莫西沙星联合微卡治疗耐多药肺结核的短期效果分析  

Analysis on short-term effect of moxifloxacin combined with micro card for treatment of multidrug-resistant pulmonary tuberculosis

作　　者：李史来 刘新民 刘桂华 黄钥藩 陈伟升 彭湘汕 

机构地区：[1]汕头市第三人民医院内四科,广东汕头515073

出　　处：《中国临床研究》2015年第6期706-708,共3页Chinese Journal of Clinical Research

基　　金：广东省汕头市医疗科技计划项目(汕府科[2014]62号)

摘　　要：目的分析在常规化疗基础上加用莫西沙星及微卡治疗耐多药肺结核病的疗效及安全性。方法 2011年1月至2013年1月收治的112例耐多药肺结核患者,随机分为治疗组与对照组各56例。常规化疗药物为力克肺疾(D)、吡嗪酰胺(Z)、丙硫异烟胺(Pto)、丁胺卡那霉素(Am),化疗方案为8(D+Z+Pto+Am)/12(D+Z+Pto)。对照组给予常规化疗并全程给予莫西沙星治疗,治疗组在对照组的基础上加用微卡。两组疗程均为20个月(强化期8个月,巩固期12个月),比较两组患者治疗后2、4、6及12个月的痰菌阴转率;X线胸片检查病灶吸收情况;治疗后CD3+、CD4+、CD8+、CD4+/CD8+淋巴细胞亚群检测情况及患者不良反应发生情况。结果 (1)治疗组患者治疗后2、4、6、12个月的痰菌阴转率均高于对照组(P<0.05或P<0.01)。(2)治疗组病灶吸收总有效率高于对照组(83.9%vs 51.8%,P<0.01)。(3)治疗组CD3+、CD4+、CD8+、CD4+/CD8+水平均高于对照组(P均<0.05)。(4)两组均为轻微不良反应,对症处理后即消失,未影响治疗。结论莫西沙星和微卡联合应用方案治疗耐多药肺结核病,可提高临床痰菌转阴率,有助于病灶吸收,提高患者免疫力,同时不增加临床不良反应。Objective To analyze the therapeutic effect and safety of moxifloxacin combined micro card regimen for the treatment of multidrug-resistant pulmonary tuberculosis（ MDR-TB）. Methods A total of 112 patients with MDR-TB admitted from January 2011 to January 2013 were enrolled in this study. The patients were randomly divided into treatment group and control group（ n = 56 each）. The routine chemotherapy drugs were dipasic（ D）,pyrazinamide（ Z）,protionamide（Pto）,amikacin（Am）,and the chemotherapy regimen was 8（D ＋ Z ＋ Pto ＋ Am） /12（D ＋ Z ＋ Pto）. In control group,the routine chemotherapy drugs plus moxifloxacin were administered in control group;in treatment group,micro card was added on top of the drugs of control group. The courses of two groups were all 20 months（8 months for intensive period,12 months for consolidation period）. The sputum negative conversion rates and the lesions absorption conditions by Chest X-ray inspection at 2-,4-,6-,12-month were compared. The detection results of lymphocyte subsets CD3＋,CD4＋,CD8＋and CD4＋/ CD8＋and adverse reactions after treatment were compared. Results Compared with control group,The sputum negative conversion rates at 2-,4-,6-,12-month（ P〈0. 05 or P 0. 01）,the total effective rate of lesions absorption（83. 9% vs 51. 8%,P 0. 01）and the lymphocyte subsets CD3＋,CD4＋,CD8＋and CD4＋/ CD8＋in treatment group all increased significantly（ all P〈0. 05）. In two groups,the adverse reactions were all light and disappeared quickly after symptomatic treatment without influence to therapy. Conclusions For the treatment of MDR-TB,the therapy regimen of moxifloxacin combined with micro card can improve the sputum negative conversion rates,contribute to lesions absorption,improve the patients＇ immunity,and meanwhile do not increase the clinical adverse reactions

关 键 词：耐多药肺结核病 化疗 莫西沙星 微卡 淋巴细胞亚群 不良反应 

分 类 号：R521[医药卫生—内科学]