结核性脑膜炎患者脑脊液中异烟肼浓度与疗效的相关研究

发布时间：2018-02-13 11:38

本文关键词： 结核性脑膜炎异烟肼鞘内注射不同剂量疗效　出处：《重庆医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：研究给予不同剂量的异烟肼（Isoniazid，INH）和鞘内注射异烟肼治疗后在结核性脑膜炎（Tuberculous meningitis，TBM）患者脑脊液（cerebrospinal fluid，CSF）中INH的浓度差异，及不同剂量、不同用药途径与临床疗效和不良反应的相关性。方法：将50例患者中未使用异烟肼鞘内注射的41例患者分别给予异烟肼300mg/d（300mg组11例）、600mg/d（600mg组10例）、900mg/d（900mg组20例）治疗，再根据是否进行鞘内注射异烟肼将使用异烟肼600mg治疗的19例患者患者分为鞘内注射组9例及非鞘内注射组10例。所有患者同时给予其他抗结核药物治疗。收集所有患者脑脊液标本，采用高效液相色谱法（High performance liquid chromatogram，HPLC）测定脑脊液中异烟肼的含量，并分析各组的疗效及不良反应。结果：300mg组、600mg组、900mg组脑脊液异烟肼浓度差异有统计学意义（P＜0.05），其中900mg组和600mg组中伴有神经系统损害患者的临床疗效差异无统计学意义（P＞0.05），在治疗前后脑脊液压力和蛋白变化方面900mg组差异有显著统计学意义（P＜0.01），600mg组差异无统计学意义（P＞0.05），鞘内注射组有显著统计学意义（P＜0.01），而非鞘内注射组差异无统计学意义（P＞0.05）。900mg组脑脊液好转率为88.2%，600mg组好转率为70%，两组相比差异无统计学意义（P＞0.05）。900mg组的患者不良反应发生率为70%，600mg组不良反应发生率30%，差异具有统计学意义（P＜0.05）。鞘内注射组与非鞘内注射组脑脊液中异烟肼浓度差异无统计学意义（P＞0.05），鞘内注射组与非鞘内注射组的临床疗效和脑脊液好转率相比均有统计学意义（P＜0.05）。结论：异烟肼的剂量越高，在脑脊液中的药物浓度越高，更有利于脑脊液指标的恢复，但是不同剂量异烟肼的临床治疗效果及脑脊液好转率并无差异。而增加异烟肼的剂量，相对的也增加了其不良反应的发生率。使用鞘内注射对于脑脊液中异烟肼浓度的增加效果不明显，，但临床疗效及脑脊液指标的好转均优于未使用鞘内注射的患者。
[Abstract]:Objective: to study the difference of INH concentration in cerebrospinal fluid (CSF) of patients with tuberculous meningitis treated with different doses of isoniazidine (Isoniazididine) and intrathecal injection of isoniazidine (isoniazidine) and different doses of isoniazid in cerebrospinal fluid (CSF) of patients with tuberculous meningitis (TBM). The correlation between different ways of drug use and clinical efficacy and adverse reactions. Methods: Forty-one of 50 patients without intrathecal injection of isoniazid were treated with isoniazid 300mg / dc300mg group (n = 11, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10). According to the intrathecal injection of isoniazid, 19 patients who were treated with isoniazid 600mg were divided into intrathecal injection group (n = 9) and non-intrathecal injection group (n = 10). All patients were treated with other anti-tuberculosis drugs at the same time. There are cerebrospinal fluid samples from patients, The content of isoniazid in cerebrospinal fluid (CSF) was determined by high performance liquid chromatography (performance liquid chromatogramme HPLC), and the curative effect and adverse reaction of each group were analyzed. Results there was significant difference in CSF isoniazid concentration between the two groups (P < 0.05). There was no significant difference in the clinical effect between 900mg group and 600mg group with nervous system damage (P > 0.05). Before and after treatment, cerebrospinal fluid pressure and egg were not significantly different (P > 0.05). There was significant difference in white changes in 900mg group (P < 0.01). There was no significant difference (P > 0.05) in the 600mg group. There was significant difference in the intrathecal injection group (P < 0.01), but there was no significant difference in the non-intrathecal injection group (P > 0.05). The cerebrospinal fluid improvement rate in the non-intrathecal injection group was 88.22600 mg group and that in the non-intrathecal injection group was 88.22600mg group. There was no significant difference in the incidence of side effects between the two groups (P > 0.05, P > 0.050.900 mg). The incidence of adverse reactions in the 70,600mg group was 30. The difference was statistically significant (P < 0.05). The difference in the concentration of isoniazid in cerebrospinal fluid between the intrathecal injection group and the non-intrathecal injection group was significant (P < 0.05). There was no statistical significance (P > 0.05). The clinical efficacy and cerebrospinal fluid improvement rate of intrathecal injection group and non-intrathecal injection group were significantly higher than that of non-intrathecal injection group (P < 0.05). Conclusion: the higher the dosage of isoniazid, the higher the concentration of isoniazid in cerebrospinal fluid, which is more favorable to the recovery of cerebrospinal fluid index, but there is no difference in clinical treatment effect and CSF improvement rate between different doses of isoniazid, but increase the dose of isoniazid, and increase the dosage of isoniazid. The effect of intrathecal injection on the concentration of isoniazid in cerebrospinal fluid was not obvious, but the clinical efficacy and the improvement of cerebrospinal fluid index were better than those without intrathecal injection.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R529.3

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