含利福布丁方案治疗复治肺结核患者的疗效观察

目的观察含利福布丁方案治疗复治肺结核患者的疗效。方法采用前瞻性队列研究设计，将河南省商丘市结核病防治所2009年9月15日至2010年6月30日期间诊断为复治肺结核的120例患者以数字表法随机将患者分别纳入利福布丁组（60例）和利福平组（60例）进行治疗，比较两组各治疗阶段的痰菌转阴率、病灶吸收情况及空洞闭合率。利福布丁组的化疗方案为：2HBZES/6HBE（B:利福布丁），利福平组为：2HRZES/6HRE。采用SPSS 13.0软件进行整理分析。组间比较用χ²检验，P<0.05为差异有统计学意义。结果2个月末，两组的痰菌转阴率：利福布丁组为48.33%(29/60)，利福平组为30.0%(18/60)，差异有统计学意义(χ²=4.23，P<0.05)。X线胸片显示：利福布丁组与利福平组的显效率分别为21.67%(13/60)和8.33%(5/60)，差异有统计学意义（χ²=4.18，P<0.05)；有效率分别为36.67%(22/60)和18.33%(11/60)，差异有统计学意义(χ²=5.06，P<0.05）。疗程结束时，利福布丁组与利福平组的痰菌转阴率为81.67%(49/60)和61.67%(37/60)，差异有统计学意义(χ²=5.91，P<0.05)。影像学检查结果：利福布丁组和利福平组空洞的闭合率分别为47.92%(23/48)和27.45%(14/51),差异有统计学意义（χ²=4.43，P<0.05）。病灶吸收情况，利福布丁组和利福平组的显效率53.33%(32/60)和35.00%(21/60),差异有统计学意义（χ²=4.09，P<0.05)；有效率分别为 68.33%(41/60)和48.33%(29/60)，差异有统计学意义（χ²=4.94，P<0.05）。结论在联合相同化疗药物时，含利福布丁方案组对于复治涂阳肺结核患者的疗效优于含利福平方案组，具有较好的临床疗效。

Observation of therapeutic effect of rifabutin on retreatment smear-positive pulmonary tuberculosis

Objective To learn the therapeutic effect of rifabutin on retreatment smear-positive pulmonary tuberculosis. Methods This was a prospective cohort study. One hundred and twenty retreatment pulmonary tuberculosis（PTB）inpatients registered from September 15,2009 to June 30,2010 in Shangqiu Research Institute for Tuberculosis Control and Prevention were selected and divided into 2 groups randomly. One group（60 cases）were treated with the regimen 2HBZES/6HBE（B： rifabutin）, and the other group（60 cases）were treated with the regimen 2HRZES/6HRE. The sputum conversion rates, changes of lesion absorption and cavity closure rates were compared between the two groups. SPSS 13.0 software was used for data sorting and analysis. Chi-square test was applied for comparison. A P-value of 0. 05 was used to signify statistical significance. Results At the end of 2 months of treatment,the sputum conversion rate was 48. 33% （29/60）for rifabutin group and 30.0%（18/60）for rifmpicin group, and the difference was statistical significant（χ^2 = 4.23, P〈0. 05）. According to the results of chest X-ray, the efficiency rate of rifabutin group （ 21.67 % （ 13/60 ） ） was significantly higher than rifampicin group 8. 33 % （ 5/60 ） （χ^2 = 4. 18, P〈0. 05）, and the effective rates were 36.67 % （22/60） and 18.33 %/ （11/60） respectively, with significant difference（χ^2= 5.06, P〈0. 05）. The sputum conversion rates at the end of treatment in the 2 groups were 81.67 %/ （49/60） and 61.67 % （37/60） respectively, and the difference was significant（χ^2= 5.91, P〈0.05）. The radiographic outcomes showed that the cavity closure rate of Rifabutin group 47.92% （23/48））was significantly higher than rifampicin group（27.45%（14/51））（Z2= 4. 43, P〈0.05）. For the changes of lesion absorption, the efficiency rates were 53. 33%（32/60）and 35.00% （21/60）, respectively,with significant difference（x2 =4. 09 ,P〈0. 05）. The effective rate of rifabutin group（68. 33% （41/60））was significantly higher than rifampicin group（48. 33 % （29/60））（χ^2 = 4.94,P〈0. 05）. Conclusion The regimen with rifabutin has better clinical therapeutic effect on retreatment pulmonary tuberculosis.