【摘要】 目的 了解耐多药肺结核(MDR-TB)化学治疗的不良反应情况。方法 回顾性研究广州市胸科医院2008年11月至2013年7月纳入全球基金MDR-TB治疗项目并且完成疗程的96例患者。患者的治疗方案为6Km(Am)-Z-Lfx(Ofx)-PAS(Cs)-Pto/18Z-Lfx(Ofx)-PAS(Cs)-Pto。根据病历资料,收集患者的一般情况、治疗方案、药物不良反应(ADR)、处理方法,并进行分析。结果96例患者中出现ADR 83例(86.5%),无ADR 13例(13.5%);治愈者与治疗失败者ADR的发生率分别是87.1%(54/62)和85.3%(29/34),差异无统计学意义(χ~2=0.06,P=0.806);在0～1个月、2～6个月的疗程治愈的患者ADR发生率分别是40.7%(22/54)和46.3%(25/54);治疗失败者分别是34.5%(10/29)和55.2%(16/29),两者比较差异无统计学意义(χ~2=0.31,P=0.577和χ~2=0.60,P=0.441)。常见的ADR是胃肠道反应、关节痛、头昏头痛、肝损伤,发生率分别是50.0%(48/96)、25.0%(23/96)、13.5%(13/96)、15.6%(15/96);以Cfz、Pto、PAS、Clr、Lfx、Km、Z的ADR发生率较高,分别是100%(7/7)、48.7%(39/80)、48.4%(31/64)、47.1%(8/17)、28.5%(20/70)、28.3%(17/60)、26.2%(22/84);107例次(69.5%)需停用相关的药物,替换其他药物。结论 MDR-TB治疗的ADR发生率较高、种类多,需采用正确的对策和进行规范处理。更多还原

【Abstract】 Objective To explore adverse drug reactions(ADR)of chemotherapy and treatment in patients with multidrug resistant tuberculosis(MDR-TB). Methods We analyzed retrospectively 96 patients enrolled MDR-TB project of Global fund and completed treatment in Guangzhou chest hospital from November 2008 to July2013.The chemotherapy regimen was 6 Km(Am)-Z-Lfx(Ofx)-PAS(Cs)-Pto/18 Z-Lfx(Ofx)-PAS(Cs)-Pto.The data including general condition,regimen,ADR and treatment were analyzed. Results There were 83 cases(86.5%,83/96)suffered from ADR in 96 patients who completed the course of treatment.The occurrence rate of ADR for the cases of cure and failure were 87.1%(54/62)and 85.3%(29/34)without statistical significance(χ~2=0.06,P=0.806),respectively.In 0-1 st month,2 nd-6 th month of treatment,the incidences of ADR were40.7%(22/54)and 46.3%(25/54)among patients who cured;34.5%(10/29)and 55.2%(16/29)among patients who were failure,respectively.There was no statistical difference(χ~2=0.31,P=0.577 andχ~2=0.60,P=0.441).The common ADRs were nausea/vomiting(50.0%,48/96),arthralgia(25.0%,23/96),dizziness and headache(13.5%,13/96),and hepatitis(15.6%,15/96).The ADRs caused by Cfz,Pto,PAS,Clr,Lfx,Km,Z were common,and the incidence of these drugs were 100%(7/7),48.7%(39/80),48.4%(31/64),47.1%(8/17),28.5%(20/70),28.3%(17/60),and 26.2%(22/84).107 cases(69.5%)needed to stop relative drugs and then replaced with other drugs. Conclusion The occurrence rate of ADR of the chemotherapy for MDR-TB are relatively higher and vary.It needs to adopt correct strategy and standardized treatment.更多还原