耐多药及广泛耐药结核病的临床治疗策略

耐多药结核病(MDR-TB)和广泛耐药结核病(XDR-TB)通常被认为具有很高的死亡率,但如药物选择得当,联合治疗方案设计合理,其中的许多病例是能够治愈的.本文依据现有抗TB药物的疗效、安全性和治疗费用等分组(5组)探讨了它们在这些难治性TB推荐方案(由4种或以上对结核杆菌分离株可能敏感的药物组成)中的选用原则.其中,...     

耐多药及广泛耐药结核病的临床治疗策略

耐多药和广泛耐药结核病的病死率较高,在临床治疗时如果合理选择药物和设计联合治疗方案,大部分病例都能得到有效治疗。本研究根据现有抗结核病药物的疗效、安全性以及治疗费用等进行分组,讨论了耐多药及广泛耐药结核病的临床治疗策略。     

耐多药结核病和严重耐多药结核病治疗进展

20世纪末以来,由于耐药菌株的产生和治疗的不合理等多种原因,耐多药结核病和严重耐多药结核病的发生率不断升高,使得结核病重新成为临床治疗的大问题。大多数情况下,只要合理选择和联用现有的抗结核药物,耐多药结核病和严重耐多药结核病是可以治愈的。本文总结临床常用的一些抗结核药物在治疗耐多药结核病和严重耐多药结核病时推荐的用法和治疗方案,以及为避免长期使用抗生素所致二重感染的中药治疗方法。同时在制定治疗方案时应充分考虑药敏试验结果、长期用药的安全性和有效性,联合用药的原则,进行规律、全程的治疗,就可减少耐多药结核病和严重耐多药结核病的病死率。     

耐多药结核病耐药原因及用药

耐多药结核病（MDR-TB）指患者至少对异烟肼（INHH）和利福平（RFPR）两种以上药物产生耐药的结核患者。MDR-TB往往发生在经标准短化方案和复活方案反复治疗失败的患者。MDR—TB大多见于复治结核病患者,其耐药品种及具体情况不尽相同,故治疗方案必须相对个性化。     

耐药结核病

世界卫生组织(WHO)于1993年史无前例地宣布：全球结核病紧急状态。随着全球结核病流行的加剧，1998年又重申：遏制结核病毒行动刻不容缓。中国是全球22个结核病高负担国家之一，结核病人数位居世界第二，仅次于印度。耐多药结核病的增加，是结核病疫情上升的主要原因及新世纪结核病控制面临的严峻挑战之一。我国属结核病高耐药国家，其中耐多药结核病的情况更为严重。耐多药结核病的形     

多药耐药结核病死亡相关风险因素的文献回顾性分析

目的：调查分析多药耐药结核病（multidrug-resistant tuberculosis,MDR-TB）患者死亡相关风险因素及影响,为临床防治提供参考。方法：检索PubMed/Medline、OVID、中国知网（CNKI）、万方医学网及维普中文期刊（VIP）等数据库中有关MDR-TB患者死亡相关风险因素的临床病例对照研究或回顾性队列分析,时间为2000年1月至2019年11月;对患者一般社会人口学特征、生活方式因素、合并躯体疾病等因素进行计量统计学分析。结果：获12篇文献,质量推荐等级A级3篇,B级8篇,C级1篇;涉及8个国家MDR-TB患者,共计62 665例,其中包括23项风险因素测评。死亡风险构成分布显示,在社会人口学资料方面：男性略高于女性（59.83%vs 40.17%）,老年人（≥60岁）（51.05%）,工人（矿工）（42.12%）,低学历（学习时间≤6年）（45.09%）,低收入（≤2 000元）（43.84%）均风险占比较高;在生活方式方面：吸烟、饮酒均有较大影响,体质量偏轻结核病患者,或多次治疗、中断治疗后死亡风险也会增加;合并躯体疾病的影响方面：癌症（80.22%）,C-反应蛋白升高（69.05%）、糖尿病（40.88%）为风险占比较高的前三名。结论：MDR-TB有广泛性、高死亡率特点,老年人、工作环境差、饮食不良、治疗不规范、合并多种躯体疾病的MDR-TB患者为死亡高危人群,临床治疗时宜对该类人群进行重点医学教育和干预。     

微孔药敏检测法检测耐多药结核病 33例耐药分析

目的 探讨MicroDSTTM(微孔药敏检测法)微孔板法检测结核分枝杆菌的耐药情况分析.方法 用MicroDSTTM微孔板法对贵阳市公共卫生救治中心2018年1月至2019年11月期间部分用比例法药敏试验随机筛选的33例耐多药结核病(MDR-TB)阳性菌株进行16种抗结核药药物敏感性检测.结果 异烟肼、利福平耐药率与比例法比较符合率为97.0％(32/33)、93.9％(31/33);对16种药总耐药率33％(174/528);一线总耐药率70.5(93/132)、二线总耐药率20.5(81/396).结论 微孔板法检测的MDR-TB病人筛选率与比例法具有较高符合率、且本地区MDR-TB病人的耐药情况较严重,应加强药物监测,选择有效药物化疗,而MicroDSTTM微孔板法的推广使用有利于MDR-TB诊断和药物筛选.     

