R2E2、Ⅲ组2HREZ/4HR和Ⅳ组2H2R2E2Z2/4H2R2方案进行组间分层分析比较.评价痰菌阴转率、治愈率、复发率和不良反应.结果(1)强化期痰菌阴转和疗程结束痰菌阴转情况:Ⅰ组和Ⅱ组痰菌阴转优于Ⅲ组和Ⅳ组;(2)强化期结束和疗程结束X线吸收情况:Ⅰ组和Ⅱ组X线吸收优于Ⅲ组和Ⅳ组;(3)3年内细菌学复发Ⅰ组和Ⅲ组、Ⅳ组存在显著性差异;(4)不良反应各组无差异.结论 结控项目中重症肺结核9个月方案疗效明显优于6个月方案.