乳酸左氧氟沙星序贯疗法治疗耐多药肺结核的临床研究

The clinical investigation of levofloxacin lactate in the treatment of multiple drug resistant pulmonary tuberculosis by sequential therapy

研究乳酸左氧氟沙星序贯疗法对耐多药肺结核 (MDR- PTB)的疗效。对 18例经 Bactec- 46 0法和改良罗氏法痰培养证实的 MDR- PTB患者采用 3AHPVX/18DVX方案治疗 [A阿米卡星 (0 .4～ 0 .6 ) g/d,H异烟肼 (0 .3～ 0 .4) g/d,P对氨基水杨酸钠 (8～ 12 ) g/d,V乳酸左氧氟沙星 (0 .4～ 0 .6 ) g/d,X为根据既往用药及耐药报告所选药物 ,D帕司烟肼 (0 .8～ 1.2 ) g/d],即前 3个月强化期采用 AHPV静脉用药冲击疗法 ,后18个月巩固期采用 DVX口服用药的序贯疗法 ,观察其短期疗效。结果显示 ,上述治疗 12个月后 18例患者痰菌阴转率 83.33% (15 /18) ,X线胸片总有效率 88.89% (16 /18)。病人依从性、耐受性均显示良好。提示乳酸左氧氟沙星序贯疗法治疗 MDR- PTB具有较好的短期疗效。

Objective: To investigate the effect of sequential therapy with levofloxacin lactate (LVFX) for multiple drug resistant pulmonary tuberculosis (MDR PTB). Methods: 18 MDR PTB patients diagnosed by sputum culture of improved L J medium and Bactec 460 system were treated with a regimen of 3AHPVX/18DVX (A: amikacin 0.4~0.6g qd; H: isoniazid 0.3~0.4g qd; P: para amino salicylic acid 8~12g qd; V: LVFX 0.4 ~0.6g qd; X: one drug selected according to the former drug use history and drug susceptive test; D: dipasic 0.8~1.2g qd) during the 3 months intensified phase. AHPV were given intravenously. And druing the 18 months consolidated phase, DVX were administrated orally. Then the short course effects were observed 12 months later. Results: 12 months after therapy the sputum negative conversion rates were 83.33% (15/18). The overall effective rates chest X ray absorption were 88.89% (16/18). The compliance and tolerance of patients appeared quite well. Conclusion: The sequential therapy of LVFX has good effect on the patients of multiple drug resistant pulmonary tuberculosis.