脂质体逆转肿瘤多药耐药研究进展

本文就肿瘤细胞多药耐药机理、脂质体的一般特点、脂质体逆转肿瘤细胞多药耐药的机理以及近年来脂质体应用于逆转肿瘤细胞多药耐药的研究进行综述。     

耐多药结核病的治疗

［摘要］耐药结核病尤其是耐多药结核病（MDR TB）已成为结核病控制工作的严重挑战,如何有效控制已成为全球结核病控制面临的紧迫任务。随着MDR TB的增多,艾滋病和结核病双重感染也不断出现,对这些患者即便采用有效的抗结核化学治疗（化疗）有时也难以控制其进展,为此以化疗为中心的,辅以免疫制剂、外科手术和介入治疗的综合治疗已成为治疗MDR TB的重要策略。由于耐药结核病的产生主要是由于不规律治疗、不合理用药等人为因素所致,故大部分耐药结核是可预防的,关键是如何对治疗进行规范化实施与管理,如何更好地贯彻全程督导化疗（DOTS）和DOTS Plus。     

多药耐药基因1甲基化与多药耐药及逆转的研究进展

近年来,新的化疗药物应用于肿瘤的临床治疗,大大提高了化疗疗效。然而,对大多数的肿瘤患者来说,化疗仍然是一种姑息的治疗方法。肿瘤细胞对抗肿瘤药物产生的多药耐药性（MDR）严重地影响了化疗的有效率。其中对于由多药耐药基因1（mdrl）基因编码的P-糖蛋白（P-gp）介导的MDR研究最早也较多。mdrl基因的过表达是肿瘤预后的不良因素之一,它参与了大多数肿瘤的耐药机制。     

罗红霉素治疗耐多药肺结核病的疗效分析

目的 观察和评价罗红霉素缓释胶囊联合其它抗结核药物治疗耐多药肺结核病( MDR-PTB)的疗效.方法 选择我院住院的MDR-PTB患者120例做为研究对象,将其随机分为治疗组60例和对照组60例;对照组采用司帕沙星、丁氨卡那霉素及其他三种抗结核药物作为抗痨方案,治疗组在对照组基础上添加罗红霉素缓释胶囊,疗程12个月;观察两组转阴率和疗效.结果 第3个月末,治疗组痰菌转阴率为64％,对照组为42％,两组对比差异有统计学意义(x2=5.52,P＜0.05).疗程结束时,治疗组痰菌转阴率为91％,对照组为72％,两组比较差异有统计学意义(x2=6.62,P＜0.01);治疗组病灶吸收显效率为89％,对照组为70％,两组对比差异有统计学意义(x2=6.14,P＜0.05).结论 罗红霉素缓释胶囊联合其它抗结核药物治疗MDR-PTB疗效肯定,对促进痰菌阴转、病灶吸收、空洞闭合有显著作用.     

Treatment and prevention of multidrug-resistant tuberculosis.

Multidrug-resistant tuberculosis (MDRTB), which is defined as combined resistance to isoniazid and rifampicin, is a 'man-made' disease that is caused by improper treatment, inadequate drug supplies or poor patient supervision. Patients with MDRTB face chronic disability and death, and represent an infectious hazard for the community. Cure rates of 96% have been achieved but require prompt recognition of the disease, rapid accurate susceptibility results, and early administration of an individualised re-treatment regimen. Such regimens are usually based on a quinolone and an injectable agent (i.e. an aminoglycoside or capreomycin) supplemented by other 'second-line' drugs. This therapy is prolonged (e.g. 24 months), expensive, and has multiple adverse effects. Prevention of MDRTB is therefore of paramount importance. The World Health Organization (WHO) has recommended a multifaceted programme, known by the acronym DOTS (directly observed therapy, short-course), that promotes effective treatment of drug-susceptible TB as the prime method of limiting drug resistance. DOTS was part of a successful MDRTB control programme in New York City, which also included treatment of prevalent MDRTB cases, streamlined laboratory testing, effective infection control procedures and wider application of screening and preventive therapy (although the optimal chemotherapy for MDRTB infection remains undefined). Industrialised countries have the resources to treat patients with MDRTB and to mount these extensive control programmes. Unfortunately, MDRTB is also prevalent in Asia, South America and the former Soviet Union. First world countries have a vested interest, as well as a moral responsibility, to assist in controlling MDRTB in these 'hot spots'.     

