左氧氟沙星和卷曲霉素联合化疗方案用于耐多药肺结核的临床观察

发布时间：2018-03-30 21:19

本文选题：左氧氟沙星　切入点：卷曲霉素　出处：《中国药房》2016年27期

【摘要】：目的:观察左氧氟沙星和卷曲霉素联合化疗方案用于耐多药肺结核的疗效和安全性。方法:84例耐多药肺结核患者随机分为观察组(42例)和对照组(42例)。观察组患者给予注射用硫酸卷曲霉素0.75 g,加入0.9%氯化钠注射液100 ml中,静脉滴注,每日1次+盐酸左氧氟沙星片0.4 g,口服,每日1次+丙硫异烟胺片0.2 g,口服,每日3次+帕司烟肼片0.3 g,口服,每日3次+吡嗪酰胺片0.5 g,口服,每日4次。对照组患者给予硫酸阿米卡星注射液0.4 g,加入0.9%氯化钠注射液100 ml中,静脉滴注,每日1次+氧氟沙星片0.3 g,口服,每日2次+丙硫异烟胺片(用法用量同观察组)+帕司烟肼片(用法用量同观察组)+吡嗪酰胺片(用法用量同观察组)。两组患者均给予葡醛内酯片0.1 g,口服,每日3次。两组疗程均为12个月。观察两组患者的痰阴转率、痰菌转阴时间、症状改善时间、病灶吸收率、肺部空洞闭合情况,治疗前后免疫指标(CD4~+CD25~+/CD4~+、CD4~+CD25~+CD127~(low)/CD4~+)、白细胞介素(IL)-17水平及不良反应发生情况。结果:观察组患者治疗3、6、9、12、18个月后的痰阴转率、病灶吸收率、肺部空洞闭合及缩小占比率均显著高于对照组,痰菌转阴时间、症状改善时间均显著短于对照组,差异均有统计学意义(P0.05)。治疗前,两组患者CD4~+CD25~+/CD4~+、CD4~+CD25~+CD127~(low)/CD4~+、IL-17水平比较,差异均无统计学意义(P0.05)。治疗后,两组患者CD4~+CD25~+/CD4~+、CD4~+CD25~+CD127~(low)/CD4~+均显著低于同组治疗前,且观察组低于对照组,IL-17水平显著高于同组治疗前,且观察组高于对照组,差异均有统计学意义(P0.05)。两组患者不良反应发生率比较差异无统计学意义(P0.05)。结论:左氧氟沙星和卷曲霉素联合化疗方案用于耐多药肺结核可显著提高疗效,有效降低患者调节性T淋巴细胞水平,升高IL-17水平,且不增加不良反应的发生。
[Abstract]:Objective: to observe the efficacy and safety of levofloxacin combined with caprethromycin in multi-drug resistant pulmonary tuberculosis.Methods 84 cases of multidrug resistant pulmonary tuberculosis were randomly divided into observation group (n = 42) and control group (n = 42).The patients in the observation group were treated with tetracycline sulfate 0.75 g for injection, adding 0.9% sodium chloride injection 100ml, intravenous drip, levofloxacin hydrochloride 0.4 g once a day, once a day, once a day, 0.2 g of propyleneisoniamin tablets, orally.Pasteinizide 0.3 g, pyrazinamide 0.5 g 3 times a day, 4 times a day.Patients in control group were given amikacin sulfate injection 0.4 g, added 0.9% sodium chloride injection 100ml, intravenous drip, once a day ofloxacin tablets 0.3 g, oral, oral.The dosage of propyl isonicotinamide tablets was the same as that of the observation group, and the dosage of passiniazide tablets was the same as that of the observation group, and the dosage of pyrazinamide tablets was the same as that of the observation group.The patients in both groups were given 0. 1 g of metolactone tablets, 3 times a day.The course of treatment was 12 months in both groups.The sputum negative conversion rate, sputum bacteria negative conversion time, symptom improvement time, focus absorption rate, pulmonary cavity closure, immunological index CD4 ~ CD25 ~ / CD4 ~ / CD4 ~ CD127, IL-IL-17 level and adverse reactions were observed in the two groups before and after treatment.Results: the sputum negative conversion rate, lesion absorption rate, pulmonary cavity closure and reduction in the observation group were significantly higher than those in the control group. The sputum negative time and symptom improvement time were significantly shorter in the observation group than in the control group.The difference was statistically significant (P 0.05).Before treatment, the levels of CD4- CD25- / CD4- CD4- CD127- IL-17 were not significantly different between the two groups.There was no significant difference in the incidence of adverse reactions between the two groups (P 0.05).Conclusion: levofloxacin combined with tetracycline can significantly improve the efficacy of multi-drug resistant pulmonary tuberculosis, reduce the level of regulatory T lymphocytes and increase the level of IL-17, and does not increase the incidence of adverse reactions.
【作者单位】：青海省第四人民医院呼吸科;
【分类号】：R521

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