138例耐多药肺结核患者使用环丝氨酸后的不良反应分析

doi:10.3969/j.issn.2095-3755.2018.03.010

摘要/Abstract

摘要：

目的分析138例耐多药肺结核患者使用环丝氨酸的精神、神经系统不良反应发生情况。方法回顾性分析2012年7月1日至2014年6月30日湖南省胸科医院耐药科收治的138例耐多药肺结核患者的临床资料,对采用含环丝氨酸方案治疗的患者不良反应发生情况和处理对策进行总结分析。结果 138例耐多药肺结核患者使用环丝氨酸后有18例(13.04%)患者出现精神、神经系统不良反应,有7例(5.07%)患者停用环丝氨酸,采用6Cm(Am)-Lfx(Mfx)-Pto-PAS-Z/18Lfx(Mfx)-Pto-PAS-Z方案继续进行治疗,未再出现精神、神经系统症状;其余11例(7.97%)患者增加维生素B6剂量,维持原方案进行抗结核治疗后未再出现精神、神经系统症状。结论在掌握适应证与密切监测下,使用含环丝氨酸方案治疗耐多药肺结核是相对安全的。

关键词: 结核, 肺, 结核, 抗多种药物性, 环丝氨酸, 不良反应

Abstract:

Objective To analyze the psychiatric and neurologic adverse reactions of cycloserine in 138 patients with multidrug-resistant tuberculosis. Methods Retrospective analysis was conducted based on the clinical data of 138 cases of multidrug-resistant tuberculosis who were admitted to the Department of Multidrug Resistant Tuberculosis, Hu’nan Chest Hospital from July 1, 2012 to June 30, 2014. The occurrence and treatment strategies of adverse reactions of cycloserine were summarized and analyzed. Results Of the 138 cases of multidrug-resistant tuberculosis using cycloserine, 18 (13.04%) occurred the psychiatric and neurologic adverse reactions. Seven (5.07%) cases discontinued cycloserine. They received 6Cm(Am)-Lfx(Mfx)-Pto-PAS-Z/18Lfx(Mfx)-Pto-PAS-Z regimen, and all psychiatric and neurologic adverse reactions disappeared. The remaining 11 (7.97%) cases increased the dosage of VitB6, and maintained the original regimen for anti-tuberculosis treatment. After treatment, they all did not occur the psychiatric and neurologic adverse reactions. Conclusion It is relatively safe to use cycloserine-containing regimen to treat multidrug-resistant tuberculosis, if we master the indications and closely monitor the adverse events.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Cycloserine, Adverse reactions

文新民,杨坤云,易恒仲,罗丹霖,张勇,唐志冈,厉娟,袁甜. 138例耐多药肺结核患者使用环丝氨酸后的不良反应分析[J]. 结核病与肺部健康杂志, 2018, 7(3): 194-197. doi: 10.3969/j.issn.2095-3755.2018.03.010

Xin-min WEN,Kun-yun YANG,Heng-zhong YI,Dan-lin LUO,Yong ZHANG,Zhi-gang TANG,Juan LI,Tian YUAN. Clinical analysis of the adverse reactions in 138 cases of multidrug-resistant tuberculosis following cycloserine treatment[J]. Journal of Tuberculosis and Lung Health, 2018, 7(3): 194-197. doi: 10.3969/j.issn.2095-3755.2018.03.010

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服药后时间 (月)	不良反应种类(例)								合计 (例)
服药后时间 (月)	头晕	焦虑	嗜睡	兴奋性增高	精神抑郁	烦躁不安	精神错乱	自杀倾向	合计 (例)
1	1	0	0	0	0	0	0	0	1
2	1	0	0	0	0	0	0	1	2
3	2	1	0	1	0	0	0	0	4
4	0	0	0	0	1	0	0	0	1
5	1	0	0	0	0	0	0	0	1
6	0	1	0	1	0	0	0	0	2
7	1	0	0	0	0	0	0	0	1
8	0	0	0	1	0	0	0	0	1
9	0	1	0	0	1	0	0	0	2
10	0	0	0	0	0	1	0	0	1
11	0	0	0	0	0	0	0	0	0
12	0	0	0	0	0	0	0	0	0
15	1	0	0	0	0	0	0	1	2
18	0	0	0	0	0	0	0	0	0
21	0	0	0	0	0	0	0	0	0
24	0	0	0	0	0	0	0	0	0
合计	7	3	0	3	2	1	0	2	18