吡嗪酰胺与左旋氧氟沙星治疗肺结核合并糖尿病近期疗效和安全性分析

发布时间：2018-04-23 18:34

本文选题：肺结核 + 糖尿病　；参考：《安徽医科大学》2017年硕士论文

【摘要】：背景:中国是一个肺结核高负担的国家,肺结核发病率占全球发病率的25%,在世界排名第二,仅次于印度。肺结核是传染性疾病,当人吸入含有结核杆菌的微滴,就可能感染结核菌。糖尿病患者免疫力低下,是肺结核病的高危人群,更容易感染结核菌。肺结核合并糖尿病是一种病情复杂的慢性消耗性疾病,临床症状较重,肺部病灶广泛复杂,预后差。它严重危害人类健康,探索有效且不良反应小的治疗方法成为临床棘手的问题。目的:分析研究在1年疗程内,选用不同的化疗方案,肺结核合并糖尿病的近期治疗效果及安全性,以探索更加合理有效的抗结核治疗方案,从而使患者多方面收益,开辟新的途径和突破点,为今后制定新的抗结核治疗方案提供参考,为消灭结核病做出努力。方法:选择2013年1月~2015年6月马鞍山市第四人民医院120例初治肺结核合并2型糖尿病患者,随机均分为A、B、C三组,A组选用左旋氧氟沙星(Lfx),B组选用吡嗪酰胺(PZA,Z),C组二者皆选,分别给予3HRELfx/9HR、3HREZ/9HR、3HREZLfx/9HR的抗结核方案治疗,其中H为异烟肼(INH),R为利福平(RFP),E为乙胺丁醇(EMB),对比分析三组痰菌转阴情况、病灶吸收和空洞闭合情况,以及药物不良反应发生的情况。结果:抗结核治疗效果:A、B两组比较差异无统计学意义(P0.05),C组痰菌转阴率和病灶总吸收率在治疗开始后的前1~3个月明显优于A、B组(P0.05),3个月后无明显差异(P0.05)。药物不良反应发生率:B、C组明显高于A组(P0.01),B、C组组间差异不明显(P0.05)。结论:肺结核合并2型糖尿病的抗结核药物的不良反应发生率较高,采用左旋氧氟沙星联合吡嗪酰胺治疗,可以加速痰菌转阴和病灶吸收,但单用左旋氧氟沙星时药物不良反应发生率最低,对肺结核合并2型糖尿病患者安全有效,临床上可根据具体情况选择合适的个体化治疗方案。
[Abstract]:Background: China is a country with high TB burden. The incidence of TB accounts for 25% in the world, and it ranks second only to India in the world. Tuberculosis is an infectious disease that can be infected when a person inhales a microdrop of Mycobacterium tuberculosis. Diabetic patients with low immunity, is a high-risk group of tuberculosis, more susceptible to tuberculosis. Pulmonary tuberculosis complicated with diabetes mellitus is a chronic and expendable disease with severe clinical symptoms, complicated pulmonary lesions and poor prognosis. It is a serious harm to human health, and it has become a difficult clinical problem to explore effective and less adverse reaction treatment methods. Objective: to analyze and study the short-term efficacy and safety of different chemotherapy regimen in the treatment of pulmonary tuberculosis complicated with diabetes in order to explore a more reasonable and effective anti-tuberculosis treatment scheme, so as to make the patients benefit from many aspects. To open up new ways and breakthrough points, to provide reference for the future formulation of new anti-tuberculosis treatment program, and to make efforts to eliminate tuberculosis. Methods: from January 2013 to June 2015, 120 patients with primary pulmonary tuberculosis complicated with type 2 diabetes in the fourth people's Hospital of Ma'anshan City were randomly divided into three groups: group A and group A, respectively. 3HRELfx- / 9HR-3HREZLfx3HREZLfx3HREZLfx9HR were given antituberculous regimens, where H was isoniazid and INHX / 9HR, where H was isoniazid, and rifampicin, RFPnP, E was ethambutanol EMBB. The sputum negative conversion, focus absorption and cavity closure, and adverse drug reactions in the three groups were compared and analyzed. Results: there was no significant difference between the two groups in the effect of anti-tuberculosis treatment. The sputum negative rate and the total absorption rate of sputum in group P0.05C were significantly better than those in group A (P 0.05) 3 months after the beginning of treatment, and there was no significant difference after 3 months (P 0.05). The incidence of adverse drug reactions in group B was significantly higher than that in group A (P 0.01) and there was no significant difference between group C and group B (P 0.05). Conclusion: the incidence of adverse effects of anti-tuberculosis drugs in patients with pulmonary tuberculosis complicated with type 2 diabetes mellitus is higher. Levofloxacin combined with pyrazinamide can accelerate sputum negative and focus absorption. However, levofloxacin alone had the lowest incidence of adverse drug reactions, which was safe and effective for patients with pulmonary tuberculosis and type 2 diabetes mellitus.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R521;R587.1

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