目的 探討利奈唑胺聯(lián)合常規(guī)化療治療廣泛耐藥肺結(jié)核的臨床效果及安全性。方法 選取2010年1月-2014年1月唐山市第四醫(yī)院收治的廣泛耐藥結(jié)核病患者94例，按治療方案不同分為對照組（40例）和治療組（54例）。對照組口服丙硫異煙胺腸溶片，0.25 g/次，2~3次/d；口服鹽酸左氧氟沙星膠囊，0.2 g/次，2次/d；口服鹽酸乙胺丁醇片，0.75 g/次，1次/d；口服吡嗪酰胺片，0.75 g/次，2次/d；靜脈靜滴硫酸阿米卡星注射液，0.2 g/次，2次/d。治療組在對照組基礎(chǔ)上，初始靜脈滴注利奈唑胺注射液，600 mg/次，2次/d；治療1~2個月后，根據(jù)患者耐受度和不良反應(yīng)情況改為600 mg，1次/d，或者口服利奈唑胺片，600 mg/次，1次/d。兩組患者均治療4~10個月，平均時間（8.5±0.6）個月。觀察兩組的臨床療效，比較兩組的癥狀改善時間、SF-36量表評分、復(fù)發(fā)和轉(zhuǎn)歸的情況。結(jié)果 治療后，對照組和治療組的總有效率分別為45.00%、85.19%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，治療組空洞縮小時間、空洞閉合時間、痰涂片轉(zhuǎn)陰時間、痰培養(yǎng)轉(zhuǎn)陰時間和痰定量PCR陰轉(zhuǎn)時間均短于對照組，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。隨訪6、12、18個月后，兩組SF-36量表評分均上升，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05）；且治療組SF-36量表評分的升高程度明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。對照組和治療組的復(fù)發(fā)率分別為35.00%、7.41%，轉(zhuǎn)歸率分別為30.00%、59.26%，兩組比較差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 利奈唑胺聯(lián)合常規(guī)化療治療廣泛耐藥結(jié)核病具有較好的臨床療效，可改善臨床癥狀，縮短痰菌陰轉(zhuǎn)時間，改善生活質(zhì)量，具有一定的臨床推廣應(yīng)用價值。

Objective To explore clinical effect and safety of linezolid combined with conventional chemotherapy in treatment of extensively drug-resistant tuberculosis. Methods Patients (84 cases) with extensively drug-resistant tuberculosis in Tangshan Fourth Hospital from January 2010 to January 2014 were enrolled in this study. According to the difference treatment plan, patients were divided into control group (40 cases) and treatment group (54 cases). Patients in the control group were po administered with Protionamide Enteric-coated Tablets, 0.25 g/time, 2-3 times daily. And patients in the control group were po administered with Levoloxacin Hydrochloride Capsules, 0.2 g/time, twice daily. And patients in the control group were po administered with Ethambutol Hydrochloride Tablets, 0.75 g/time, once daily. And patients in the control group were po administered with Pyrazinamide Tablets, 0.75 g/time, twice daily. And patients in the control group were iv administered with Amikacin Sulfate Injection, 0.2 g/time, twice daily. Patients in the treatment group were iv administered with Amikacin Sulfate Injection on the basis of the control group, starting dosage was 600 mg/time, once daily. After treatment for 1-2 months, according to the patient's tolerance and adverse reactions, the dose was changed to iv administered with Amikacin Sulfate Injection, or po administered with Amikacin Sulfate Injection, 600 mg/time, once daily. Patients in two groups were treated for 4-10 months, average time (8.5 ±0.6) months. After treatment, the clinical efficacies were evaluated, and symptoms improvement time, SF-36 scale score, recurrence, and prognosis in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 45.00% and 85.19%, respectively, and there was difference between two groups (P<0.05). After treatment, cavity shrinking time, cavity closure time, sputum smear negative conversion time, sputum culture negative conversion time, and sputum quantitative PCR negative conversion time in the treatment group were shorter than those in the control group, and there was difference between two groups (P<0.05). After treatment for 6, 12 and 18 months, SF-36 scores in two groups were increased, and the difference was statistically significant in the same group (P<0.05). And SF-36 scores in the treatment group were significantly higher than those in the control group, with significant difference between two groups (P<0.05). The recurrence rates in the control and treatment groups were 35.00% and 7.41%, respectively, and the recovery rates in the control and treatment groups were 30.00% and 59.26%, respectively, and there was difference between two groups (P<0.05). Conclusion Linezolid combined with conventional chemotherapy has clinical curative effect in treatment of extensively drug-resistant tuberculosis, and can improve clinical symptoms, shorten sputum bacteria negative conversion time, improve quality of life, which has a certain clinical application value.