初治肺结核短程(6个月)化疗效果及其副反应

本文报导初治痰菌阳性肺结核病人102例,用SM、INH、RFP和PZA方案,疗程6个月,不住院全监给药。停药时痰涂片阳性和培养阳性病例的痰菌阴转率分别为94.11％和97.56％,随访18个月痰细菌学复发率分别为3.22％和3.80％。因药物副反应的停药率为3.77％。认为本疗法安全、经济、疗效高值得推广。     

利福平注射液治疗初治涂阳肺结核的疗效及安全性观察

目的评估利福平注射液与口服利福平治疗初治涂阳肺结核的疗效及安全性。方法选取初治涂阳肺结核患者110例,分为治疗组（I）（INH、舒兰新、PZA、EMB）,对照组（Ⅱ）（INH,RFP,PZA,EMB口服）,分别观察第一个月、第二个月痰菌好转（或阴转）率、x线好转率及药物不良反应。结果第一个月末I、Ⅱ组的痰菌好转（或阴转）率分别为81.7％、20％（P〈0.05）,X线好转率分别为68.3％、20％（P〈0.05）;第二个月痰菌好转（或阴转）率分别为91.7％、88％（P〉0.05）,X线好转率分别为76.7％、64％（P〉0.05）;药物不良反应分别为15％、14％（P〉0.05）,不良反应与利福平口服剂型相同。     

82例初治涂阳老年肺结核的近期临床观察

目的：探讨初治涂阳老年肺结核病人和对抗结核药物的耐受性以及左氧氟沙星的有效性和安全性。方法：将82例初治涂阳老年肺结核按4：3分为治疗组（2HL2EZ／4HL2E、35例）进行6个月的临床总结。结果：治疗组和对照组2个月痰菌阴转率分别为72．7％和63．3％（P＞0．05）,治疗6个月痰菌阴转率分别为88．6％和83．3％（P＞0．05）,药物副反应发生率分别为25．5％和51．4％（P＞0．05）。结论：老年肺结核疗效相对较低,药物副反应发生率高,左氧氟沙星对老年肺结核安全有效。     

82例初治痰涂片阳性老年肺结核患者的近期临床观察

目的 探讨初治痰涂片阳性老年肺结核患者的疗效、对抗结核药物的耐受性及左氧氟沙星的有效性和安全性。方法 将82例初治痰涂片阳性老年肺结核患者按4：3分为治疗组和对照组进行6个月的临床观察（强化期2个月，巩固期4个月）。治疗组选用可乐必妥，按2HLEV／4HLE方案给药；对照组用吡嗪酰胺，按2HLEZ／4HLE给药。结果 治疗组和对照组2个月痰菌阴转率分别为72．7％和63．3％（P＞0．05），治疗6个月痰菌阴转率分别为88．6％和83．3％（P＞0．05），胸部X线病灶吸收分别为86．4％和86．7％（P＞0．05），空洞闭合率分别为30．0％和24．1％（P＞0．05），药物副反应发生率分别为25．5％和51．4％（P＜0．05）。结论 老年人肺结核治愈率较低，药物副反应发生率高，左氧氟沙星对老年人肺结核安全有效。     

左氧氟沙星治疗肺结核患者近期临床疗效观察

目的观察左氧氟沙星联合其他-线抗结核药物治疗初治肺结核患者的疗效和安全性。方法人选88例患者随机分为治疗组（2HREV／7HR）和对照组（2HREZ／7HR）。观察痰菌阴转、X线好转情况及药物副反应。结果治疗2个月时治疗组和对照组痰菌阴转率分别为87．2％和87．8％，满疗程时痰菌阴转率分别为97．9％和97．6％。X线胸片肺内病灶满疗程时治疗组和对照组出现副反应分别为18．8％和44．4％。结论左氧氟沙星具有良好抗结核作用，是一种使用安全、副反应小的新一代的抗结核药物，可根据患者的不同情况应用于初治肺结核患者，但最好用于复治肺结核者。     

