含头孢西丁药物方案治疗龟-脓肿分枝杆菌肺病的近期效果

发布时间：2019-03-06 07:57

【摘要】：目的评价含头孢西丁(CXT)药物方案治疗龟-脓肿分枝杆菌肺病患者的近期效果和安全性。方法 43例确诊的资料完整的龟-脓肿分枝杆菌肺病患者,全部患者根据就诊的先后次序随机选择分为观察组20例和对照组23例,对照组为以克拉霉素(CTM)+阿米卡星(AMK)为核心的传统治疗方案;观察组为以CTM+AMK联合CXT组合成个体化治疗方案,比较两组的近期治疗效果并观察不良反应。结果 (1)共入选43例龟-脓肿分枝杆菌肺病患者,MIC方法药物敏感性检测显示AMK、TOB、CTM、CXT、LZD有较低的耐药率。(2)35例完成疗程的患者中,CXT组14例,年龄28~71(55.7±12.3)岁;对照组21例,年龄21~73(53.5±15.5)岁。两组患者在年龄、性别、病变范围、空洞数量和耐药结果分布等方面比较差异无统计学意义(P0.05),具有可比性。其中8例(18.6%)患者因为药物不良反应而退组,观察组的退组率30.0%(6/20),明显高于对照组的8.7%(2/23)。(3)细菌学改变:治疗9个月后观察组与对照组的阴转率分别为57.1%、38.1%(醊2=1.228,P=0.268)。(4)影像学改变:观察组与对照组的病变吸收率均为57.1%(醊2=0.000,P=1.000);空洞吸收有效率分别为54.5%、47.4%(醊2=0.007,P=0.934)。(5)治疗2周后,观察组与对照组发热、咳嗽、咳痰、痰中带血等症状均得到明显改善。(6)完成疗程的患者中不良反应发生率:观察组有11例(78.6%)、对照组有11例(52.4%)(醊2=2.468,P=0.116)。结论含CXT药物方案治疗龟-脓肿分枝杆菌肺病患者,疗效优于以AMK+CTM为核心的治疗方案,但有较高的药物不良反应发生率,调整合理的疗程与用药剂量能有较好的安全性,更好的治疗依从性。
[Abstract]:Objective to evaluate the short-term efficacy and safety of cefoxitin-containing (CXT) regimen in the treatment of Mycobacterium abscess pulmonary disease. Methods 43 patients with mycobacterium abscess lung disease were randomly divided into observation group (n = 20) and control group (n = 23) according to the order of their visits, and all patients were divided into observation group (n = 20) and control group (n = 23). The control group was treated with clarithromycin (CTM) and amikacin (AMK) as the core. The patients in the observation group were treated with CTM AMK combined with CXT. The short-term effects of the two groups were compared and the adverse reactions were observed. Results (1) A total of 43 patients with Mycobacterium abscessus pulmonary disease were enrolled in the study. The drug sensitivity test of MIC method showed that AMK,TOB,CTM,CXT,LZD had a low drug resistance rate. (2) of the 35 patients who had completed the course of treatment, 14 patients in the CXT group, 14 patients in the CXT group, and 14 patients in the CXT group. The age was 28 / 71 (55.7 卤12.3) years old; In the control group, 21 cases were 21 years old (53.5 卤15.5) years old. There was no significant difference in age, sex, lesion scope, cavity number and drug resistance distribution between the two groups (P0.05). Among them, 8 patients (18.6%) left the group due to adverse drug reactions, and the rate of withdrawal in the observation group was 30.0% (6 / 20). It was significantly higher than 8.7% (2? 23). (3) bacteriological changes in the control group: after 9 months of treatment, the negative conversion rates of the observation group and the control group were 57.1% and 38.1% respectively. Imaging changes: the absorption rate of the lesions in the observation group and the control group was 57.1% (P < 0.05). (P < 0.05, P < 0.01). The effective rates of cavity absorption were 54.5% and 47.4%, respectively. After 2 weeks of treatment, the observation group and the control group had fever, cough and expectoration. (6) there were 11 cases (78.6%) in the observation group and 11 cases (52.4%) in the control group. (6) the incidence of adverse reactions in the patients who completed the course of treatment: 11 cases (52.4%) in the observation group and 11 cases (52.4%) in the control group (P = 0.116). Conclusion the therapeutic effect of CXT-containing drug regimen on patients with Mycobacterium abscess pulmonary disease is better than that of AMK CTM-centered regimen, but it has a higher incidence of adverse drug reactions. It is safe to adjust the reasonable course of treatment and dosage of drugs. Better treatment compliance.
【作者单位】：广东省广州市胸科医院重症结核科、呼吸疾病国家重点实验室;
【基金】：2013年广东省自筹经费类科技计划项目(编号:113) 广州市医药卫生科技一般引导项目立项项目(编号:20121A011088)
【分类号】：R563.1

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