期刊文献+

含环丝氨酸方案治疗耐多药肺结核患者发生不良反应的临床分析 预览

Analysis on the Adverse Events among Multidrug-resistant Pulmonary Tuberculosis Patients Receiving Cycloserine-containing Regimen
在线阅读 下载PDF
分享 导出
摘要 目的分析含环丝氨酸(Cs)化疗方案治疗耐多药肺结核患者发生药物不良反应的情况.方法选取 2013年1月至2016年6月全国11家单位纳入全球基金第五轮耐多药结核病防治项目、符合选例标准的耐多药肺结核患者作为研究对象,共计623例.所有患者均采用标准化治疗方案,即:6PZA-Am ( Cm )-Lfx ( Mfx )-Pto-Cs/18PZA-Lfx ( Mfx )-Pto-Cs;替代方案:PAS 替代 Pto, Cm 替代Am, Mfx替代Lfx(PZA:毗嗪酰胺;Am :阿米卡星;Cm :卷曲霉素;Lfk :左氧氟沙星;Mfx :莫西沙星;Pto:丙硫异烟胺;Cs :环丝氨酸;PAS:对氨基水杨酸钠).收集患者在治疗过程中的药物不良反应发生情况,分析药物不良反应的临床特征、严重程度、发生时间、持续时间、处理方法及预后,并判定其与药物之间的相关性.结果623例研究对象中有316例(50.7%)发生至少一种药物不良反应,36例(5.8%)患者由于药物不良反应停服药物或者更改治疗方案。最常见的药物不良反应为高尿酸血症(22.8%, 142/623 )和肝功能异常(18.8%, 117/623 );出现与Cs很可能相关的中枢神经系统或精神症状者有27例(4.3%),发生时间的中位数(四分位数)[M(QI,Q3)]为3 (2, 6)个月,对患者进行停用Cs或心理辅导等处理后,症状消失.结论应用含Cs的标准化疗方案进行治疗的耐多药肺结核患者中,发生中枢神经系统或精神症状与Cs有关,在对患者使用含Cs方案治疗期间需密切监测其中枢神经系统或精神系统症状. Objective To analyze the adverse events in multidrug-resistant pulmonary tuberculosis patients treated with cycloserine-containing chemotherapy regimen. Methods A total of 623 multidrug-resistant pulmonary tuberculosis patients who were eligible for inclusion in the Global Fund' s fifth round of multidrug-resistance control program during January 2013 to June 2016 from 11 hospitals in China were selected. All patients used a standardized treatment regimen: 6PZA-Am(Cm)-Lfx(Mfx)-Pto-Cs/18PZA-Lfx(Mfx)-Pto-Cs;alternatives: PAS instead of Pto, Cm instead of Am, Mfx replacement Lfx (PZA: pyrazinamide. Am: amikacin. Cm: capreomycin, Lfx: levofloxacin, Mfx: moxifloxacin, Pto: prothionamide, Cs: cycloserine, PAS: p-aminosalicylide sodium). The adverse events during treatment were collected, their clinical characteristics, severity, occurring time, duration, treatment method and prognosis were analyzed, and the correlation between the drugs and adverse events were determined. Results Of the 623 multidrug-resistant pulmonary tuberculosis patients treated with cycloserine-containing regimen, 316 (50.7%) patients had at least one adverse event, and 36 (5.8%) patients discontinued the treatment or changed the treatment regimen due to adverse reactions. The most common adverse reactions were hyperuricemia (22.8%, 142/623) and abnormal liver function (18.8%, 117/623). Twenty-seven (4.3%, 27/623) patients developed central nervous system or psychiatric symptoms that were likely to be associated with cycloserine, and the median (interquartile range) time of occurrence was 3 (2, 6) months. After drug discontinuance or psychological counseling, the symptoms disappeared. Conclusion In multidrug-resistant pulmonary tuberculosis patients who received cycloserinecontaining regimen, the occurrence of nervous system or psychiatric symptoms was mainly related to cycloserine. Patients need to be closely monitored for these symptoms during treatment that includes cycloserine.
作者 王敬 荆玮 陈维 郭茹 韩喜琴 吴琍敏 杨光旭 杨坤云 陈聪 蒋凛 蔡春葵 窦志 刁丽娟 潘洪秋 王建云 杜斐斐 王黎霞 李仁忠 初乃惠 Wang Jing;Jing Wei;Chen Wei;Guo Ru;Han Xiqin;Wu limin;Yang Guangxu;Yang Kunyun;Chen Cong;Jing Lin;Cai Chunkui;Dou Zhi;Diao Lijuan;Pan Hongqiu;Wang Jianyun;Du Feifei;Wang Lixia;Li Renzhong;Chu Naihui(Department of Tuberculosis, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, China)
出处 《结核病与胸部肿瘤》 2019年第1期26-30,共5页 Tuberculosis and Thoracic Tumor
基金 国家“重大新药创制”科技重大专项(2017ZX09304009).
关键词 环丝氨酸 结核 抗多种药物性 药物毒性 药物评价 Cycloserine Tuberculosis, multidrug-resistant Drug toxicity Drug evaluation
作者简介 第一作者:王敬;第一作者:荆玮;第一作者:陈维;第一作者:郭茹;通信作者:王黎霞,Email: wanglx@chinacdc.cn;通信作者:李仁忠,Email: iirz@chinacdc.cn;通信作者:初乃惠,Email: dongchul994@sina.com.
  • 相关文献

