含利奈唑胺化疗方案治疗重症结核性脑膜炎的效果评价

目的探讨含利奈唑胺化疗方案治疗重症结核性脑膜炎的有效性及安全性。方法收集2018年1-12月重庆市公共卫生医疗救治中心收治的167例结核性脑膜炎患者,其中33例通过英国医学研究理事会(MRC)结核性脑膜炎分级标准判定为重症结核性脑膜炎。按照是否接受利奈唑胺进行抗结核药物治疗将患者分为两组,16例接受了含利奈唑胺的化疗方案,设为观察组;17例接受了不含利奈唑胺的常规化疗方案,设为对照组。比较分析两组患者治疗4周后的体温、格拉斯哥(GCS)评分和脑脊液指标变化情况,同时记录利奈唑胺导致的药物不良反应。采用SPSS 17.0软件对数据进行统计学分析;计量资料呈正态分布时以x±s表示,采用t检验进行比较;呈偏态分布时以中位数(四分位数)[M(Q1,Q3)]表示,采用Wilcoxon秩和检验进行比较;均以P<0.05为差异有统计学意义。结果治疗第7天,观察组平均体温降至(37.83±0.74)℃,明显低于对照组的(38.49±0.87)℃,差异有统计学意义(t=-2.15,P=0.041);治疗第10天,观察组体温恢复正常[(36.99±0.51)℃];对照组于治疗第21天时体温恢复正常[(36.93±0.76)℃]。治疗前,两组患者GCS评分均较低;治疗2周后,观察组GCS评分为(13.06±1.34)分,明显高于对照组的(11.35±1.93)分,差异有统计学意义(t=-2.99,P=0.006);治疗4周后,观察组的GCS评分达到(14.69±0.60)分,接近15分(GCS评分<15分为意识障碍),明显高于对照组的(13.88±1.49)分,差异有统计学意义(t=-2.01,P=0.050)。在脑脊液指标变化方面,治疗前观察组脑脊液葡萄糖/同步血糖比值[0.18(0.05,0.52)]和脑脊液蛋白定量[1.34(0.60,7.81)g/L]与对照组[0.28(0.03,0.52)和1.81(0.60,2.53)g/L]相比,差异均无统计学意义(Z=-0.90,P=0.368;Z=-0.18,P=0.857);治疗4周后,观察组脑脊液葡萄糖/同步血糖比值[0.61(0.17,6.00)]明显高于对照组[0.33(0.06,0.79)],脑脊液蛋白定量[0.87(0.35,5.40)g/L]明显低于对照组[0.97(0.38,3.71)g/L],差异均有统计学意义(Z=-3.35,P=0.001;Z=-3.17,P=0.002)。结论重症结核性脑膜炎患者使用含利奈唑胺的化疗方案,在控制体温、改善GCS评分和改善脑脊液部分指标方面具有优势。

Evaluation of effectiveness of chemotherapy regimens with linezolid in treatment of severe tuberculous meningitis

Objective To explore the efficacy and safety of the chemotherapy regimens with linezolid in the treatment of severe tuberculous meningitis. Methods A total of 167 patients with tuberculous meningitis were treated at the Chongqing Public Health Medical Center from January to December 2018.Among them,33 patients were determined as severe tuberculous meningitis by using the criteria of the Medical Research Council(MRC)of UK.Those severe patients were divided into two groups according to whether they received linezolid for antituberculosis(anti-TB)treatment or not:16 patients received the chemotherapy regimens with linezolid and was called as the observation group;17 patients received the conventional chemotherapy regimens without linezolid and was called as the control group.After 4 weeks treatment,the changes of the patients’ body temperature,Glasgow(GCS)score and the indicators of cerebrospinal fluid in the two groups were compared and analyzed;at the same time,the side-effect of linezolid was also recorded.SPSS 17.0 software was used to carry out data statistical analysis;when the measurable data were in normal distribution,x±swas used to illustrate it and t test was used for comparison;when the measurable data were in skew distribution,median(quartile)(M(Q1,Q3))was used to illustrate it and Wilcoxon rank sum test was used for comparison;the difference was statistically significant with P<0.05. Results On the 7 th day of treatment,the average body temperature of the patients in the observation group decreased to(37.83±0.74)℃,which was significantly lower than that of in the control group(38.49±0.87)℃,the difference was statistically significant(t=-2.15,P=0.041).On the 10 th day of treatment,the body temperature of the patients in the observation group returned to normal((36.99±0.51)℃)while the body temperature of the patients in the control group returned to normal((36.93±0.76)℃)on the 21 st day of treatment.Before treatment,the GCS scores of the patients in the two groups were lower;after 2 weeks treatment,the GCS score of the patients in the observation group was(13.06±1.34)which was significantly higher than that in the control group(11.35±1.93),the difference was statistically significant(t=-2.99,P=0.006);after4 weeks treatment,the GCS score of the patients in the observation group was(14.69±0.60)which was closed to15 scores(GCS score<15 was regarded as consciousness disorder)and significantly higher than that in the control group(13.88±1.49),the difference was statistically significant(t=-2.01,P=0.050).In terms of the changes of CSF indicators,before treatment,the ratio of CSF glucose to synchronized blood glucose was 0.18(0.05,0.52)and the CSF protein quantification was 1.34(0.60,7.81)g/L in the observation group while those values were0.28(0.03,0.52)and 1.81(0.60,2.53)g/L in the control group respectively,there were no significant differences between the two groups(Z=-0.90,P=0.368;Z=-0.18,P=0.857);after 4 weeks treatment,the ratio of CSF glucose to synchronized blood glucose was 0.61(0.17,6.00),which was significantly higher than that in the control group(0.33(0.06,0.79));the CSF protein quantification in the observation group was 0.87(0.35,5.40)g/L which was significantly lower than that in the control group(0.97(0.38,3.71)g/L);the differences were statistically significant(Z=-3.35,P=0.001;Z=-3.17,P=0.002). Conclusion The chemotherapy with linezolid has advantages for the patients with severe tuberculous meningitis on controlling their body temperature,improving GCS score and improving some of cerebrospinal fluid indicators.