• 四川大學(xué)華西醫(yī)院中國(guó)循證醫(yī)學(xué)中心（成都 610041）;

目的 　循證評(píng)價(jià)復(fù)治涂陽(yáng)肺結(jié)核繼續(xù)期治療方案，為WHO基本藥物目錄（WHO EML）調(diào)整及國(guó)家指南更新提供依據(jù)。
方法 　計(jì)算機(jī)檢索官方網(wǎng)站和CBMdisc（1978～2006），Cochrane 圖書館（2006年第4期），DARE（1994～2006），MEDLINE（1950～2006），EMBASE（1974~2006），BIOSIS Previews（1997~2006）等數(shù)據(jù)庫(kù)，同時(shí)手檢相關(guān)雜志和參考文獻(xiàn)。按照納入、排除標(biāo)準(zhǔn)嚴(yán)格選擇文獻(xiàn)。對(duì)納入文獻(xiàn)分類分級(jí)，循證分析。
結(jié)果 　共納入28篇RCT，4篇CCT，11篇敘述性研究和5篇WHO/ 國(guó)家指南。WHO及高結(jié)核負(fù)擔(dān)國(guó)家結(jié)核防治指南中Ⅱ類結(jié)核治療繼續(xù)期均使用利福平、異煙肼和乙胺丁醇，但療程、劑量有差異。此外，此3藥也較多用于其它類型結(jié)核。
結(jié)論 　建議將利福平（R）、異煙肼（H）和乙胺丁醇（E）固定劑量聯(lián)用（FDC-RHE）納入WHO EML2007用于復(fù)治涂陽(yáng)肺結(jié)核的治療；HRE劑量比例建議為1∶1∶2，劑量為H 150 mg， R 150 mg，E 300 mg。最佳劑量尚須根據(jù)更多高質(zhì)量臨床研究以指導(dǎo)調(diào)整。有必要開展對(duì)WHO及高結(jié)核負(fù)擔(dān)國(guó)家結(jié)核防治指南有效性、安全性、經(jīng)濟(jì)性和適用性的臨床研究，并對(duì)其進(jìn)行系統(tǒng)評(píng)價(jià)，以考察結(jié)核用藥方案效果，指導(dǎo)指南更新和資源合理配置，提高治療績(jī)效。有必要加強(qiáng)替代/備選藥物研究，開發(fā)有效、安全、經(jīng)濟(jì)、適用的抗結(jié)核藥物及藥物組合用于耐藥結(jié)核的防治。

引用本文： 楊曉妍,毛秀,孫鑫,段蔭喬,李幼平. 復(fù)治涂陽(yáng)肺結(jié)核繼續(xù)期治療方案的循證評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2007, 07(3): 211-221. doi: 復(fù)制

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  3. 3. He LF, Cha JY, Wu SL. Observation of therapeutic effect of Spirulina plus transfer factor as adjunctive therapy for retreated pulmonary tuberculosis. The Journal of the Chinese Antituberculosis Association, 2005, 27(1): 33–35.
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  5. 5. Yu D, Wang J, Hu X. Clinical research of pasinizid on retreated sputum positive pulmonary tuberculosis in senilities. Chinese Journal of Tuberculosis and Respiratory Diseases, 2001, 24(10): 608–610.
  6. 6. Cheng HL, Hu JG, Hu XW. The Comparison of the Clinical Effects of Using Lifuxin and Lifuping in the Treatment of Retreated Tuberculosis. Journal of Clinical Pulmonary Medicine, 2003, 8(3): 223–225.
  7. 7. Zeng L,Wang GB, Gao SY, et al. Clinical research of intravenous drip of capastat sulfate treating for the patients with tuberculosis. Henan Medical Research, 2002, 11(3): 230–232.
  8. 8. Chen YZ. Clinical Observation on the Clinical Efficacy and Safety of Retreated and Smear Positive Patient with Pulmonary Tuberculosis Treated by Levofloxcin. Journal of Jiangsu University (Medicine Edition), 2004, 14(2): 120–122.
  9. 9. He HL. Observation of therapeutic effect of Lentinan and Oleanolic Acid Tablets in treating patients of retreated pulmonary tuberculosis. Journal of Guiyang College of Traditional Chinese Medicine, 2001, 23(1): 21–22.
  10. 10. Huang CS, Wu CC. Observation of the clinical efficacy of sparfloxacin in the treatment of multiple drug resistance pneumonial tuberculosis. Chinese Journal of Antibiotics, 2000, 25(4): 302–303+316.
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  12. 12. Xie HA, Yang GT, Lin SZ, et al. Editor-in-Chief. Modern Phthisiology. 1st. Beijing: People’s Medical Publishing House, 2000. 232–236.
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  19. 19. Ma F, Fan X. Therapeutic effect and evaluation of Isoniazid Aminosalicylate on RSP-TB. Journal of Clinical Pulmonary Medicine, 2005, 10(4): 443–444.
  20. 20. Wen SM, Su Y, Zhang F, et al. Analysis of short-term effects of short-course intermittent chemotherapies of the World Bank Loaned Project. Chinese Journal of Tuberculosis and Respiratory Diseases, 1996, 19(6): 357–359.
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