母牛分支杆菌菌苗在初治肺结核治疗中的作用

目的 观察和评价母牛分支杆菌菌苗（微卡菌苗）在初治肺结核免疫治疗中的疗效及安全性。方法 采用随机配对分组法将342例初治菌阳肺结核患者分入微卡菌苗治疗组（M组,171例）和对照组（C组,171例）。M组化疗方案为2HRZE／2HR,C组为2HRZE／4HR。M组加用微卡菌苗治疗6个月,C组不用微卡菌苗。结果 M组第1个月涂片阴转率36．8％,培养转率19．3％;第2个月涂片阴转率80．1％,培养阴转率85．9％。C组第1个月涂片阴转率19．9％,培养阴转率19．3％;第2个月涂片阴转率54．4％,培养阴转率67．8％。头2个月痰菌阴转率M组显著高于C组（P＜0．01）。疗程满6个月后M组涂片阴转率98．2％,培养阴转率99．4％;C组涂片阴转率98．8％,培养阴转率98．8％。M组与C组治疗6个月痰菌阴转率无显著性差异（P＞0．05）。病灶吸收好转及空洞缩小关闭速度,M组优于C组。M组的细胞免疫功能显著改善。1年后随访M组和C组的的细菌学复发率分别是3．0％和5．6％（P＞0．05）。结论 微卡菌苗能改善初治肺结核患者的细胞免疫功能,加快痰菌阴转、病灶吸收及空洞缩小关闭的速度,缩短短程化疗疗程。不良反应少且较轻微。复发率底。微卡菌苗可用作初治肺结核的免疫治疗和短化的辅助治疗。     

结核病

初治痰涂片阳性老年肺结核近期疗效观察——李志凤等（广西柳州龙潭医院结核内科545005）；《广西医科大学学报》，2005，22（2）：266—267【目的：探讨初治痰涂片阳性老年肺结核的最佳治疗方案。方法：随机抽取初治痰涂片阳性老年肺结核患102例，分为治疗组55例，对照组47例。治疗组用含异烟肼（H）、利福喷丁（L）、乙胺丁醇（E）、左氧氟沙星（V）组成的方案（2HL2EV／4HL2），对照组用含异烟肼、利福喷丁、乙胺丁醇、毗嗪酰胺（Z）组成的方案（2HL2EZ／4HL2）。结果：治疗组和对照组2个月痰菌阴转率分别是72．7％和68．1％。化疗6个月。痰菌阴转率分别是92．7％和89．4％（P〉0．05）；肺部病变吸收有效率分别是89．1％、87．2％（P〉0．05）；空洞闭合率分别是83．3％、81．5％（P〉0．05）；不良反应发生率分别是21．8％、48．9％伊〈0．05）。结论：两组的治疗方案对于老年肺结核均有较好的疗效。但2HL2EV／4HL2治疗方案不良反应低。老年人耐受性好，使用更安全。】     

胸腺肽联合化疗治疗难治性肺结核疗效观察

目的评价胸腺肽在难治性肺结核治疗中的作用。方法78例难治性肺结核病人随机分为对照组（单纯化疗组）和治疗组（胸腺肽联合化疗组）。对照组应用2S（E）RHZ／4HR督导化疗6个月。治疗组在上述方案上加用胸腺肽6个月。观察两组痰菌阴转和病变吸收情况。结果疗程结束后,治疗组、对照组的痰菌阴转率分别为81．6％、57．5％;病灶吸收好转率分别为76．3％、55．0％;空洞闭合率分别为75．0％、30．8％,三者均有显著差异。随访结果：治疗组的痰菌转阳率及病情复发加重者均低于对照组,但无显著性差异（P〉0．05）。结论胸腺肽可作为难治性肺结核的安全有效辅助疗法。     

