左氧氟沙星和莫西沙星分别联合2HRZE/4HR方案治疗活动性结核病的疗效及对PI3K-Akt-mTOR信号通路活化状态的影响  

Efficacy of levofloxacin or moxifloxacin combined with 2HRZE/4HR regimen in treating active tuberculosis and its influence on the activation status of PI3K-Akt-mTOR signaling pathway

作　　者：孟祥国 杨拴盈 田思嘉 毛晓辉 MENG Xiang-guo;YANG Shuan-ying;TIAN Si-jia;MAO Xiao-hui(Xi'an Jiaotong University,Xi'an 710061,Shaanxi,CHINA;Department of Tuberculosis Complications,Xi'an Chest Hospital,Xi'an 710061,Shaanxi,CHINA)

机构地区：[1]西安交通大学,陕西西安710061 [2]西安市胸科医院结核病合并症科,陕西西安710061

出　　处：《海南医学》2024年第21期3050-3054,共5页Hainan Medical Journal

基　　金：陕西省重点研发计划项目(编号:2019SF-224)。

摘　　要：目的探讨左氧氟沙星和莫西沙星分别联合2HRZE/4HR方案治疗活动性结核病的疗效及对磷脂酰肌醇3激酶(PI3K)-蛋白激酶B(Akt)-哺乳动物雷帕霉素靶体蛋白(mTOR)信号通路活化状态的影响。方法回顾性分析2020年5月至2023年5月于西安市胸科医院就诊的90例活动性结核病患者临床诊治资料,依据治疗方法不同分为左氧氟沙星组(左氧氟沙星联合2HRZE/4HR方案)44例和莫西沙星组(莫西沙星联合2HRZE/4HR方案)46例,两组患者均连续治疗6个月。治疗结束后评价两组患者的临床疗效,以及治疗后3个月、6个月的痰菌转阴率和外周血T淋巴细胞和Treg细胞PI3K-Akt-mTOR信号通路的活化状态,同时比较两组患者治疗期间的不良反应发生情况。结果莫西沙星组患者的治疗总有效率为93.48%,略高于左氧氟沙星组的86.36%,但差异无统计学意义(P>0.05);治疗3个月、6个月时莫西沙星组的痰菌转移率分别为91.30%、100.00%,明显高于左氧氟沙星组的75.00%、88.64%,差异均有统计学意义(P<0.05);治疗前,两组患者T淋巴细胞中CD3^(+)Akt^(+)细胞、CD3^(+)p-Akt^(+)细胞、CD3^(+)mTOR^(+)细胞、CD3^(+)p-mTOR^(+)细胞比例比较差异均无统计学意义(P>0.05);治疗后,莫西沙星组患者T淋巴细胞中CD3^(+)Akt^(+)细胞、CD3^(+)p-Akt^(+)细胞、CD3^(+)mTOR^(+)细胞、CD3^(+)p-mTOR^(+)细胞比例分别为(14.36±2.77)%、(11.43±2.25)%、(13.43±2.55)%、(13.64±2.76)%,明显高于对照组的(12.87±2.45)%、(9.81±2.27)%、(10.79±2.07)%、(10.48±2.47)%,差异均有统计学意义(P<0.05)。治疗前,两组患者Treg细胞中Akt^(+)细胞、p-Akt^(+)细胞、mTOR^(+)细胞、p-mTOR^(+)细胞比例比较差异均无统计学意义(P>0.05);治疗后,莫西沙星组患者Treg细胞中Akt^(+)细胞、p-Akt^(+)细胞、mTOR^(+)细胞、p-mTOR^(+)细胞比例分别为(86.96±7.77)%、(90.28±7.34)%、(89.73±6.65)%、(90.32±6.36)%,明显高于对照组的(83.57±7.25)%、(86.62±8.79)%、(86.88±6.37)%、(86.96�Objective To explore the efficacy of levofloxacin or moxifloxacin combined with 2HRZE/4HR regimen in the treatment of active tuberculosis and its influence on the activation status of phosphatidylinositol 3-kinase(PI3K)-protein kinase B(Akt)-mammalian target of rapamycin(mTOR)signaling pathway.Methods A total of 90 patients with active tuberculosis admitted in Xi'an Chest Hospital from May 2020 to May 2023 were selected for retrospective analysis.According to different treatment methods,the patients were divided into levofloxacin group(n=44,levofloxacin combined with 2HRZE/4HR regimen)and moxifloxacin group(n=46,moxifloxacin combined with 2HRZE/4HR regimen).After treatment,the clinical efficacy of the two groups of patients was evaluated,as well as sputum culture conversion rate and the activation status of the PI3K-Akt-mTOR signaling pathway in peripheral blood T lymphocytes and Treg cells at 3 and 6 months after treatment,and the occurrence of adverse reactions.Results The total effective rate of treatment in the moxifloxacin group(93.48%)was slightly higher than that in the levofloxacin group(86.36%),P>0.05.The sputum culture conversion rates in the moxifloxacin group were 91.30%and 100.00%at 3 months and 6 months after treatment,significantly higher than 75.00%and 88.64%in the levofloxacin group(P<0.05).Before treatment,there were no statistically differences in the proportions of CD3^(+)Akt^(+)cell,CD3^(+)p-Akt^(+)cell,CD3^(+)mTOR^(+)cell,and CD3^(+)p-mTOR^(+)cell in T lymphocytes between the two groups(P>0.05);after treatment,the proportions were(14.36±2.77)%,(11.43±2.25)%,(13.43±2.55)%,and(13.64±2.76)%in the moxifloxacin group,which were significantly higher than(12.87±2.45)%,(9.81±2.27)%,(10.79±2.07)%,and(10.48±2.47)%in the levofloxacin group(P<0.05).Before treat-ment,the proportions of Akt^(+)cell,p-Akt^(+)cell,mTOR^(+)cell,and p-mTOR^(+)cell in Treg cells were not significantly differ-ent between the two groups(P>0.05);after treatment,the proportions in the moxifloxacin group were(86.96±7.77)%,

关 键 词：活动性结核病 左氧氟沙星 莫西沙星 2HRZE/4HR方案 临床疗效 

分 类 号：R52[医药卫生—内科学]