利奈唑胺治疗危重结核性脑膜炎的临床研究

发布时间：2018-09-11 10:34

【摘要】：目的.即使经过正规的抗结核治疗,结核性脑膜炎(尤其是危重患者)的预后仍然较差,因此有必要探寻新的治疗策略改善结核性脑膜炎患者的预后。利奈唑胺近年来治疗耐药肺结核方面取得不错的疗效,同时该药有良好的血脑屏障通透性,但缺乏治疗结核性脑膜炎的临床证据。本研究通过评估危重结核性脑膜炎患者早期接受含利奈唑胺的抗结核方案与不含利奈唑胺的抗结核方案的治疗应答与不良反应,探寻危重结核性脑膜炎患者早期加用利奈唑胺治疗的可行性与策略。方法.通过回顾性病例对照研究的方式,在MRC分级Ⅱ级和Ⅲ级的危重结核性脑膜炎患者中,比较在抗结核治疗背景方案基础上加用和未加用利奈唑胺的两组患者治疗前4周脑脊液指标改善情况、格拉斯哥(GCS)评分改善情况以及体温恢复情况,同时记录利奈唑胺导致的药物不良反应。结果.共纳入33例符合条件的病例,包括接受背景(BR, background)抗结核药物加上利奈唑胺(LZD, linezolid)的患者16例,仅接受背景抗结核治疗方案未加用利奈唑胺患者17例。治疗4周时,LZD+BR组的脑脊液糖／同步血糖比值显著高于BR组(中位数,0.40 vs 0.34, p=0.04), LZD+BR组的脑脊液白细胞计数显著低于BR组(中位数,17 vs 42 X 10t/L, p=0.02)。LZD+BR组治疗前4周的GCS评分恢复正常的速度以及体温恢复速度显著快于BR组。前4周2例患者发生可逆的利奈唑胺相关的药物不良反应。结论.重症结核性脑膜炎患者危重期间短期加用利奈唑胺的抗结核方案能够在治疗前4周显著改善患者的脑脊液常规、生化指标,使患者意识状况和体温恢复更快,显著改善危重患者的病情,同时仅少数患者发生可逆的利奈唑胺相关不良反应。短期加用利奈唑胺可以作为治疗危重TBM患者安全有效的选择。
[Abstract]:Objective The prognosis of tuberculous meningitis (especially in critically ill patients) is still poor even after regular anti-tuberculosis treatment. Therefore it is necessary to explore new treatment strategies to improve the prognosis of patients with tuberculous meningitis. In recent years, the efficacy of linazolamide in the treatment of drug-resistant pulmonary tuberculosis is good. At the same time, the drug has good blood-brain barrier permeability, but there is no clinical evidence for the treatment of tuberculous meningitis. This study assessed the early response and adverse reactions of patients with critical tuberculous meningitis to an anti-tuberculosis regimen containing linazolamide and an anti-tuberculosis regimen that did not contain lenazolidomide. To explore the feasibility and strategy of early treatment of severe tuberculous meningitis. Method A retrospective case-control study was conducted in critically ill tuberculous meningitis patients with MRC grade 鈪，

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