个体性化疗方案在耐药肺结核患者治疗中的应用研究(3)
在三种治疗方案中都出现了不良反应。化疗过程中，大剂量、多种类药物的应用会导致肝、肾、胃肠道以及关节等的损害，尤以肝损害严重[17]。除了定期对患者进行肝功能检查之外，还要应用一些护肝药物，加强护肝治疗。对其他症状的发生，应及时给予相应的对症治疗，以使患者能够完成整个疗程的抗结核治疗。耐药肺结核病患者肺内伴有广泛纤维病变，厚壁空洞等不可逆病变，而且患者常反复感染、咯血，因此，需密切监护患者，防止各种并发症的发生[18]。除此之外，肺结核疾病的传染性也应引起重视，尤其是咯血患者，应严格执行消毒隔离制度，防止院内感染等情况的发生。
参考文献
[1]胡克.结核病影响因素研究进展[J].中国医学创新，2013，10(4)：160-162.
[2] Burns K E，Liu W T，Boshoff H I，et al.Proteasomal protein degradation in Mycobacteria is dependent upon a prokaryotic ubiquitin-like protein[J].Journal of Biological Chemistry，2009，284(5)：3069-3075.
, http://www.100md.com
[3]李芳.支气管结核单纯化疗和介入综合治疗近期效果观察[J].中国医学创新，2013，10(10)：44-45.
[4] Striebel F，Imkamp F，Sutter M，et al.Bacterial ubiquitin-like modifier Pup is deamidated and conjugated to substrates by distinct but homologous enzymes[J].Nature Structural & Molecular Biology，2009，16(6)：647-651.
[5]万轲.左氧氟沙星和利福平治疗初治肺结核的临床疗效比较[J].中国医学创新，2012，9(23)：51-52.
[6] Sutter M，Striebel F，Damberger F F，et al.A distinct structural region of the prokaryotic ubiquitin-like protein (Pup) is recognized by the N-terminal domain of the proteasomal ATPase Mpa[J].FEBS letters，2009，583(19)：3151-3157.
, 百拇医药
[7] Wang T，Darwin K H，Li H.Binding-induced folding of prokaryotic ubiquitin-like protein on the Mycobacterium proteasomal ATPase targets substrates for degradation[J].Nature Structural & Molecular Biology，2010，17(11)：1352-1357.
[8] Burns K E，Pearce M J，Darwin K H.Prokaryotic ubiquitin-like protein provides a two-part degron to Mycobacterium proteasome substrates[J].Journal of Bacteriology，2010，192(11)：2933-2935.
[9] Striebel F，Hunkeler M，Summer H，et al.The mycobacterial Mpa-proteasome unfolds and degrades pupylated substrates by engaging Pup’s N-terminus[J].The EMBO Journal，2010，9(7)：1262-1271.
, http://www.100md.com
[10] Imkamp F，Rosenberger T，Striebel F，et al.Deletion of dop in Mycobacterium smegmatis abolishes pupylation of protein substrates in vivo[J].Molecular Microbiology，2010，75(3)：744-754.
[11] Cerda-Maira F A，Pearce M J，Fuortes M，et al.Molecular analysis of the prokaryotic ubiquitin-like protein (Pup) conjugation pathway in Mycobacterium tuberculosis[J].Molecular Microbiology，2010，77(5)：1123-1135.
[12] Darwin K H.Prokaryotic ubiquitin-like protein (Pup)，proteasomes and pathogenesis[J].Nat Rev Microbiol，2009，7(7)：485-491.
, 百拇医药
[13] Sutter M，Damberger F F，Imkamp F，et al.Prokaryotic ubiquitin-likeprotein (Pup) is coupled to substrates via the side chain of its C-terminal glutamate[J].Journal of the American Chemical Society，2010，132(16)：5610-5612，[14] Reyes-Turcu R E，Ventii K H，Wilkinson K D.Regulation and cellular roles of ubiquitin-specific deubiquitinating enzymes[J].Annual Review of Biochemistry，2009，78(6)：363-397.
[15] Wilkinson K D.DUBs at a glance[J].Journal of Cell Science，2009，122(14)：2325-2329.
, 百拇医药
[16] Burns K E，Cerda-Maira F A，Wang T，et al.Depupylation of prokaryotic ubiquitin-like protein from mycobacterial proteasome substrates[J].Molecular Cell，2010，39(5)：821-827.