参考文献8

二级参考文献193

  • 1沙巍,王洁,胡忠义,肖和平,唐神结.痰噬菌体生物扩增法检测一线抗结核药物敏感性的临床应用研究[J].中华临床感染病杂志,2011(5). 被引量:3
  • 2肖和平.耐多药结核病化疗药物的选择与方案的制定[J].中华结核和呼吸杂志,2006,29(8):517-519. 被引量:32
  • 3朱莉贞,傅瑜,初乃惠,叶志忠,肖和平,王巍,苑松林,张侠,罗永艾,马丽萍.利福类联合多种药物长疗程方案治疗耐多药肺结核[J].中华结核和呼吸杂志,2006,29(8):520-523. 被引量:54
  • 4Blumberg HM, Burman WJ, Chaisson RE, et al. American Tho- racic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America : treatment of tuberculosis [ J ]. Am J of Respir Crit Care Med, 2003,167(4) :603-662. 被引量:1
  • 5Ormerod LP, Horsfleld N. Frequency and type of reactions to anti-tuberculosis drugs: observations in routine treatment [ J ]. Tuber Lung Dis, 1996,77( 1 ) :37-42. 被引量:1
  • 6Pate1 A, McKeon J. Avoidance and management of adverse reac- tions to antituberculosis drugs [ J]. Drug Saf, 1995,12( 1 ) : 1-25. 被引量:1
  • 7Shin SS, Pasechnikov AD, Gelmanova IY, et al. Adverse reac- tions among patients being treated for MDR-TB in Tomsk, Russia [J]. Int J Tuberc Lung Dis, 2007,11 (12) :1314-1320. 被引量:1
  • 8Furin JJ, Mitnick CD, Shin SS, et al. Occurrence of serious ad- verse effects in patients receiving community-based therapy for muhidrug-resistant tuberculosis [ J ]. Int J Tuberc Lung Dis, 2001,5 (7) :648-655. 被引量:1
  • 9Tsrtin T, Giing6r G, Ozmen I, et al. Side effects associated with the treatment of muhidrug-resistant tuberculosis [ J ]. Int J Tuberc Lung Dis, 2005,9(12) :1373-1377. 被引量:1
  • 10Nathanson E, Gupta R, Huamani P, et al. Adverse events in the treatment of multidrug-resistant tuberculosis: results from the DOTS-Plus initiative [ J]. Int J Tuberc Lung Dis, 2004,8 ( 11 ) : 1382-1384. 被引量:1

共引文献262

投稿分析

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部 意见反馈