【摘要】：目的.即使經(jīng)過正規(guī)的抗結(jié)核治療,結(jié)核性腦膜炎(尤其是危重患者)的預(yù)后仍然較差,因此有必要探尋新的治療策略改善結(jié)核性腦膜炎患者的預(yù)后。利奈唑胺近年來治療耐藥肺結(jié)核方面取得不錯的療效,同時該藥有良好的血腦屏障通透性,但缺乏治療結(jié)核性腦膜炎的臨床證據(jù)。本研究通過評估危重結(jié)核性腦膜炎患者早期接受含利奈唑胺的抗結(jié)核方案與不含利奈唑胺的抗結(jié)核方案的治療應(yīng)答與不良反應(yīng),探尋危重結(jié)核性腦膜炎患者早期加用利奈唑胺治療的可行性與策略。方法.通過回顧性病例對照研究的方式,在MRC分級Ⅱ級和Ⅲ級的危重結(jié)核性腦膜炎患者中,比較在抗結(jié)核治療背景方案基礎(chǔ)上加用和未加用利奈唑胺的兩組患者治療前4周腦脊液指標(biāo)改善情況、格拉斯哥(GCS)評分改善情況以及體溫恢復(fù)情況,同時記錄利奈唑胺導(dǎo)致的藥物不良反應(yīng)。結(jié)果.共納入33例符合條件的病例,包括接受背景(BR, background)抗結(jié)核藥物加上利奈唑胺(LZD, linezolid)的患者16例,僅接受背景抗結(jié)核治療方案未加用利奈唑胺患者17例。治療4周時,LZD+BR組的腦脊液糖／同步血糖比值顯著高于BR組(中位數(shù),0.40 vs 0.34, p=0.04), LZD+BR組的腦脊液白細(xì)胞計數(shù)顯著低于BR組(中位數(shù),17 vs 42 X 10t/L, p=0.02)。LZD+BR組治療前4周的GCS評分恢復(fù)正常的速度以及體溫恢復(fù)速度顯著快于BR組。前4周2例患者發(fā)生可逆的利奈唑胺相關(guān)的藥物不良反應(yīng)。結(jié)論.重癥結(jié)核性腦膜炎患者危重期間短期加用利奈唑胺的抗結(jié)核方案能夠在治療前4周顯著改善患者的腦脊液常規(guī)、生化指標(biāo),使患者意識狀況和體溫恢復(fù)更快,顯著改善危重患者的病情,同時僅少數(shù)患者發(fā)生可逆的利奈唑胺相關(guān)不良反應(yīng)。短期加用利奈唑胺可以作為治療危重TBM患者安全有效的選擇。
[Abstract]:Objective The prognosis of tuberculous meningitis (especially in critically ill patients) is still poor even after regular anti-tuberculosis treatment. Therefore it is necessary to explore new treatment strategies to improve the prognosis of patients with tuberculous meningitis. In recent years, the efficacy of linazolamide in the treatment of drug-resistant pulmonary tuberculosis is good. At the same time, the drug has good blood-brain barrier permeability, but there is no clinical evidence for the treatment of tuberculous meningitis. This study assessed the early response and adverse reactions of patients with critical tuberculous meningitis to an anti-tuberculosis regimen containing linazolamide and an anti-tuberculosis regimen that did not contain lenazolidomide. To explore the feasibility and strategy of early treatment of severe tuberculous meningitis. Method A retrospective case-control study was conducted in critically ill tuberculous meningitis patients with MRC grade 鈪，

本文編號：2236446