[17] Imkamp F，Striebel F，Sutter M，et al.Dop functions as a depupylase in the prokaryotic ubiquitin-like modification pathway[J].EMBO Reports，2010，11(10)：791-797.
[18] Vandal O H，Nathan C F，Ehrt S.Acid resistance in Mycobacterium tuberculosis[J].Journal of Bacteriology，2009，191(15)：4714-4721.
(收稿日期：2015-01-05) (本文编辑：蔡元元), 百拇医药(张绿洲)
参考文献
[1]胡克.结核病影响因素研究进展[J].中国医学创新，2013，10(4)：160-162.
[2] Burns K E，Liu W T，Boshoff H I，et al.Proteasomal protein degradation in Mycobacteria is dependent upon a prokaryotic ubiquitin-like protein[J].Journal of Biological Chemistry，2009，284(5)：3069-3075.
, http://www.100md.com
[3]李芳.支气管结核单纯化疗和介入综合治疗近期效果观察[J].中国医学创新，2013，10(10)：44-45.
[4] Striebel F，Imkamp F，Sutter M，et al.Bacterial ubiquitin-like modifier Pup is deamidated and conjugated to substrates by distinct but homologous enzymes[J].Nature Structural & Molecular Biology，2009，16(6)：647-651.
[5]万轲.左氧氟沙星和利福平治疗初治肺结核的临床疗效比较[J].中国医学创新，2012，9(23)：51-52.
[6] Sutter M，Striebel F，Damberger F F，et al.A distinct structural region of the prokaryotic ubiquitin-like protein (Pup) is recognized by the N-terminal domain of the proteasomal ATPase Mpa[J].FEBS letters，2009，583(19)：3151-3157.
, 百拇医药
[7] Wang T，Darwin K H，Li H.Binding-induced folding of prokaryotic ubiquitin-like protein on the Mycobacterium proteasomal ATPase targets substrates for degradation[J].Nature Structural & Molecular Biology，2010，17(11)：1352-1357.
[8] Burns K E，Pearce M J，Darwin K H.Prokaryotic ubiquitin-like protein provides a two-part degron to Mycobacterium proteasome substrates[J].Journal of Bacteriology，2010，192(11)：2933-2935.
[9] Striebel F，Hunkeler M，Summer H，et al.The mycobacterial Mpa-proteasome unfolds and degrades pupylated substrates by engaging Pup’s N-terminus[J].The EMBO Journal，2010，9(7)：1262-1271.
, http://www.100md.com
[10] Imkamp F，Rosenberger T，Striebel F，et al.Deletion of dop in Mycobacterium smegmatis abolishes pupylation of protein substrates in vivo[J].Molecular Microbiology，2010，75(3)：744-754.
[11] Cerda-Maira F A，Pearce M J，Fuortes M，et al.Molecular analysis of the prokaryotic ubiquitin-like protein (Pup) conjugation pathway in Mycobacterium tuberculosis[J].Molecular Microbiology，2010，77(5)：1123-1135.
[12] Darwin K H.Prokaryotic ubiquitin-like protein (Pup)，proteasomes and pathogenesis[J].Nat Rev Microbiol，2009，7(7)：485-491.
, 百拇医药
[13] Sutter M，Damberger F F，Imkamp F，et al.Prokaryotic ubiquitin-likeprotein (Pup) is coupled to substrates via the side chain of its C-terminal glutamate[J].Journal of the American Chemical Society，2010，132(16)：5610-5612，[14] Reyes-Turcu R E，Ventii K H，Wilkinson K D.Regulation and cellular roles of ubiquitin-specific deubiquitinating enzymes[J].Annual Review of Biochemistry，2009，78(6)：363-397.
[15] Wilkinson K D.DUBs at a glance[J].Journal of Cell Science，2009，122(14)：2325-2329.
, 百拇医药
[16] Burns K E，Cerda-Maira F A，Wang T，et al.Depupylation of prokaryotic ubiquitin-like protein from mycobacterial proteasome substrates[J].Molecular Cell，2010，39(5)：821-827.
[17] Imkamp F，Striebel F，Sutter M，et al.Dop functions as a depupylase in the prokaryotic ubiquitin-like modification pathway[J].EMBO Reports，2010，11(10)：791-797.
[18] Vandal O H，Nathan C F，Ehrt S.Acid resistance in Mycobacterium tuberculosis[J].Journal of Bacteriology，2009，191(15)：4714-4721.
(收稿日期：2015-01-05) (本文编辑：蔡元元), 百拇医药(张绿洲)