Correlation Between Curative Effect and Concentration of Drugs in Cerebrospinal Fluid in Tuberculous Meningoencephalitis
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摘要:
目的 探索腰大池置管后，1次与2次鞘内注射异烟肼脑脊液中药物浓度监测，并观察浓度与疗效的相关性。 方法 按入组条件，收集90例结核性脑膜炎患者，随机分为3组，每组30例，分别为对照组、鞘内注射A1组和A2组；鞘内注射组均行腰大池置管术。通过观察2个鞘内注射组在0 h、6 h、12 h脑脊液中异烟肼浓度，比较1次与2次鞘内注射异烟肼脑脊液中药物浓度，并对比2组的疗效。 结果 对照组脑脊液中药物浓度在0 h处于较低的水平；鞘内注射的2组6 h后脑脊液药物浓度均高于对照组，但A2组脑脊液异烟肼浓度均比A1组高，差异有统计学意义（P < 0.05）。治疗2周后，A2有效率（90.0%）明显大于A1组（66.7%）。 结论 鞘内注射异烟肼比仅外周抗结核治疗结核性脑膜炎，疗效显著。同时2次鞘注比1次鞘注更能使异烟肼在脑脊液中维持较长时间的有效浓度，起到持续杀菌作用。也为不同严重程度的患者制定个性化治疗方案提供一定的依据。 Abstract:Objectives To explore the drug concentration in cerebrospinal fluid of isoniazid by one and two intrathecal injections after lumbar cisterna catheterization, and to analyze the correlation between concentration and curative effect. Methods Based on the inclusion criteria, 90 patients with tuberculous meningitis were selected and randomly divided into 3 groups with 30 patients in each group, including control group, intrathecal injection A1 group and A2 group, respectively. The 2 intrathecal injection groups received lumbar cistern catheterization. By observing the concentration of isoniazid in the cerebrospinal fluid of the two intrathecal injection groups at 0 h, 6 h and 12 h, the concentration of isoniazid in the cerebrospinal fluid of the one and two intrathecal injections was compared, and the efficacy of the two groups was compared. Result In the control group, the drug concentration in cerebrospinal fluid was lower at 0 h. After 6 h of intrathecal injection, the concentration of isoniazid in cerebrospinal fluid of group A2 was higher than that of group A1, the difference was statistically significant （P < 0.05）. After 2 weeks of treatment, the effective rate of A2 （90.0%） was significantly higher than that of A1 group （66.7%）. Conclusion Intrathecal injection of isoniazid is more effective than peripheral anti-tuberculosis treatment of tuberculous meningitis. Two intrathecal injections in one day can maintain the effective concentration of isoniazid in cerebrospinal fluid for a longer time than one intrathecal injection. It also provides a foundation for developing personalized treatment plan for patients of varying severity. -
Key words:
- Tuberculous meningitis /
- Isoniazid /
- Intrathecal injection /
- Drug concentration
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表 1 0 h各鞘内注射组与对照组脑脊液异烟肼药物浓度检测值[（ $\bar x \pm s $）μg/L]
Table 1. The concentration of isoniazid in cerebrospinal fluid of each intrathecal injection group and control group at 0 h [（ $\bar x \pm s $）μg/L]
分组 0 h 对照组 1.31 ± 0.59 A1 2.01 ± 0.94* A2 2.61 ± 1.12* F 9.782 P 0.000 *P< 0.05。 
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表 2 2个鞘内注射组6 h、12 h脑脊液药异烟肼物浓度检测值比较[（ $\bar x \pm s $）μg/L]
Table 2. Comparison of isoniazid concentration detected in cerebrospinal fluid at 6 h and 12 h between the two intrathecal injection groups [（ $\bar x \pm s $）μg/L]
分组 6 h 12 h A1 32.76 ± 29.17 5.16 ± 2.91 A2 375.81 ± 224.31* 43.88 ± 36.29* t −6.080 −4.258 P 0.000 0.001 *P< 0.05。
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表 3 各组治疗2周后疗效对比[n（%）]
Table 3. Comparison of curative effect of each group after 2 weeks of treatment [n（%）]
分组 有效 无效 合计（n) 对照组 12（40.0 ） 18（60.0 ） 30 A1 20（66.7 ）* 10（33.3 ）* 30 A2 27（90.0 ）*# 3（10.0 ）*# 30 合计 38（62.2 ） 22（37.8 ） 90 与对照组比较，*P< 0.05；与A1组比较，#P < 0.05。
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