蛋白质营养不良对初治涂阳肺结核患者抗痨疗效的影响

目的探讨蛋白质营养不良对初治肺结核患者抗痨疗效的影响。方法对185例初治涂阳肺结核合并蛋白质营养不良患者与193例营养状况正常的初治涂阳肺结核患者均采用2HREZ（S）／7HRE治疗，观察痰菌阴转率、X线好转率。结果2个月强化期结束时蛋白质营养不良组与营养状况正常组的痰菌阴转率分别为55．7％，65．8％（P〈0．05）；病灶吸收好转率分别为73．5％，83．9％（P〈0．05）；空洞闭合率分别为13．5％，30．4％（P〈0．05）均有显著差异。9个月疗程结束时，蛋白质营养不良组与营养状况正常组的痰菌阴转率分别为96．2％，97．4％（P〉0．05）；病灶吸收好转率分别为92．4％，95．3％（P〉0．05）；空洞闭合率分别为82．7％，84．8％（P〉0．05）均无显著差异。结论蛋白质营养不良影响肺结核患者的早期抗痨治疗效果。     

微卡联合化学治疗初治菌阳肺结核临床观察

目的评价微卡（Vaccae）治疗初治菌阳肺结核的临床疗效。方法169例初治菌阳肺结核患者，随即分为两组，A组（85例）、B组（84例），均采用2HRZS（E）／4HR方案治疗，A组加用微卡治疗。观察治疗后肺部病灶吸收，痰菌阴转情况。结果2个月末痰菌阴转率：A、B组分别为80％和65．5％，疗程结束时A、B两组痰菌阴转率分别为97．6％和84．5％。疗程结束时胸部病灶显著吸收率：A、B两组分别为90．6％和75％，空洞闭合：A、B两组分别为85．9％和64．3％。结论微卡联合化学治疗初治菌阳肺结核能提高痰菌阴转率，促进肺部病灶吸收，提高免疫细胞活性，是一种较好的免疫剂，建议推广使用。     

Bronchiolo-alveolar cell carcinoma arising after active pulmonary tuberculosis' report of two cases]

We report on two patients diagnosed as having active pulmonary tuberculosis who later developed lung cancer. In both cases, the lung cancer was detected during the treatment of pulmonary tuberculosis. Both patients were initially considered to be experiencing exacerbation of pulmonary tuberculosis. Case 1 was seen in a 74-year-old man. His chest roentgenogram revealed microscopic cavitary lesions with infiltration into both lung fields. His sputum tested positive for acid-fast bacilli. Although he was treated with isoniazid (INH), rifampicin (RFP), ethambutol (EB) and pyrazinamide (PZA), his general condition deteriorated, and the infiltrative shadows in the lung fields had expanded on subsequent chest radiography. Transbronchial lung biopsy (TBLB) yielded findings compatible with a diagnosis of bronchiolo-alveolar cell carcinoma. Case 2 occurred in a 52-year-old man. His chest radiograph revealed cavitary lesions with infiltration into both lung fields. His sputum also tested positive for acidfast bacilli. Despite medication with INH, RFP, EB and PZA, the infiltrative shadow in his chest radiograph increased in size. Bronchiolo-alveolar cell carcinoma was confirmed after examination of the sputum cytology. Case 1 was diagnosed as lung cancer 10 months after being admission to the hospital, and Case 2, seven months after hospitalization. Recent discussion concerning the simultaneous occurrence of pulmonary tuberculosis and bronchogenic carcinoma suggests a high frequency of coexistence of the two diseases. However, the coexistence of active tuberculosis with bronchiolo-alveolar cell carcinoma, as in our cases, is rare.     

