摘要
目的观察地榆升白片预防和治疗耐多药结核病(MDR-TB)患者利奈唑胺致白细胞减少的临床效果。方法选择拟采用利奈唑胺治疗的MDR-TB患者66例,按照随机数字表法分为治疗组31例、对照组35例。两组均给予含利奈唑胺的抗结核方案进行治疗,治疗组在此基础上口服地榆升白片,每次0.4 g,3次/天,共3个月。对照组利奈唑胺治疗2个月内发生白细胞减少者,参照治疗组口服地榆升白片,每次0.4 g,3次/天,共1个月。记录两组治疗1、2、3个月白细胞减少及中性粒细胞减少的发生情况。比较对照组利奈唑胺治疗2个月内发生白细胞减少者地榆升白片治疗前及治疗1个月后的白细胞计数及中性粒细胞计数,评价其疗效后计算总有效率。治疗组及对照组未使用地榆升白片者抗结核治疗3个月期间监测肝肾功能,记录肝肾功能异常情况。结果治疗组治疗1、2、3个月均无白细胞减少发生,对照组治疗1、2、3个月分别发生白细胞减少3、4、2例,白细胞减少总发生率为25.7%;治疗组治疗3个月白细胞减少总发生率低于对照组(P<0.05)。治疗组治疗1、2、3个月均无中性粒细胞减少发生,对照组治疗1、2、3个月分别发生中性粒细胞减少2、4、2例,中性粒细胞减少总发生率为22.9%;治疗组治疗3个月中性粒细胞减少总发生率低于对照组(P<0.05)。利奈唑胺治疗2个月内对照组7例白细胞减少者地榆升白片治疗前后白细胞计数分别为(2.90±0.93)×10^(9)/L、(4.47±1.46)×10^(9)/L,中性粒细胞计数分别为(1.45±0.54)×10^(9)/L、(2.64±1.27)×10^(9)/L;与治疗前比较,对照组白细胞减少者治疗后白细胞计数、中性粒细胞计数均升高(P均<0.05)。对照组白细胞减少者地榆升白片治疗后显效5例、有效1例、无效1例,总有效率为85.71%。两组治疗期间肝功能异常发生率比较差异无统计学意义(P>0.05),治疗组治疗期间肾功能异常发生率低于对照组未使用地榆升白片者(P<0.05)。结论地榆升白片可有效预防和治疗MDR-TB患者采用利奈唑胺治疗而引起的白细胞减少,且安全性较高。
Objective To observe the clinical effects of Diyu Shengbai tablets in the prevention and treatment of leukopenia caused by linezolid in patients with multidrug-resistant tuberculosis(MDR-TB).Methods Sixty-six patients with MDR-TB to be treated with linezolid were selected and randomly divided into the treatment group of 31 cases and control group of 35 cases.Patients in both groups were treated with an anti-tuberculosis regimen containing linezolid;in the treatment group,patients were orally administered Diyu Shengbai tablets,0.4 g each time,3 times each day for 3 months.For those who developed leukopenia within 2 months of linezolid treatment in the control group,they were instructed to orally take Diyu Shengbai tablets,0.4 g each time,3 times each day for 1 month.The occurrence of leukopenia and neutropenia at 1,2 and 3 months of treatment was recorded in both groups.We compared the white blood cell counts and neutrophil counts of leukopenic patients who developed leukopenia in the control group within 2 months of linezolid treatment with Diyu Shengbai tablets before treatment and after 1 month of treatment,and then calculated the overall effective rate after evaluating their therapeutic efficacy.Liver and kidney functions were monitored during 3 months of anti-tuberculosis treatment in the treatment group and the control group without Diyu Shengbai tablets,and abnormalities of liver and kidney functions were recorded.Results No leukopenia occurred in the treatment group at 1,2,and 3 months of treatment,and 3,4,and 2 cases of leukopenia occurred in the control group at 1,2,and 3 months of treatment,respectively,with an overall incidence of leukopenia of 25.7%(9/35);the overall incidence of leukopenia at 3 months of treatment was lower in the treatment group than in the control group(P<0.05).No neutropenia occurred in the treatment group at 1,2,and 3 months of treatment,and 2,4,and 2 cases of neutropenia occurred in the control group at 1,2,and 3 months of treatment,respectively,with an overall incidence of neutropenia of 22.9%;the overall incidence of neutropenia at 3 months of treatment was lower in the treatment group than in the control group(P<0.05).The leukocyte counts of patients with leukopenia in the control group before and after treatment were(2.90±0.93)×10^(9) and(4.47±1.46)×10^(9)/L,respectively,and the neutrophil counts were(1.45±0.54)×10^(9) and(2.64±1.27)×10^(9)/L,respectively;compared with those before treatment,the leukocyte counts and neutrophil counts of the control group increased after the treatment(both P<0.05).Within 2 months of linezolid treatment,among the 7 cases of leukopenia in the control group treated with Diyu Shengbai tablets,5 showed marked effect,1 showed effective response,and 1 was ineffective,resulting in a total effective rate of 85.71%.There was no statistically significant difference in the incidence of liver function abnormalities during treatment between the two groups(P>0.05),and the incidence of kidney function abnormalities during treatment in the treatment group was lower than that in the control group who did not use Diyu Shengbai tablets(P<0.05).Conclusion Diyu Shengbai tablets are effective and safe for the prevention and treatment of leukopenia caused by linezolid in MDR-TB patients.
作者
蒋怀龙
胡卫华
李宏宇
张晓磊
李琦剑
韩珊
金龙
JIANG Huailong;HU Weihua;LI Hongyu;ZHANG Xiaolei;LI Qijian;HAN Shan;JIN Long(Internal Medicine Department Eight,Infectious Disease Hospital of Heilongjiang Province,Harbin 150500,China;不详)
出处
《山东医药》
2025年第3期12-16,共5页
Shandong Medical Journal
基金
黑龙江省卫生健康委科研项目(20210303110315)。
