关键词: 结核, 抗多种药物性, 药物疗法, 联合, 卷曲霉素, 低钾血症, 危险因素, 因素分析, 统计学

Abstract:

Objective To analyze clinical characteristics, prognosis and possible influencing factors of capreomycin-induced hypokalemia in patients with multidrug-resistant tuberculosis.Methods One hundred and twenty-nine patients with MDR-TB treated with capreomycin from January 2016 to January 2018 in Xi’an Chest Hosipital were selected. Among them, 56 (43.4%) patients suffered from capreomycin-induced hypokalemia and 73 (56.6%) patients did not get hypokalemia. The severity, onset time, prognosis of hypokalemia and its possible influencing factors were analyzed. Student’s t test and χ ² test were used separately to compare the difference of continuous measurements and categorical variables for hypokalemia and non-hypokalemia groups, P-value <0.05 was considered as statistically significant. Logistic regression analysis was done to identify risk factors. All statistical analyses were conducted on a personal computer with the SPSS of windows (version 18.0) software package. Results (1) Incidences of mild, moderate and severe hypokalemia caused by capreomycin were 69.6% (39/56), 23.2% (13/56) and 7.2% (4/56) respectively. Hypokalemia occurred during the whole course of using capreomycin, mainly in the first 16 weeks (89.3%, 50/56). (2) 52 of 56 patients with hypokalemia recovered after receiving potassium supplementation treatment, the other four patients recovered gradually after stopping using capreomycin due to severe hypokalemia. (3) The Univariate analysis revealed that 4 factors were associated with capreomycin-induced hypokalemia: age (χ ²=5.130,P=0.024), body mass index (χ ²=7.087,P=0.029),diabetes (χ ²=13.830, P=0.000) and serum albumin (t=2.150, P=0.034); Taking these factors and whether renal impairment existed into the logistic regression model, the result showed that serum albumin (Wald χ ²=6.261,P=0.012,OR=0.362)and diabetes (Wald χ ²=10.310,P=0.001,OR=6.394) were independent high risk factors for capreomycin-induced hypokalemia. Conclusion The incidence of capreomycin-induced hypokalemia was high. Serum electrolyte should be monitored intensively throughout capreomycin using process. Most patients with hypokalemia could stand to continually using capreomycin after receiving potassium supplementation treatment. Hypoproteinemia, diabetes were risk factors for hypokalemia.

Key words: Tuberculosis, multidrug-resistant, Drug therapy, combination, Capreomycin, Hypokalemia, Risk factors, Factor analysis, statistical