本文關鍵詞： 結核性腦膜炎 異煙肼 鞘內注射 不同劑量 療效　出處：《重慶醫(yī)科大學》2013年碩士論文　論文類型：學位論文

【摘要】：目的：研究給予不同劑量的異煙肼（Isoniazid，INH）和鞘內注射異煙肼治療后在結核性腦膜炎（Tuberculous meningitis，TBM）患者腦脊液（cerebrospinal fluid，CSF）中INH的濃度差異，及不同劑量、不同用藥途徑與臨床療效和不良反應的相關性。 方法：將50例患者中未使用異煙肼鞘內注射的41例患者分別給予異煙肼300mg/d（300mg組11例）、600mg/d（600mg組10例）、900mg/d（900mg組20例）治療，再根據(jù)是否進行鞘內注射異煙肼將使用異煙肼600mg治療的19例患者患者分為鞘內注射組9例及非鞘內注射組10例。所有患者同時給予其他抗結核藥物治療。收集所有患者腦脊液標本，采用高效液相色譜法（High performance liquid chromatogram，HPLC）測定腦脊液中異煙肼的含量，并分析各組的療效及不良反應。 結果：300mg組、600mg組、900mg組腦脊液異煙肼濃度差異有統(tǒng)計學意義（P＜0.05），其中900mg組和600mg組中伴有神經系統(tǒng)損害患者的臨床療效差異無統(tǒng)計學意義（P＞0.05），在治療前后腦脊液壓力和蛋白變化方面900mg組差異有顯著統(tǒng)計學意義（P＜0.01），600mg組差異無統(tǒng)計學意義（P＞0.05），鞘內注射組有顯著統(tǒng)計學意義（P＜0.01），而非鞘內注射組差異無統(tǒng)計學意義（P＞0.05）。900mg組腦脊液好轉率為88.2%，600mg組好轉率為70%，兩組相比差異無統(tǒng)計學意義（P＞0.05）。900mg組的患者不良反應發(fā)生率為70%，600mg組不良反應發(fā)生率30%，差異具有統(tǒng)計學意義（P＜0.05）。鞘內注射組與非鞘內注射組腦脊液中異煙肼濃度差異無統(tǒng)計學意義（P＞0.05），鞘內注射組與非鞘內注射組的臨床療效和腦脊液好轉率相比均有統(tǒng)計學意義（P＜0.05）。 結論：異煙肼的劑量越高，在腦脊液中的藥物濃度越高，更有利于腦脊液指標的恢復，但是不同劑量異煙肼的臨床治療效果及腦脊液好轉率并無差異。而增加異煙肼的劑量，相對的也增加了其不良反應的發(fā)生率。使用鞘內注射對于腦脊液中異煙肼濃度的增加效果不明顯，，但臨床療效及腦脊液指標的好轉均優(yōu)于未使用鞘內注射的患者。
[Abstract]:Objective: to study the difference of INH concentration in cerebrospinal fluid (CSF) of patients with tuberculous meningitis treated with different doses of isoniazidine (Isoniazididine) and intrathecal injection of isoniazidine (isoniazidine) and different doses of isoniazid in cerebrospinal fluid (CSF) of patients with tuberculous meningitis (TBM). The correlation between different ways of drug use and clinical efficacy and adverse reactions. Methods: Forty-one of 50 patients without intrathecal injection of isoniazid were treated with isoniazid 300mg / dc300mg group (n = 11, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10, n = 10). According to the intrathecal injection of isoniazid, 19 patients who were treated with isoniazid 600mg were divided into intrathecal injection group (n = 9) and non-intrathecal injection group (n = 10). All patients were treated with other anti-tuberculosis drugs at the same time. There are cerebrospinal fluid samples from patients, The content of isoniazid in cerebrospinal fluid (CSF) was determined by high performance liquid chromatography (performance liquid chromatogramme HPLC), and the curative effect and adverse reaction of each group were analyzed. Results there was significant difference in CSF isoniazid concentration between the two groups (P < 0.05). There was no significant difference in the clinical effect between 900mg group and 600mg group with nervous system damage (P > 0.05). Before and after treatment, cerebrospinal fluid pressure and egg were not significantly different (P > 0.05). There was significant difference in white changes in 900mg group (P < 0.01). There was no significant difference (P > 0.05) in the 600mg group. There was significant difference in the intrathecal injection group (P < 0.01), but there was no significant difference in the non-intrathecal injection group (P > 0.05). The cerebrospinal fluid improvement rate in the non-intrathecal injection group was 88.22600 mg group and that in the non-intrathecal injection group was 88.22600mg group. There was no significant difference in the incidence of side effects between the two groups (P > 0.05, P > 0.050.900 mg). The incidence of adverse reactions in the 70,600mg group was 30. The difference was statistically significant (P < 0.05). The difference in the concentration of isoniazid in cerebrospinal fluid between the intrathecal injection group and the non-intrathecal injection group was significant (P < 0.05). There was no statistical significance (P > 0.05). The clinical efficacy and cerebrospinal fluid improvement rate of intrathecal injection group and non-intrathecal injection group were significantly higher than that of non-intrathecal injection group (P < 0.05). Conclusion: the higher the dosage of isoniazid, the higher the concentration of isoniazid in cerebrospinal fluid, which is more favorable to the recovery of cerebrospinal fluid index, but there is no difference in clinical treatment effect and CSF improvement rate between different doses of isoniazid, but increase the dose of isoniazid, and increase the dosage of isoniazid. The effect of intrathecal injection on the concentration of isoniazid in cerebrospinal fluid was not obvious, but the clinical efficacy and the improvement of cerebrospinal fluid index were better than those without intrathecal injection.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R529.3

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