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[老年儿童和青少年新发肺结核病例中使用统一化疗方案的可能性评估]

[Estimation of the possibilities of using unified chemotherapy regimens in new cases of pulmonary tuberculosis in old-age children and adolescents].

作者信息

Gubkina M F, Ershova N G

出版信息

Probl Tuberk Bolezn Legk. 2009(1):33-6.

Abstract

A hundred and forty children aged 13 to 17 who had new-onset active pulmonary tuberculosis were examined. There was a predominance of infiltrative tuberculosis (63.6%) in the pattern of its clinical forms. The processes were more frequently disseminated (79.3%) with lung tissue decay in every two patients (55.1%) and bacterial discharge in every three patients (39.3%). Among the new cases of pulmonary tuberculosis, the proportion of its multidrug resistance was 7.9%. The routine regimens were used for treatment. The efficiency of intensive-phase (IF) treatment was evaluated in 85 patients, including 18 patients receiving chemotherapy (CT) (HRZ/E/S) regimen 3 (Group 1), 45 having CT (HRZ/E/S) regimen 1 (Group 2), and 22 having CT (HRZE[A][Fq]/[Pt]) regimen 2B (Group 3). Clinical laboratory, Xray, and microbiological findings were criteria for evaluating the efficiency of IP CT. Abacillation occurred in all cases by month 4 of therapy. By and large, the efficiency of IF CT was 90.6% in new cases of pulmonary tuberculosis among old-age children and adolescents. In patients with disseminated processes, it ranged from 81.8% (Group 3) to 91.1% (Group 2) depending on the extent of lung tissue damage. The efficiency of therapy was as high as 100% in patients with circumscribed processes. Polyresistant resistance of Mycobacterium tuberculosis (MBT) to chemical agents, including multidrug resistance (7.9%), was a main reason of ineffective IF treatment (9.4%) in new cases of pulmonary tuberculosis among old-age children and adolescents. Overall, the actual use rate of routine CT regimens was 65.9% in new cases of pulmonary tuberculosis and adolescents. Uncontrolled adverse reactions to antituberculous drugs and drug resistance in MBT were reasons for deviations of routine regimens (modifications, use of individual regimes).

摘要

对140名年龄在13至17岁、新发性活动性肺结核患儿进行了检查。在其临床类型中,浸润性肺结核占主导(63.6%)。病变更常呈播散性(79.3%),每两名患者中就有一名出现肺组织坏死(55.1%),每三名患者中就有一名出现细菌排出(39.3%)。在新发性肺结核病例中,多重耐药比例为7.9%。采用常规方案进行治疗。对85名患者评估了强化期(IF)治疗的效果,其中18名患者接受化疗(CT)(HRZ/E/S)方案3(第1组),45名接受CT(HRZ/E/S)方案1(第2组),22名接受CT(HRZE[A][Fq]/[Pt])方案2B(第3组)。临床实验室、X线和微生物学检查结果是评估IF CT疗效的标准。治疗第4个月时所有病例均出现脱痂。总体而言,老年儿童和青少年新发性肺结核病例中IF CT的有效率为90.6%。在播散性病变患者中,根据肺组织损伤程度,有效率在81.8%(第3组)至91.1%(第2组)之间。局限性病变患者的治疗有效率高达100%。结核分枝杆菌(MBT)对化学药物的多耐药,包括多重耐药(7.9%),是老年儿童和青少年新发性肺结核病例中IF治疗无效(9.4%)的主要原因。总体而言,新发性肺结核和青少年病例中常规CT方案的实际使用率为65.9%。对抗结核药物的失控不良反应和MBT的耐药性是常规方案出现偏差(修改、使用个体化方案)的原因。

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