分析贝达喹啉合并肠内营养支持对耐多药肺结核(multi-drugresistant pulmonary tuber culosis, MDR-PTB)的疗效。

收集57例我院收治的MDR-PTB患者为对象，根据治疗方法分为观察组26例与对照组31例。对照组进行常规抗结核(左氧氟沙星、利奈唑胺、氯法齐明、环丝氨酸、吡嗪酰胺治疗)合并肠内营养支持(口服肠内营养粉剂500~1 000 ml/d，同时适量补充匀浆膳，如牛奶、蔬菜泥等，连续24周)治疗；观察组在对照组方案基础上，口服富马酸贝达喹啉片，起始剂量为400 mg/d，连续2周，之后减量为200 mg/次，隔日一次，连续22周。比较两组临床疗效、痰结核分枝杆菌转阴情况、血清免疫功能指标[免疫球蛋白(immunoglobulin, Ig)A、IgG、IgM、CD4^＋/CD8^＋ T淋巴细胞比值]、肺功能指标[第1 s用力呼气容积(forced expiratory volume in the first second, FEV₁)、最大呼气流量(peak expiratory flow, PEF)、FEV₁占预计值百分比(FEV₁%)]、计算机断层扫描(computed tomography, CT)征象[厚壁空洞、钙化影、肺部实变和胸膜增厚]、营养状况[血红蛋白(hemoglobin, Hb)、血淋巴细胞总数(total lymphocyte count, TLC)、浓度和白蛋白(albumin, ALB)水平和健康调查量表(short form36health survey questionnaire, SF-36)评分]及不良反应发生情况。

观察组有临床疗效23例(88.46%)高于对照组19例(61.29%)；观察组痰涂片阴转率22例(84.62%)、痰培养阴转率21例(80.77%)、IgA(3.91±0.82)g/L、IgG(20.18±3.97)g/L、IgM(2.57±0.34)g/L、CD4^＋/CD8^＋比值(1.41±0.16)、PEF(6.91±1.23)L/s、FEV₁(1.41±0.22)L、FEV₁%(80.83±9.58)%、TLC(1.94±0.47)×10⁹/L、Hb(117.52±19.68)g/L、ALB水平(40.14±8.75)g/L和SF-36评分(78.15±12.29)高于对照组67.74%、61.29%、(3.32±0.79)g/L、(17.94±2.68)g/L、(2.31±0.48)g/L、(1.29±0.14)、(6.28±1.07)L/s、(1.28±0.19)L、(75.19±9.64)%、(1.68±0.42)×10⁹/L、(105.73±21.56)g/L、(35.29±7.63)g/L、(71.03±13.48)分；观察组发生厚壁空洞23.08%、钙化影15.38%、肺部实变11.54%、胸膜增厚15.38%低于对照组48.39%、45.16%、38.71%、41.94%(P<0.05)；两组患者不良反应发生率比较无统计学意义(P>0.05)。

贝达喹啉合并肠内营养支持治疗MDR-PTB疗效明显，可改善患者营养状况，调节免疫功能，促进患者肺部结构和功能的恢复且安全性好。

Analyze the therapeutic effect of bedaquiline combined with enteral nutrition support on multi-drug-resistant pulmonary tuberculosis (MDR-PTB).

The clinical data of 57 MDR-PTB patients admitted to our hospital were collected and divided into an observation group with 26 cases and a control group with 31 cases according to the treatment methods. Patients in the control group received conventional anti-tuberculosis treatment (levofloxacin, linezolid, clofazimine, cycloserine, and pyrazinamide) combined with enteral nutrition support (oral enteral nutrition powder 500~1 000 ml/d, with appropriate supplementary homogenate meals such as milk and vegetable puree, for 24 consecutive weeks). Patients in the observation group, on the basis of the control group′s regimen, took bedaquiline fumarate tablets orally, with an initial dose of 400 mg/d for 2 consecutive weeks, then reduced to 200 mg per dose, 3 times a week, for 22 consecutive weeks. The clinical efficacy, sputum smear conversion of Mycobacterium tuberculosis, serum immune function indexes [immunoglobulin (Ig) A, IgG, IgM, the ratio of CD4⁺ /CD8⁺ T lymphocytes], pulmonary function indexes [forced expiratory volume in the first second (FEV₁), peak expiratory flow (PEF), percentage of FEV₁ to predicted value (FEV₁%)], computed tomography (CT) signs [thick-walled cavity, calcification shadow, pulmonary consolidation and pleural thickening], nutritional status [hemoglobin (Hb), total lymphocyte count (TLC), albumin (ALB) level and Short Form 36 Health Survey Questionnaire (SF-36) score] and the occurrence of adverse reactions were compared between the two groups.

The clinical efficacy of the observation group was 23 cases (88.46%), which was higher than 19 cases (61.29%) in the control group. The sputum smear negative conversion rate, sputum culture negative conversion rate, IgA, IgG, IgM, the CD4⁺ /CD8⁺ ratio, PEF, FEV₁, FEV₁%, TLC, Hb, ALB levels and SF-36 scores of the observation group were (84.62%), (80.77%), (3.91±0.82) g/L, (20.18±3.97) g/L, (2.57±0.34) g/L, (1.41±0.16), (6.91±1.23) L/s, (1.41±0.22) L, (80.83±9.58)%, (1.94±0.47)×10⁹/L, (117.52±19.68) g/L, (40.14±8.75) g/L, (78.15±12.29) points respectively, all of which were higher than those of the control group [(67.74%), (61.29%), (3.32±0.79) g/L, (17.94±2.68) g/L, (2.31±0.48) g/L, (1.29±0.14), (6.28±1.07) L/s, (1.28±0.19) L, (75.19±9.64)%, (1.68±0.42)×10⁹/L, (105.73±21.56) g/L, (35.29±7.63) g/L, (71.03±13.48) points]. The incidences of thick-walled cavity, calcification shadow, pulmonary consolidation and pleural thickening in the observation group were 23.08%, 15.38%, 11.54%, 15.38% respectively, which were lower than those in the control group 48.39%, 45.16%, 38.71%, 41.94%, (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Bedaquiline combined with enteral nutrition support therapy has an obvious efficacy in the treatment of MDR-PTB, which can improve the nutritional status of patients, regulate the immune function, promote the recovery of the pulmonary structure and function of patients, and the safety feature is of significant importance.