Lin T P, Suo J, Lee C N, Lee J J, Yang S P
Taiwan Provincial Tuberculosis Control Bureau, Taipei, Republic of China.
Am Rev Respir Dis. 1987 Oct;136(4):808-10. doi: 10.1164/ajrccm/136.4.808.
This is the first prospective clinical trial recorded to date of short-course chemotherapy in pulmonary tuberculosis complicated by pneumoconiosis. Forty-eight anthrasillicotic and 11 silicotic patients with previously untreated pulmonary tuberculosis completed 9-month, short-course chemotherapy regimens: 2 months of daily streptomycin, isoniazid, rifampicin, and pyrazinamide followed by daily isoniazid and rifampicin for 7 months (2SHRZ/7HR). There were 3 treatment failures (5%). The remaining 56 patients (95%) all had their sputum converted within 4 months (mean, 1.5 months). Bacteriologic relapses were noted in 3 patients (5%) after 18 to 40 months of follow-up (mean, 28.4 months). The relapses occurred within 7 months after chemotherapy was stopped. There were 2 deaths from nontuberculosis causes during the follow-up period. Fifty-one patients (90%) remained bacteriologically sterile for 28.4 +/- 6.1 months. These results suggest that the 2SHRZ/7HR regimen is satisfactory in treating anthrasilicotic or silicotic patients with pulmonary tuberculosis, though antituberculosis chemotherapy seemed less effective in patients with pneumoconiosis than in those without pneumoconiosis.
这是迄今为止记录的首例关于尘肺合并肺结核短程化疗的前瞻性临床试验。48例煤矽肺患者和11例矽肺患者，均为既往未接受过治疗的肺结核患者，完成了为期9个月的短程化疗方案：每日使用链霉素、异烟肼、利福平及吡嗪酰胺治疗2个月，随后每日使用异烟肼和利福平治疗7个月（2SHRZ/7HR）。有3例治疗失败（5%）。其余56例患者（95%）在4个月内（平均1.5个月）痰菌均转阴。在18至40个月的随访期（平均28.4个月）后，有3例患者（5%）出现细菌学复发。复发发生在化疗停止后的7个月内。随访期间有2例患者死于非结核病因。51例患者（90%）在28.4±6.1个月内细菌学检查保持阴性。这些结果表明，2SHRZ/7HR方案在治疗煤矽肺或矽肺合并肺结核患者方面效果良好，尽管抗结核化疗对尘肺患者的效果似乎比对无尘肺患者的效果要差。
