吡嗪酰胺不同给药方案治疗新发涂阳肺结核的疗效观察

曾瑞通??陈文胜??刘振扬??赵梅桂??黄文焰

[摘要] 目的 探讨吡嗪酰胺不同给药方案对新发涂阳肺结核临床疗效及不良反应的影响，从而优化给药方案。 方法 采用异烟肼、利福平、吡嗪酰胺、乙胺丁醇治疗肺结核患者90例，按照吡嗪酰胺的给药方案，按照总用药量相同，分为1天1次给药组（A组）、1天2次给药组（B组）、1天3次给药组（C组），每组各30例，分析三组患者的疗效和不良反应发生情况。 结果 经过2个月的治疗，A组痰菌阴转率为90.0%，B组为83.3%，C组为80.0%。X线胸片好转率分别为93.3%、80.0%、80.0%。A组的痰菌阴转率和X线胸片好转率均优于B组及C组，差异有统计学意义（P<0.05）。三组患者的不良反应情况主要有肝功能损害、尿酸升高和消化道症状，但三组间比较差异无统计学意义（P>0.05）。A组及B组患者依从性良好，均能按时服药，C组患者中有3例患者出现偶有漏服药情况。 结论 吡嗪酰胺1天1次给药方案治疗有效率高，虽转氨酶异常有所升高，但较轻且可控，值得临床推广应用。

[关键词] 肺结核；吡嗪酰胺；疗效；肝损伤

[中图分类号] R521 [文献标识码] A [文章编号] 2095-0616（2017）12-32-04

Curative effect observation of pyrazinamide different dosing regimens for the treatment of new smear positive tuberculosis

ZENG Ruitong CHEN Wensheng LIU Zhenyang ZHAO Meigui HUANG Wenyan

Baoan District Chronic Disease Prevention and Treatment Hospital， Guangdong， Shenzhen 518101， China

[Abstract] Objective To explore the effect of pyrazinamide different dosing regimens for the treatment of new smear positive tuberculosis， and then， to optimize the dosage regimen. Methods 90 patients with pulmonary tuberculosis cured with isoniazid， rifampicin， pyrazinamide and ethambutol were selected. According to pyrazinamide regimen， according to the total dosage of the same，they were divided into 1 days， 1 times group （A group）， 1 days， 2 times group （B group）， 1 days， 3 times group （group C）， with 30 cases in each. Efficacy and adverse reactions of the three groups were analyzed. Results After 2 months of treatment， the sputum negative conversion rate was 90.0% in group A， 83.3% in group B， and 80.0% in group C. The improvement rate of chest X-ray was 93.3%， 80.0% and 80.0% respectively. The sputum negative conversion rate and the improvement rate of chest X-ray in group A were better than those in group B and group C， the difference was statistically significant （P<0.05）. The adverse reactions of the three groups were mainly liver function impairment， uric acid elevation and digestive tract symptoms， but there was no significant difference between the three groups （P>0.05）. The patients in group A and group B had good compliance and could take the medicine on time. In C group， 3 patients had occasional leakage of medicine. Conclusion Pyrazinamide with 1 days dosing 1 times has high efficiency. Although transaminase abnormal increases， but it is light and controllable， it is worthy of clinical application.

[Key words] Pulmonary tuberculosis； Pyrazinamide； Curative effect； Liver injury

肺結核是全球最常见的慢性传染性疾病之一，尤其以发展中国家为甚，致残率、致死率高，对人民群众的身体健康及经济和社会发展造成沉重的负担。目前，肺结核的短程强化治疗多采用异烟肼、利福平、乙胺丁醇和吡嗪酰胺联合用药。吡嗪酰胺能转化为具有活性的吡嗪酸，而具有活性的吡嗪酸

能绑定结核分枝杆菌的核糖体蛋白S1，阻止该蛋白编码结核杆菌的脱氧核糖核酸，最终阻止维系结核杆菌生存的其他蛋白的生成。通过该种方式，吡嗪酰胺最终可以将9 ～ 12个月的抗结核病化疗疗程缩短到数个月[1]。……