首次复治肺结核患者采用短程化疗方案的疗效评价

目的 探讨采用短程化疗方案治疗首次复治肺结核的疗效、依从性及不良反应情况,为临床诊治提供依据。方法 收集2018年6月至2021年3月在安徽省胸科医院就诊的符合条件的首次复治肺结核患者101例,采用随机数字表法将患者分为两组,分别为短疗程方案组(73例,采用6个月莫西沙星、利福布汀、对氨基水杨酸异烟肼、吡嗪酰胺、乙胺丁醇)和标准方案组(28例,强化期3个月使用异烟肼、利福平、吡嗪酰胺、乙胺丁醇,巩固期6个月使用异烟肼、利福平、乙胺丁醇),比较两组患者2个月痰菌阴转率、治疗转归情况、影像学病灶吸收率及不良反应发生情况。结果 短疗程方案组2个月痰菌阴转率为69.0%(29/42),高于标准方案组[41.2%(7/17)],差异有统计学意义(χ²=3.952,P=0.047)。短疗程方案组治疗成功率为78.1%(57/73),高于标准方案组[60.7%(17/28)],差异有统计学意义(Fisher确切概率法,P=0.039)。短疗程方案组病灶吸收情况[57例治疗成功患者中,病灶全吸4例(7.0%),显吸24例(42.1%),吸收29例(50.9%),不变0例(0.0%),恶化0例(0.0%)] 明显好于标准方案组[17例治疗成功患者中,病灶全吸0例(0.0%),显吸3例(17.6%),吸收13例(76.5%),不变1例(5.9%),恶化0例(0.0%)],两组之间差异有统计学意义(Fisher确切概率法,P=0.046)。短疗程方案组不良反应发生率为11.0%(8/73),标准方案组不良反应发生率为14.3%(4/28),差异无统计学意义(χ²=0.014,P=0.905)。结论 在首次复治肺结核患者的治疗过程中,短疗程方案组患者相较于标准方案组患者具有更高的治疗依从性,且短疗程方案有助于痰菌阴转和病灶吸收,能够明显缩短治疗时间并提高疗效。

Efficacy evaluation of short-course chemotherapy in patients with retreated pulmonary tuberculosis for the first time

Objective To investigate the efficacy, compliance and adverse reactions of short-course chemotherapy in the patients with retreated pulmonary tuberculosis for the first time, and to provide evidence for clinical diagnosis and treatment. Methods A total of 101 eligible retreated tuberculosis patients admitted to Anhui Chest Hospital from June 2018 to March 2021 were enrolled and randomly divided into two groups. The short-course regimen group (73 cases) was given moxifloxacin, rifambutin, isoniazid aminosalicylate, pyrazinamide and ethambutol for 6 months, and the 28 patients in standard treatment group were treated with isoniazid, rifampicin, pyrazinamide and ethambutol for 3 months during the intensive phase, and isoniazid, rifampicin and ethambutol for 6 months during the continuation period. The 2-month sputum conversion rate, treatment success rate, imaging focus absorption rate and adverse reactions were compared between the two groups. Results The 2 month sputum negative conversion rate (69.0%, 29/42) in short-course regimen group was higher than that in standard regimen group (41.2%, 7/17), the difference was statistically significant (χ²=3.952, P=0.047).The treatment success rate of the short-course regimen group was 78.1% (57/73), which was higher than that of the standard regimen group (60.7%, 17/28), the difference was statistically significant (Fisher’s test, P=0.039). The absorption of the lesions in the short-course regimen group was significantly better than that in the standard control group. In the short-course regimen group, there were 4 cases of total absorption (7.0%), 24 cases of obvious absorption (42.1%), 29 cases of absorption (50.9%), 0 case of constant absorption (0.0%), and 0 case of deterioration (0.0%). In the standard treatment group, there were 0 case of total absorption (0.0%), 3 cases of obvious absorption (17.6%), 13 cases of absorption (76.5%), 1 case of constant absorption (5.9%), and 0 case of deterioration (0.0%), and there was a significant difference between the two groups (Fisher’s test, P=0.046). The incidence of adverse reactions was 11.0% (8/73) in the short-course regimen group and 14.3% (4/28) in the standard course group, with no significant difference (χ²=0.014, P=0.905). Conclusion In the treatment process of the first retreatment of pulmonary tuberculosis patients, patients in the short-course regimen group have higher compliance compared with the standard regimen group, and the short-course regimen is conducive to sputum negative conversion and lesion absorption, and could significantly shorten the treatment time and improve the efficacy.