摘要
目的观察利奈唑胺(Lzd)治疗广泛耐药结核病(XDR-TB)的临床疗效和安全性。方法 2009年4～8月起采用含Lzd为主的化疗方案治疗8例XDR-TB患者。根据患者用药史及药敏试验结果采用个体化化疗方案,Lzd用法:治疗开始时应用600mg,静脉滴注,2次/d,应用时间为1～6周;之后减为600mg,静脉滴注,1次/d。结果 Lzd应用疗程最长为11个月,最短为2个月,平均约6个月15d。3例发热患者体温均于用药第2天恢复正常,8例患者咳嗽、咳痰均有明显改善,胸闷、气促等症状也有改善。治疗6个月时,空洞闭合6例,2例空洞未闭合。所有患者痰抗酸染色涂片均阴转,转阴性时间为7～210d,平均67d。所有患者痰培养均阴转,转阴性时间为7～210d,平均73d。3例患者在治疗2～4周时出现恶心、呕吐等胃肠道反应,减量后症状消失。末梢神经炎2例,视力下降2例,均在治疗6个月时出现,停药后改善。3例出现血液系统不良反应。1例表现为白细胞减少,1例中度贫血,1例在治疗2周时出现重度贫血停用Lzd,并给予输血2周后恢复正常,后将Lzd改为600mg,1次/d,未再出现贫血。结论 Lzd治疗XDR-TB可明显改善患者的临床症状,促进病灶吸收和空洞闭合,加速痰菌阴转,提高XDR-TB患者的生活质量,不良反应较轻且能耐受。
Objective To evaluate the clinical efficacy and safety of linezolid in treatment of XDR- TB. Methods Since April 15, 2009, we have applied linezolid-based chemotherapy in the treatment of 8 XDR-TB patients. We adopted personalized chemotherapy regimens based on the patient medication history and drug susceptibility test results. Dosage of linezolid： at the beginning： 600 mg, intravenous drip, bid, with duration from 1 week to 6 weeks; Later： reduce to 600 mg, intravenous drip, qd. Results Maximum duration of linezolid for treatment is 11 months, minimum is 2 months, with an average 6. 5 months. On the second day after medication, the body temperature returned to normal for 3 febrile patients; 8 patients showed significant improvement in cough, sputum; chest tightness, breath shortness and other symptoms also improved. 6 months after treatment, 6 patients presented cavity closure. Sputum smear negative conversion occurred in all pulmonary cases at a median of 67 days （range：7-210）. Culture conversion occurred in all pulmonary cases at a median of 73 days （range： 7-210）. 3 cases presented nausea, vomiting and other gastrointestinal reactions, but symptoms disappeared after dose reduction of linezolid. Two patients developed peripheral neuropathy. Two patients developed declining of eyesight. Three cases were found hematological toxicity, 1 leucopenia, I middle anemia, 1 severe anaemia and needed blood transfusions. Conclusions Using linezolid to treat XDR-TB can significantly improve clinical symptoms, promote lesion absorption and cavity closure, and accelerate sputum negative conversion. Therefore, it can help XDR-TB patients to improve quality of life with mild adverse reaction but well tolerance.
出处
《中华临床医师杂志（电子版）》
CAS
2010年第12期68-73,共6页
Chinese Journal of Clinicians(Electronic Edition)
基金
国家重大专项课题"特大城市结核病综合防治模式研究"(2009ZX10003-017)
上海市传染病公共卫生重点学科建设(08GWZX0104)
关键词
广泛耐药结核
分枝杆菌
结核
药物疗法
副作用
利奈唑胺
Extensively drug-resistant tuberculosis
Mycobacterium tuberculosis
Drug therapy
Adverse effects
Linezolid
