2023 年第 10 期 第 18 卷

延长短程治疗时间的抗结核方案对首次复治菌阳肺结核合并糖尿病患者的临床疗效及安全性

Clinical efficacy and safety of anti-tuberculosis regimen with prolonging the duration of short-term treatment for first retreatment bacterial positive pulmonary tuberculosis patients with diabetes mellitus

作者：王玉红董雅坤刘丽景王智慧李晓倩杨帆李梅

英文作者：Wang Yuhong Dong Yakun Liu Lijing Wang Zhihui Li Xiaoqian Yang Fan Li Mei

单位：河北省胸科医院结核内二科，石家庄050041

英文单位：Second Department of Tuberculosis Hebei Chest Hospital Shijiazhuang 050041 China

关键词：肺结核；糖尿病；复治；抗结核短程方案

英文关键词：Pulmonarytuberculosis;Diabetesmellitus;Retreatment;Shorttermanti-tuberculosisregimen

• 摘要：

• 目的  探讨延长短程治疗时间的抗结核方案［8MfxRfb(Rft)PaZE，莫西沙星（Mfx）、利福布汀（Rfb）、利福喷汀（Rft）、对氨基水杨酸异烟肼（Pa）、吡嗪酰胺（Z）、乙胺丁醇（E）］对首次复治菌阳肺结核合并糖尿病患者临床疗效及安全性。方法  选取河北省胸科医院2019年7月至2021年7月收治的首次复治菌阳肺结核合并糖尿病患者50例作为研究对象。采用随机数字表法分为观察组和对照组，各25例。观察组采用8MfxRfb(Rft)PaZE治疗方案，对照组采用2HREZ/6HRE［异烟肼（H）、利福平（R）、E、Z］治疗方案。比较2组治疗前、疗程结束后肺功能变化，观察2组疗程结束后胸部CT病灶范围、痰菌转阴率、转归、不良反应及复发情况。结果  2组疗程结束后观察组第1秒用力呼气容积占预计值百分比、用力肺活量占预计值百分比及最大呼气流量占预计值百分比均高于治疗前，且观察组高于对照组［（88±15）%比（76±14）%、（89±16）%比（80±15）%、（45±13）%比（31±11）%］，差异均有统计学意义（均P＜0.05）。2组病灶吸收、空洞闭合、痰涂片转阴率、痰培养转阴率、治疗成功率、总不良反应发生率差异均无统计学意义（均P＞0.05）。观察组复发率低于对照组［4.8%（1/21）比38.9%（7/18）］（P＜0.05）。结论  8MfxRfb(Rft)PaZE抗结核方案可以改善首次复治菌阳肺结核合并糖尿病患者的呼吸功能，降低复发率，具有较好的临床疗效、且安全性良好。

• Objective  To explore the clinical efficacy and safety of anti-tuberculosis regimen with prolonging the duration of short-term treatment［8MfxRfb(Rft)PaZE, moxifloxacin(Mfx), rifapentine(Rfb), rifapentine(Rft), isoniazid p-aminosalicylate(Pa), pyrazinamide(Z), ethambutol(E)］ in the treatment for first retreatment bacterial positive pulmonary tuberculosis patients with diabetes mellitus. Methods  Totally 50 cases of first retreated bacterial positive pulmonary tuberculosis patients with diabetes mellitus admitted to Hebei Chest Hospital from July 2019 to July 2021 were selected as research subjects. They were randomly divided into observation group and control group, with 25 cases in each group. The observation group was treated with 8MfxRfb(Rft)PaZE, and the control group was treated with 2HREZ/6HRE［isoniazid(H), rifampicin(R), E, Z］. The changes of lung function before and after treatment were compared; the range of chest CT lesions, sputum negative conversion rate, prognosis, adverse reactions and recurrence rate were observed after treatment in the two groups. Results  The percentage of forced expiratory volume in the first second(FEV1%), percentage of forced vital capacity(FVC%), and percentage of maximum expiratory flow(PEF%) after treatment in both groups were higher than those before treatment, and the observation group was significantly higher than the control group［(88±15)% vs (76±14)%, (89±16)% vs (80±15)%, (45±13)% vs (31±11)%］, with significant differences(all P<0.05). There were no significant differences between the two groups in focus absorption, cavity closure, sputum smear negative conversion rate, sputum culture negative conversion rate, successful conversion rate and total adverse reaction rate(all P>0.05). The recurrence rate in the observation group was lower than that in the control group［4.8%（1/21） vs 38.9%（7/18）］(P<0.05). Conclusion  8MfxRfb(Rft)PaZE anti-tuberculosis regimen can improve the respiratory function of the first retreated bacterial positive pulmonary tuberculosis patients with diabetes mellitus, and reduce the recurrence rate, which has good clinical effect, and the safety is good.