抗结核固定剂量复合剂与板式组合药治疗肺结核效果对比分析

目的研究国产抗结核FDC的有效性和安全性,探索适合深圳市结核病防治用药。方法从深圳市罗湖区和南山区登记的全部初治涂阳病例中随机抽取200例,其中FDC组、对照组(板式组合药)各100例,均采用全程督导的方式。对两组病人的用药剂量、临床表现、治疗效果、不良反应进行分析比较。结果(1)FDC组与对照组患者1、2、3、6个月末相关临床症状(如盗汗、发热、咳嗽、咯血、胸痛、呼吸困难、乏力)的出现率均逐渐下降,两组无显著性差异(P<0.05);(2)FDC组与对照组2个月末痰菌阴转率分别为88%、84%,6个月末痰菌阴转率提高到98%、97%,两组6个月末结核空洞闭合率分别为58.3%、48.6%,痰菌阴转率X线胸片吸收率和空洞闭合率均无显著性差异(P<0.05);(3)FDC组与对照组临床不良反应率分别为25%和18%,WBC异常率分别为18%和11%,AST异常率分别为16%和9%,TBIL异常率分别为19%和15%,临床和实验室检测的结果均无显著性差异(P<0.05);(4)FDC中利福平(R)的体质量与剂量相关系数为0.804,高于组合药中利福平(R)的体质量与剂量相关系数(0.781)。FDC组异烟肼(H)、利福平(R)、吡嗪酰胺(Z)、乙胺丁醇(E)的用药剂量低于对照组,有显著性差异(P<0.05)。结论国产FDC与板式组合药的治疗效果相同,不良反应率相近,但FDC药物的用药剂量低,具有一定的推广应用前景。     

Fixed-dose combination chemotherapy (Rifater/Rifinah) for active pulmonary tuberculosis in Taiwan: a two-year follow-up.

SETTING: Veterans General Hospital-Taipei, Taiwan. OBJECTIVE: To assess the efficacy and safety of a fixed-dose combination (FDC) of Rifater (RFT)/Rifinah (RFN) in the treatment of newly diagnosed smear-positive pulmonary tuberculosis. DESIGN: Patients were randomly assigned to two 6-month short-course chemotherapy regimens. One group of patients was treated with FDCs and another was given the four component drugs (INH, RMP, EMB and PZA) as separate formulations. RESULTS: The 105 patients enrolled in the study were divided into two treatment groups. Fifty-one patients who had completed treatment without interruption, 26 in the FDC group and 25 in the separate regimen, were eligible for analysis at the end of 2 years. Among the patients with a drug susceptibility test result available, four in the FDC group had bacilli resistant to pyrazinamide. In the separate regimen group, two patients had bacilli resistant to ethambutol and six had bacilli resistant to pyrazinamide. The two regimens were of similar effectiveness with regard to sputum conversion, compliance and radiological improvement. No patient with FDC treatment developed gastointestinal symptoms, visual disturbance or peripheral neuropathy (P < 0.05). However, FDC treatment resulted in drug-induced fever in one patient. One patient (3.8%) in the FDC group relapsed 5 months after completing treatment. CONCLUSION: This study suggests that the two regimens had similar effectiveness in the treatment of smear-positive pulmonary tuberculosis. However, the fewer adverse drug events among those patients treated with the FDC regimen suggests that it has a better safety profile.     

A case of pulmonary tuberculosis complicated with tuberculosis of bilateral cervical lymph nodes and exacerbated pericostal abscess

A 23-year-old man was admitted to our hospital because of cough and sputum in April 2001. A chest roentgenogram revealed infiltrative shadow with cavity formation in the bilateral lung fields. He was treated with sensitive antituberculous drugs. After starting the antituberculous therapy with INH, RFP, EB and PZA, bilateral cervical lymphadenopathy developed. Three months later, pericostal abscess appeared in the left anterior chest wall. Microscopic examination of the specimen obtained by needle aspiration biopsy disclosed positive for acid-fast bacilli. Smears of the pus showed acidfast bacilli identified as Mycobacterium tuberculosis by DNA-DNA PCR method. He developed tuberculous bilateral cervical lymphadenopathy and pericostal abscess during the course of antituberculosis chemotherapy. Drug sensitivity test revealed that tubercle bacilli in this case were sensitive. One year after the administration of chemotherapy, cervical lymphadenopathy and pericostal abscess were improved. Both masses were discontinuous with pulmonary tuberculosis and the possibility of lymphogenous spread of organism was speculated as its etiology. We assumed that both masses were due to paradoxical response to the antituberculosis chemotherapy.     

Case of pulmonary tuberculosis in late stage of pregnancy

A 28-year-old woman who was a nurse was admitted to our hospital because her sputum was positive for M. tuberculosis. She was pregnancy of 35 weeks. First, she was administered INH, RFP, PZA and was treated with cesarean section on the 21st day after starting tuberculosis chemotherapy. The operation was done in operating room of negative pressure ventilation. The patient returned to the tuberculosis ward, and the newborn infant entered to a newborn nursery room after confirming negative tubercle bacilli in amnionic fluid by PCR examination. EB was added to the regimen of chemotherapy after childbirth. In general hospitals, infection control is an important issue as seen in this case.     

