含利福布汀方案联合微卡治疗复治涂阳肺结核疗效观察

目的观察含利福布汀方案联合微卡(注射用母牛分枝杆菌)治疗复治涂阳肺结核的临床疗效及不良反应。方法连续纳入67例抗酸杆菌阳性复治肺结核病人,随机分为三组:Ⅰ组采用3L2PaVEThAK/6L2PaVETh/9L2PaVE方案,Ⅱ组采用3BPaVEThAK/6BPaVETh/9BPaVE方案;Ⅲ组在Ⅱ组方案的基础上加用微卡22.50μg,强化期每周一次深部肌肉注射,继续期每两周一次深部肌肉注射。结果治疗3、6、9个月后,Ⅰ组痰菌阴转率为40.9%、59.0%、63.6%,治疗3个月胸片或肺CT病灶吸收率为22.7%,空洞吸收率为13.6%;Ⅱ组痰菌转阴率为68.2%、77.3%、86.4%,病灶吸收率36.4%,Ⅲ组痰菌转阴率为86.9%、95.7%、100%,病灶吸收率分别为47.8%,空洞吸收率30.4%。利福布汀的不良反应与抗结核药物中常见的副作用一致。结论使用利福布汀联合微卡治疗可以进一步提高复治涂阳肺结核患者的痰菌阴转率、胸片或肺CT病灶吸收率、空洞吸收率,提高疗效。

Observation of therapeutic effect of a regimen containing rifabutin combined with mycobacterium vaccae in the treatment of retreated smear positive pulmonary tuberculosis

Objective To observe the therapeutic effects and adverse reactions of a regimen containing rifabutin combined with mycobacterium vaccae for injection in the treatment of retreated smear positive pulmonary tuberculosis.Methods A total of 67 retreated smear positive pulmonary tuberculosis patients were randomly divided into three groups.Cases in group A(n=22) were treated by a regimen of 3L2PaVEThAK/6L2PaVETh/9L2PaVE;cases in group B(n=22) were treated by a regimen of 3BPaVEThAK/6BPaVETh/9BpaVE;cases in group C(n=23) were treated by the same regimen of group B in addition with 22.50ug of mycobacterium vaccae for injection.In the intensive phase,they were given a deep intramuscular injection once a week.In the continuation phase,they were given a deep intramuscular injection every two weeks.Results The sputum negative conversion rates at the end of 3,6,9 th month were 40.9%,59.0%,63.6% for group A;68.2%,77.3%,86.4% for group B;86.9%,95.7%,100% for group C.The rates of focus absoption in chest radiograph or CT were 22.7%,36.4%,47.8%.The rates of cavity absorption were 13.6%,27.3%,30.4%.Adverse reactions of rifabutin were common side effects of antituberculotic.Conclusion Compared with conventional antituberculous drug,rifabutin combined with mycobacterium vaccae for injection in the treatment of retreated smear positive pulmonary tuberculosis can achieve good results in the sputum negative conversion rate,the rate of focus absorption and cavity absorption in chest radiograph or CT,and clinical efficacy.It has little side effect.It is worth being recommended for a wider use in clinical practice.