介入疗法在耐多药肺结核综合治疗中的作用

目的 评价介入疗法在耐多药结核病综合治疗中的作用.方法 2002年1至10月对沈阳市胸科医院等6家医院,心肺功能正常、伴肺部空洞的61例耐多药肺结核患者,在含帕司烟肼、利福喷汀、左旋氧氟沙星、乙胺丁醇、丙硫异烟胺、阿米卡星和克拉霉素化疗方案加母牛分枝杆菌免疫治疗的基础上,进行介入治疗,介入治疗后继续化疗至18个月.结果 介入治疗后3个月痰抗酸菌涂片同时结核分枝杆菌培养阴转率为50.8%(31/61),治疗18个月达83.6%(51/61).X线影像学结果显示,介入治疗后3个月病灶吸收显效率为50.8%(31/61),有效率为93.4%(57/61);治疗18个月显效率达78.7%(48/61),有效率为96.7%(59/61).疗程结束时显效率和有效率分别达78.7%(48/61),96.7%(59/61).经空洞闭合率介入后3个月为21.3%(13/61),治疗18个月达49.2%(30/61).治疗结束时发热、咯血、咳痰、乏力、呼吸困难等症状消失率为73.2%～94.4%.结论 介入疗法对耐多药肺结核具有加速痰细菌学阴转、病灶吸收和空洞闭合的作用,可促进症状改善,提高患者的生活质量.

The effect of interventional therapy in multimodality treatment on multi-drug resistant pulmonary tuberculosis

OBJECTIVE: To evaluate the effect of interventional therapy with antituberculous drug instillation to the lesions in the treatment of multi-drug resistant pulmonary tuberculosis (MDR-PTB) on conventional therapy. METHODS: Sixty-one cases of MDR TB were included from January 2001 to October 2002 in five hospitals. Pasiniazide, rifapentine levofloxacin, ethambutol, ethionamide, amikacin and clarithromycin were used as the basic chemotherapy regimen. In addition, M. vaccac and interventional therapy were used, and chemotherapy was continued for a total of 18 months. RESULTS: The sputum negative conversion rate (including sputum smear and culture) was 50.8% (31/61) after 3 months of interventional therapy. The rate increased to 83.6% (51/61) after 18 months of therapy. Chest X-ray showed that, the foci were markedly absorbed in 50.8% (31/61), and the effective rate was 93.4% (57/61) after 3 months of therapy. The foci were markedly absorbed in 78.7% (48/61) after 18 months of treatment. The effective rate was 96.7%. The rate of cavity closure was 21.3% (13/61) after 3 months of interventional therapy and it increased to 49.2% (30/61) after 18 months of treatment. The rate of symptom disappearance was 73.2%-94.4%, including fever, hemoptysis and dyspnea. CONCLUSION: For the treatment of MDR-TB, interventional therapy is effective in improving sputum negative conversion, lesion absorption and cavity closure.