目的 探讨药物敏感复治肺结核患者应用不同剂量异烟肼抗结核化疗方案治疗的效果及安全性。方法 选取收治的对药物敏感的复治肺结核患者97例，按照随机抽样的方式将其分为标准组(n=48)和高剂量组(n=49)，标准组依据国家统一的常规剂量(异烟肼0。3 g·d-1)给药，高剂量组根据患者体质量决定用药量，≥70 kg者异烟肼剂量为0。5g·d-1，＜70 kg者为0。4 g·d-1，疗程为8个月。比较2组患者治疗结束后X线摄影显示肺部病灶吸收情况的变化;痰菌阴转情况;血清细胞因子水平变化[白细胞介素-18(interleukin-18，IL-18)、γ干扰素(interferon-γ，IFN-γ)、肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)、白细胞介素-10(interleukin-10，IL-10)]、生活质量[肺癌生活质量评估量表(functional assessment of cancer therapy-lung，FACT-L)]评分以及不良反应情况。结果 高剂量组病灶吸收率为87。76％，明显高于标准组的70。83％(P＜0。05);治疗第1个月和第2个月，2组患者痰液转阴率比较差异无统计学意义，治疗第4个月和第8个月高剂量组患者痰菌转阴率显著高于标准组(P＜0。05);治疗8个月后，2组患者血清IL-18、IFN-y、TNF-α及IL-10水平均显著低于治疗前，且高剂量组显著低于标准组(P＜0。05);2组患者FACT-L评分均显著高于治疗前，且高剂量组高于标准组(P＜0。05);高剂量组不良发应发生率(18。37％)与标准组(16。67％)比较差异无统计学意义。结论 对药物敏感复治肺结核采用高剂量异烟肼治疗疗效较好，能有效增强患者肺部病灶吸收，加快空洞闭合，痰液尽早恢复阴性，血清中的炎症因子水平降低，从而提高生活质量，且无明显不良反应。
Efficacy of anti-tuberculosis regimens with different doses of isoniazid on drug-sensitive retreatment of pulmonary tuberculosis
Objective To explore the therapeutic effect and safety of anti-tuberculosis chemotherapy regimens with different doses of isoniazid on drug-sensitive patients with retreatment of pulmonary tuberculosis.Methods 97 drug-sensitive patients with re-treatment of pulmonary tuberculosis treated in the hospital were selected and divided into standard group(n=48)and high-dose group(n=49)by the random sampling method.The standard group adopted the unified conventional dose(0.3 g·d-1of isonia-zid)implemented in China,and the high-dose group adopted isoniazid dose determined by the patient's weight(0.5 g·d-1 for≥70 kg,0.4 g·d-1 for＜70 kg).The both groups were treated for 8 months.The changes of pulmonary lesion absorption shown by X-ray photography after the end of treatment,sputum negative conversion,changes of serum cytokines[interleukin-18(IL-18),interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),and interleukin-10(IL-10)],quality of life[Functional Assessment of Cancer Therapy-Lung(FACT-L)]and adverse reactions were compared between the 2 groups.Results The lesion absorption rate was 87.76％in high-dose group,which was significantly higher than 70.83％in standard group(P＜0.05).In the 1st month and 2nd month of treatment,there was no significant difference in the sputum negative conversion rate between the 2 groups.In the 4th month and 8th month of treatment,the sputum negative conversion rate in high-dose group was significantly higher than that in standard group(P＜0.05).After 8 months of treatment,the serum levels of IL-18,IFN-y,TNF-α and IL-10 in the 2 groups were significantly lower than those before treatment,and the levels were significantly lower in high-dose group than those in standard group(P＜0.05).The FACT-L scores in the 2 groups were significantly higher than those before treatment,and the scores in high-dose group were higher than those in standard group(P＜0.05).The incidence rate of adverse reactions was 18.37％in high-dose group,which was not significantly different from 16.67％in standard group.Conclusion High-dose isoniazid has a good effect in the treatment of drug-sensitive patients with retreatment of pulmonary tuberculosis.It can effectively enhance the absorption of pulmonary lesions,accelerate the closure of cavity,recover negative sputum as soon as possible,reduce the inflamma-tory factors in serum,and improve the quality of life,and it has no obvious side effects.
isoniaziddifferent dosespatients with retreatment of pulmonary tuberculosissafety
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