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目的探讨DPLA(氨基水杨酸异烟肼片+阿米卡星+左氧氟沙星+吡嗪酰胺)方案化疗联合护肝、解毒方法治疗耐药肺结核的疗效及其对患者肝功能的影响。方法 162例耐药肺结核患者随机分为对照组、护肝组和解毒组各54例,对照组给予DPLA方案化疗;护肝组在对照组治疗基础上联合应用肝得治+护肝片;解毒组在对照组治疗基础上联合应用复方甘草酸单铵+还原型谷胱甘肽;3组均连续治疗6个月。分别于治疗及治疗后6个月测定3组白蛋白(albumin,Alb)、总胆红素(total bilirubin,TBil)、谷草转氨酶(glutamic-oxalacetic transaminase,GOT)、谷丙转氨酶(glutamic-pyruvic transaminase,GPT)水平;比较3组治疗6个月后痰菌转阴率、病灶吸收好转率、空洞闭合缩小率及不良反应发生情况。结果对照组治疗后TBil[(47.9±7.2)μmol/L]较治疗前[(36.8±5.7)μmol/L]增高(P<0.05),Alb、GOT、GPT与治疗前比较差异无统计学意义(P>0.05);护肝组治疗后Alb[(38.6±6.8)g/L]较治疗前[(28.7±7.1)g/L]增高,TBil[(20.3±5.5)μmol/L]、GOT[(22.8±9.5)u/L]、GPT[(27.6±10.7)u/L]较治疗前[TBil(37.0±4.8)μmol/L,GOT(60.9±18.7)u/L,GPT(86.7±14.9)u/L]下降(P<0.05);解毒组治疗后Alb[(37.4±5.6)g/L]较治疗前[(29.2±7.9)g/L]增高,TBil[(19.6±4.9)μmol/L]、GOT[(21.4±9.6)u/L]、GPT[(26.3±10.6)u/L]较治疗前[TBil(36.4±5.2)μmol/L,GOT(61.0±19.1)u/L,GPT(87.6±15.4)u/L]下降(P<0.05);护肝组治疗后痰菌转阴率、病灶吸收好转率及空洞闭合缩小率分别为85.2%、81.5%、81.5%,解毒组分别为87.0%、83.3%、85.2%,对照组分别为66.7%、68.5%、72.2%,护肝组和解毒组痰菌转阴率、病灶吸收好转率均高于对照组(P<0.05),不良反应发生率(11.1%,9.3%)均低于对照组(25.9%)(P<0.05);护肝组与解毒组治疗后各指标比较差异均无统计学意义(P>0.05)。结论对耐药肺结核患者,在DPLA方案化疗基础上应用保肝及解毒药物均可提高抗结核治疗效果,改善患者肝功能,减轻化疗不良反应。
Objective To investigate the curative effect of DPLA (isoniazid aminosalicylate tablet + amikacin + levofloxacin + pyrazinamide) regimen combined with protecting liver and detoxifying drug-resistant pulmonary tuberculosis and its effect on liver function. Methods 162 patients with drug-resistant pulmonary tuberculosis were randomly divided into control group, liver protection group and detoxification group 54 cases, control group given DPLA regimen chemotherapy; liver protection group in the control group based on the combination of liver treatment + liver tablets; detoxification Group in the control group based on the combination of compound glycyrrhizic acid monoamine + reduced glutathione; 3 groups were continuous treatment for 6 months. Three groups of albumin (ALB), total bilirubin (TBil), glutamic-oxalacetic transaminase (GOT), glutamic-pyruvic transaminase , GPT). The sputum negative conversion rate, lesion absorption rate, shrinkage rate of void closure and adverse reactions were compared between the three groups after 6 months treatment. Results The levels of TBil [(47.9 ± 7.2) μmol / L] in the control group were significantly higher than those before the treatment [(36.8 ± 5.7) μmol / L], but there was no significant difference in Alb, GOT and GPT (P <0.05). Alb [(38.6 ± 6.8) g / L] in the treatment group was significantly higher than that before treatment [(28.7 ± 7.1) g / L and TBil [(20.3 ± 5.5) μmol / (22.8 ± 9.5) u / L and GPT (27.6 ± 10.7) u / L compared with those before treatment [TBil (37.0 ± 4.8) μmol / L, GOT (37.4 ± 5.6) g / L compared with those before treatment [(29.2 ± 7.9) g / L] and TBil [(19.6 ± 4.9) (24.4 ± 5.2) μmol / L, GOT (21.4 ± 9.6) u / L and GPT [(26.3 ± 10.6) μL / L, GPT (87.6 ± 15.4) u / L] decreased (P <0.05). The rate of negative conversion of sputum, the rate of improvement of lesion absorption and the rate of reduction of hollow closure were 85.2%, 81.5% and 81.5% The detoxification rate was 87.0%, 83.3% and 85.2% in the detoxification group and 66.7%, 68.5% and 72.2% in the control group, respectively. The negative conversion rate and the rate of lesion absorption in the hepatoprotective and detoxification groups were higher than those in the control group (P < 0.05), the incidence of adverse reactions (11.1%, 9.3%) were lower than the control group (25.9%) (P <0.05); liver protection group and detoxification group after treatment There was no significant difference between the indexes (P> 0.05). Conclusion For patients with drug-resistant pulmonary tuberculosis, application of hepatoprotective drugs and detoxification drugs on the basis of DPLA regimen can improve the anti-TB treatment effect, improve liver function and reduce chemotherapy adverse reactions.