A surgically treated case of ileus caused by small intestinal tuberculosis during treatment for pulmonary tuberculosis

A 44-year-old man consulted medical clinic, complaining of cough and sputum. Then he was admitted to our hospital, because of positive acid-fast bacilli in his sputum and positive PCR (polymerase chain reaction) for Mycobacterium tuberculosis. Combined use of isoniazid (INH), rifampicin (RFP), ethambutol (EB) and pyrazinamide (PZA) was started. But 4 days after starting treatment, we had to suspend tuberculosis chemotherapy because of hepatopathy. Since then he started to complain epigastralgia and vomiting. Plain abdominal X-ray and abdominal computed tomography (CT) led to a diagnosis of ileus. Inspite of insertion of ileus tube symptoms of ileus did not improve. Small bowl series showed severe stenosis at ileum end, necessitating jejunectomy. Macroscopic study revealed a ring ulcer and multiple epithelioid cell granuloma with Langhans' giant cells was detected histopathologically. PCR for M. tuberculosis of extracts from ileum was positive. Therefore the patient was diagnosed small intestinal tuberculosis. Treatment was continued by the combination of INH, RFP, EB, and the symptoms markedly improved. There have been no sign of recurrence since the end of the 6-month treatment for tuberculosis.     

Agranulocytosis due to anti-tuberculosis drugs including isoniazid (INH) and rifampicin (RFP)--a report of four cases and review of the literature

We experienced 4 cases of agranulocytosis due to anti-tuberculosis drugs (rifampicin [RFP], isoniazid [INH], ethambutol [EB], streptomycin [SM] or pyrazinamide [PZA]) among some 6,400 tuberculosis patients who underwent chemotherapy over the past 20 years from 1981 to 2002 in our hospital, and the incidence rate of agranulocytosis was estimated at 0.06%. The 4 cases of agranulocytosis were as follows. CASE 1: A 51-year-old woman with right chest pain and fever was admitted to our hospital on Jan 4, 2001. The white blood cell (WBC) count was 5,200/microliter. The tubercle bacilli were cultured in her sputum. The treatment with INH 0.3, RFP 0.45, EB 0.75, PZA 1.2 g/day, allopurinol and teprenone was started on Jan 13. Pyrazinamide and allopurinol were stopped because of hyper-uric acidemia on Feb 7. Agranulocytosis and eosinophilia (WBC 1,300 [Neut 1%, Ly 57%, Eos 35%]) developed on Feb 13. All drugs were withdrawn and G-CSF drug nartograstim 100 micrograms was injected subcutaneously for 3 days. The WBC recovered to normal level and she was thereafter treated with INH, EB and Levofloxacin (LVFX) without any further trouble. Agranulocytosis in this case was supposed to be due to RFP. CASE 2: A 66-year-old man who had had nephrotic syndrome and hypothyroidism and has been treated with prednisolone 10 mg/day was admitted to our hospital on Aug 9, 2000 because of miliary tuberculosis. The tubercle bacilli were cultured in his sputum and the treatment with INH 0.3, RFP 0.45, and EB 0.75 g/day were started on Aug 10, but it was withdrawn on Aug 17 because of general skin eruption. After re-starting treatment with EB and INH on Aug 24, RFP was added in small dosage (0.05 g) on Oct 12, but agranulomatosis (WBC 2,300/microliter [Neut 2%]) developed on Nov 21, and all drugs were withdrawn again. The G-CSF drug filgrastim was used once subcutaneously, and WBC recovered immediately. He was thereafter treated with INH, EB, LVFX successfully. Agranulocytosis was supposed to be due to RFP. CASE 3: A 60-year-old woman without symptoms had abnormal chest roentgenograph, and consulted with our hospital on Aug 26, 2002. The broncho-alveolar lavage fluid was smear and culture-negative, but PCR-TB positive, and the case was diagnosed as pulmonary tuberculosis. Treatment with INH 0.3, RFP 0.45, EB 0.75, PZA 1.2 g/day, alloprinol 300 mg and rebamipide 300 mg/day was started on Sept. 5, 2002. Late in September, she complained of appetite loss. The laboratory data on Oct 3 revealed WBC 900/microliter (Neut 1%, Ly 94%), aspartate aminotransferase (AST) 199 IU/l, and alanine aminotransferase (ALT) 253 IU/l, showing agranulocytosis and drug-induced hepatitis. The chemotherapy was immediately withdrawn and she was admitted to our hospital on the next day. Glycyrrhizin derivative (SNMC) 40 ml was injected for 5 days, and WBC recovered, and AST and ALT also became normal. CASE 4: A 60-year-old man was admitted to our hospital on March 11, 1981 because pulmonary tuberculosis had recurred. He had been treated with SM, PAS and INH in 1973 for pulmonary tuberculosis. On admission examination of blood count and blood chemistry were normal. Treatment with RFP, INH and SM was started on March 11. He stopped out from the hospital on April 17, but in a few days he returned back with sore throat, lower lip swelling and gingival bleeding. Blood cell count on April 24 showed pancytopenia with RBC 226, Hb 7.5, WBC 800 (Ly 96%, Eos 4%) and Plt 10,000/microliter. The bone-marrow showed NCC (nuceated cell count) of 5,500, and megakaryocyte 0. Thereafter ground glass appearance shadows were seen on the whole lung field, and he died May 26. Autopsy showed generalized aspergillosis. It was strongly suspected that either of RFP, INH or SM was responsible for his pancytopenia. We collected another 10 cases of agranulocytosis due to anti-tuberculosis drugs in the world wide literature, and found men/women ratio 5/8 (in one case gender was not known), the duration of chemotherapy before appearance of agranulocytosis 1-3 months, no change in the lymphocyte count of the peripheral blood, and the accompanying of another allergic signs such as skin eruption, blood eosinophilia or drug-induced hepatitis in some cases, and these findings suggest that the mechanism of agranulocytosis due to anti-tuberculosis drugs was allergic in nature.     

