Jacobs R F, Sunakorn P, Chotpitayasunonah T, Pope S, Kelleher K
Department of Pediatrics, Arkansas Children's Hospital, Little Rock 72202.
Pediatr Infect Dis J. 1992 Mar;11(3):194-8. doi: 10.1097/00006454-199203000-00004.
This nonrandomized, open clinical investigation of tuberculous meningitis evaluated 53 children with Stage I (n = 8), Stage II (n = 29) and Stage III (n = 16) disease. The overall mortality was 20.8% (11 of 53) with a rate of sequelae of 35.7% (15 of 42) in survivors reflecting the advanced stages of children at diagnosis. Various combinations of standard antituberculous drugs including isoniazid, rifampin, pyrazinamide, streptomycin and ethambutol were given. Three treatment durations used during various time periods were evaluated: 12, 9 and 6 months with only the 6-month regimen receiving pyrazinamide (PZA). This prospective evaluation demonstrated that: (1) severe disease at presentation is highly associated with early mortality (P less than 0.05), regardless of drug regimen; and (2) intensive short course chemotherapy (6 months) with PZA, regardless of stage of disease at presentation, is more efficacious than longer course therapy (9 or 12 months) without PZA in preventing total negative outcomes and sequelae (P less than 0.05). This study demonstrates that a 6-month regimen containing PZA can be used in treating children with tuberculous meningitis.
这项针对结核性脑膜炎的非随机、开放性临床研究评估了53例处于I期（n = 8）、II期（n = 29）和III期（n = 16）疾病的儿童。总死亡率为20.8%（53例中的11例），幸存者的后遗症发生率为35.7%（42例中的15例），这反映出儿童在诊断时处于疾病晚期。给予了包括异烟肼、利福平、吡嗪酰胺、链霉素和乙胺丁醇在内的各种标准抗结核药物组合。评估了在不同时间段使用的三种治疗疗程：12个月、9个月和6个月，只有6个月疗程使用了吡嗪酰胺（PZA）。这项前瞻性评估表明：（1）就诊时的严重疾病与早期死亡率高度相关（P < 0.05），无论药物治疗方案如何；（2）在预防总体不良结局和后遗症方面，含PZA的强化短程化疗（6个月），无论就诊时疾病处于何阶段，都比不含PZA的较长疗程治疗（9个月或12个月）更有效（P < 0.05）。这项研究表明，含PZA的6个月疗程可用于治疗儿童结核性脑膜炎。
