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目的研究脊柱结核患者应用异烟肼(INH)化疗时体内不同组织中的药物分布。方法24例遵循2SHRZ/2.5H2R2Z2化疗方案+手术治疗的患者,按有无病椎骨硬化分为硬化组(15例)和非硬化组(9例),连续服药4周手术。术晨服药后120～130min和240～250min两个时点分别取硬化组的病椎硬化骨、硬化壁外“亚正常骨”、硬化壁内病变组织和非硬化组的病椎结核病变组织、病变组织外“亚正常骨”以及两组患者的血浆、髂骨。采用反相高效液相色谱法测定上述样本INH浓度。结果异烟肼的组织分布差异显著,在髂骨及病椎“亚正常骨”可达有效杀菌浓度,而在病椎硬化壁仅为最低抑菌浓度,硬化壁内坏死干酪组织则未检测到INH;非硬化组中的结核坏死病变中INH可达最低杀菌浓度。结论脊柱结核病椎硬化骨为阻碍INH由正常椎骨穿透到椎体病灶内的主要原因。
Objective To study the distribution of drugs in different tissues of patients with spinal tuberculosis during isoniazid (INH) chemotherapy. Methods Twenty-four patients who underwent 2SHRZ / 2.5H2R2Z2 chemotherapy plus surgery were divided into sclerotic group (n = 15) and non-sclerotic group (n = 9) according to disease-free vertebral sclerosis. Harmless group vertebral sclerosis bone, sclerosis wall outside the “normal bone”, sclerosis wall lesions and non-sclerosis group of vertebral tuberculosis lesions at 120 ~ 130min and 240 ~ 250min after surgery, Tissue, diseased tissue outside “sub-normal bone ” and two groups of patients with plasma, ilium. The INH concentration of the above samples was determined by reverse-phase high-performance liquid chromatography. Results The tissue distribution of isoniazid differed significantly, reaching effective bactericidal concentration in the iliac bone and the diseased vertebrae, but not in the diseased vertebral wall INH was detected; INH in non-sclerosis group reached the lowest bactericidal concentration in tuberculous necrosis lesions. Conclusion Vertebral tuberculosis vertebral sclerosis is the main reason that impedes INH from penetrating normal vertebral body into vertebral body.