A case of multidrug-resistant pulmonary tuberculosis]

A 44-year-old woman with multidrug-resistant pulmonary tuberculosis was admitted to our hospital in August 1998. She had been treated with the anti-tuberculosis agents isoniazid (INH), rifampicin (RFP), pyrazinamide and streptomycin (SM) for two months. However, tubercule bacilli found in a sputum culture on admission showed resistance to INH, RFP and SM, and so these agents were replaced with kanamycin (KM), ethionamide, cycloserine and levofloxacin. Unfortunately, the bacilli persisted in the sputum smears, and the patient complained of prolonged pain in the sites of intramuscular injection of KM. In January 1999, inhalation of KM was begun, resulting in the disappearance of the bacilli from the sputum and in improvements in chest radiographs. Inhalation of KM could be an effective therapy, with fewer adverse effects, in cases of multidrug-resistant pulmonary tuberculosis.     

A case of tuberculous peritonitis diagnosed by a direct smear of ascitic fluid complicated with an active pulmonary tuberculosis and intestinal tuberculosis

We sometimes encounter difficulties in differentiating tuberculous peritonitis from other inflammatory disorders or ascites due to carcinomatous peritonitis. Acid-fast bacilli are very rarely detected in ascites. In this study, we reported a case of tuberculous peritonitis accompanied with active pulmonary tuberculosis in which acid-fast bacilli were detected in ascites. The patient was a 37-year-old single man who had been admitted to our hospital on February 28, 2000, because acid-fast bacilli were detected in sputum, faces and ascites by a direct smear. He had a lower abdominal distention and pain. His serum CA 125 level was high, 121 U/ml. Abdominal ultrasonography showed marked ascites in Douglas pouch. However adenosine deaminase level was not high in his ascites. During treatment by the combination chemotherapy with INH, RFP, EB, and PZA, serum CA 125 level was decreased.