耐多药肺结核的治疗探讨

Discussion of Treatment of Multi-drug Resistant Pulmonary Tuberculosis

目的探讨左氧氟沙星联合其他二线抗结核药物治疗多种耐药结核病的近期疗效。方法对100例耐多药肺结核进行回顾性分析并观察左氧氟沙星的多药联合方案的疗效。结果不规则用药64例(占64.0%),初治化疗方案不合理20例(占20.0%),原发耐药16例(占16.0%);88例(占88.0%)在治疗2～5个月痰菌阴转,12例治疗至18个月痰菌仍阳性,属治疗失败;治疗有效88例满疗程与治疗前X线胸片比较,病灶显著吸收23例(占26.1%),吸收54例(占61.3%),不变11例(占12.5%)。有空洞80例中,空洞闭合23例(占28.1%),缩小45例(占56.2%),不变12例(占15.0%);严重胃肠道反应12例,经对症治疗后好转,肝功能异常15例,对症治疗好转10例,被迫停药3例,四肢关节疼痛10例,经对症治疗后好转。结论合理使用短程化疗,初治患者的规范化治疗是防止MDR的关键。对MDR-TB采用含左氧氟沙星联合其他二线药物治疗在临床上是可行和安全的。

Objective To investigate the levofloxacin with other second-line anti-tuberculosis drugs for a variety of drug-resistant tubercu- losis （MDR-TB） short-term efficacy. Methods 100 cases of multi-drug resistant tuberculosis were analyzed retrospectively and observed the multi-drug levofloxacin with multi-drug joint programmes. Results Irregular treatment 64 patients（64.0% ）, initial treatment regimen unreasonable in 20 cases（20.0% ）, 16 cases of primary resistance（ 16.0% ）. Treatment period sputum change 88 cases（88.0% ） in the treatment of 2 to 5 month,sputum conversion, 12 cases of treatment to 18 months were still positive sputum was a treatment failure; effective treatment of 88 cases before the full course of treatment and treatment of X-ray comparison, the lesions significantly absorbed in 23 cases （26.1% ）, absorbing 54 cases（61.3%）,unchanged in 11 cases（12.5%）. 80 cases were empty,hollow closed 23 cases（28.1%）,and narrow 45 cases（56.2%）,unchanged in 12 cases （15.0%）; serious gastrointestinal reactions in 12 cases,the symptoms improved after treatment,abnormal liver function 15 cases, 10 cases of symptomatic treatment improved,forced to stop 3 cases, 10 cases limbs,joint pain,the symptoms improved after treatment. Conclusion MDR-TB might be prevented by a combination of health education and rational use of short-course chemotherapy. Levofloxacin and other second-line anti-tuberculosis drugs are effective and tolerated in treating patients with NDR-TB.