耐多药结核病化疗药物的基本选择

耐多药结核病(MDR-TB)指的是致病结核菌至少同时耐异烟肼(INH)和利福平(RFP)。据报道,全世界约有三分之二的结核病人处于发生耐多药结核病的危险之中;我国耐多药结核病的流行也相当严重,截止2000年初始,获得耐多药率仍分别高达7.6％和17.1％。耐多药结核病已成为结核病控制中急待解决的问题。迄今为止,MDR-TB的化学治疗仍处于一个投入与产出明显不成比例的状态,表现为高治疗费用、高不良反应、长程治疗和低治疗效果,需要进一步积累经验和研究新的药物。本文根据近期相关的研究进展,就耐多药结核病化疗药物的基本选择向读者作一专题介绍,供各位同道在临床实践中参考。     

莫西沙星在耐多药肺结核治疗中的应用

目的：探讨莫西沙星在耐多药肺结核患者治疗中的应用价值。方法96例耐多药肺结核患者按治疗方法分为两组,观察组48例,在联合治疗中应用莫西沙星;对照组48例,在联合治疗中应用左氧氟沙星,共治疗12个月。治疗后第3、6、12个月进行痰涂片检查,观察不良反应。治疗前后测定血清血管活性肠肽（VIP）水平。结果观察组在治疗后3个月、6个月、12个月的痰菌转阴率分别为36．0％、87．5％、95．8％,对照组分别为62．5％、77．1％、83．3％,观察组痰菌转阴率均明显高于对照组（χ2＝5．12、5．96、7．28,均P＜0.05）。治疗后对照组总有效率为83．3％,观察组总有效率为95．8％,观察组总有效率明显高于对照组（χ2＝5．28,P＜0．05）。两组在治疗后血清VIP分别为（29．3±6．7）ng/L、（20．7±5．4）ng/L,均较治疗前明显降低,与对照组治疗后比较,观察组降低更明显（t＝3．01,P＜0．05）。用药期间,两组白细胞减少、胃肠道反应、肝功能损害及神经系统症状等不良反应发生率差异均无统计学意义（χ2＝1．56、1．74、2．02、0．00,均P＞0．05）。结论莫西沙星治疗耐多药肺结核效果优于左氧氟沙星。     

Activity of linezolid-containing regimens against multidrug-resistant tuberculosis in mice

The objective of the present study was to compare the activities of regimens containing linezolid (LZD) with those not containing LZD against Mycobacterium tuberculosis infection in mice. The three regimens excluding LZD selected in this study are often used in practice against multidrug-resistant tuberculosis (MDR-TB). When LZD was added to these MDR-TB regimens, the combinations were significantly more active after 2 months of therapy with regard to lung CFU reductions. The activity of LZD-containing regimens was greater than the World Health Organization's standard first-line regimen of rifampicin + isoniazid + pyrazinamide. In particular, when LZD was included in the combination levofloxacin + amikacin + para-aminosalicylic acid + pyrazinamide + clofazimine, culture negativity of the lungs was reached after 2 months of treatment in every case. In addition, the serum levels of interleukin-10 and interferon-γ of mice were determined and were found not to be surrogate markers of bacterial clearance.     

Coexistence of pancreatic tuberculosis with systemic brucellosis: a case report

Isolated pancreatic tuberculosis is an extremely rare clinical entity and is difficult to diagnose particularly in immunocompetent individuals. Clinical findings and symptomatology of brucellosis are often similar to tuberculosis thus making the differentiation amongst the two entities difficult. We report a case of pancreatic tuberculosis with systemic brucellosis in a 29 year old veterinarian who presented with epigastric pain and loss of appetite. Initial investigations revealed leukocytosis with moderately elevated transaminase, gamma glutamyl transferase, amylase and lipase levels. Imaging studies revealed an anechoic multiloculated cyst in the body and tail of the pancreas. Given the patient’s occupational risk coupled with the presence of a positive Brucella agglutination test (with a titer of 1:320); a diagnosis of pancreatitis secondary to brucellosis was given. In addition to standard pancreatitis therapy of bowel rest with intravenous fluid/electrolyte replacement, anti-brucellosis therapy was also administered. The patient’s initial response to therapy was positive however, 6 weeks into therapy, his abdominal pain recurred and repeat CT scan revealed the development of a pseudocyst in the pancreas. After failing a second attempt at conservative supportive therapy, the patient underwent an explorative laparotomy. Histological examination of the resected pancreatic specimen showed necrosis and was positive for tuberculosis by polymerase chain reaction. Herein, we describe the first case reported in the medical literature of the coexistence of systemic brucellosis with pancreatic tuberculosis. We suggest that the possibility of the coexistence of brucellosis with tuberculosis be kept in mind when assessing pancreatitis patients in endemic regions and in individuals with occupational risk hazards.