Chen Y Q, Du J, Liu Y H, Sun Z G, Ma Y, Shu W, Lyu X Y, Tian X Z, Li L, Gao W W
Beijing Chest Hospital, Capital Medical University, Beijing 101149, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2018 Jul 12;41(7):529-533. doi: 10.3760/cma.j.issn.1001-0939.2018.07.005.
To study the relationship between the weight change trend of initial treatment patients with pulmonary tuberculosis and the dose change trend of isoniazid, and therefore to analyze the appropriate dose of isoniazid. Data of initial treatment inpatients with pulmonary tuberculosis from May 1955 to December 2012 were retrospectively analyzed. Elderly patients with pulmonary tuberculosis, patients with drug-resistant tuberculosis, extrapulmonary tuberculosis and those with complications were excluded from the study. The time period was separated as 20th century 1950s to 1960s, 1970s, 1980s, 1990s, 21th century 2000s and 2010s. Samples were selected in each year and month between 1950s to 1960s and 1970s. After 1980s, samples of 1 year were taken from each 5 years. The sex, age and weight for every patient were collected, as well as the dose of isoniazid of every inpatient on a day in therapeutic regimen. Meanwhile, the weight change trend of the patients in different ages and the dose change trend of isoniazid were compared. The total number of cases was 1 398, with 924 males and 474 females, averaging (36.7±14.4) years old. The weight of the patients increased when it was compared between that in 1950s to 1960s, 1970s or 1980s and that in 2000s, with a increasing weight of 3 kg, 3.5 kg and 3 kg respectively. The difference showed statistical significance (<0.003). The difference was also significant when the weight in 70s was compared with that in 2010s (=0.002). The therapeutic dose of isoniazid remained invariable regardless of the weight change. At 1990s, 2000s and 2010s, the dose of isoniazid per kilogram of body weight would reduce to 0.005 4 g, 0.005 2 g and 0.0054 g relative to patients' weight increase, and the difference was statistically significant (<0.001). The weight of pulmonary tuberculosis inpatients increased in recent 60 years. The weight has a close relation with the dose of isoniazid. A fixed dose of isoniazid (0.3 g/d) regardless of the weight change could result in low blood drug concentration . To avoid tolerance of isoniazid and increase the cure rates of pulmonary tuberculosis, the dosage of isoniazid should be increased based on the weight increase of patients.
研究初治肺结核患者体重变化趋势与异烟肼剂量变化趋势的关系,进而分析异烟肼的合适剂量。回顾性分析1955年5月至2012年12月初治肺结核住院患者的数据。排除老年肺结核患者、耐药肺结核患者、肺外结核患者及有并发症的患者。时间段分为20世纪50年代至60年代、70年代、80年代、90年代、21世纪00年代和10年代。在20世纪50年代至60年代和70年代期间的每年每月选取样本。20世纪80年代以后,每5年抽取1年的样本。收集每位患者的性别、年龄和体重,以及治疗方案中每位住院患者某一天的异烟肼剂量。同时,比较不同年龄段患者的体重变化趋势和异烟肼的剂量变化趋势。病例总数为1398例,男性924例,女性474例,平均年龄(36.7±14.4)岁。将20世纪50年代至60年代、70年代或80年代患者的体重与21世纪00年代患者的体重进行比较,患者体重有所增加,分别增加了3kg、3.5kg和3kg。差异具有统计学意义(<0.003)。将70年代患者的体重与2010年代患者的体重进行比较时,差异也具有显著性(=0.002)。无论体重如何变化,异烟肼的治疗剂量保持不变。在20世纪90年代、00年代和10年代,相对于患者体重增加,每千克体重的异烟肼剂量分别降至0.0054g、0.0052g和0.0054g,差异具有统计学意义(<0.001)。近60年来肺结核住院患者体重增加。体重与异烟肼剂量密切相关。不考虑体重变化而采用固定剂量的异烟肼(0.3g/d)可能导致血药浓度偏低。为避免异烟肼耐受并提高肺结核治愈率,应根据患者体重增加情况增加异烟肼剂量。