卷曲霉素、左氧氟沙星及对氨基水杨酸钠联合方案治疗耐多药和可疑耐多药肺结核疗效分析

Clinical efficacy of a combination regimen with capreomycin, levofloxacin and sodium aminosalicylate in the treatment of multi-drug resistant pulmonary tuberculosis

目的评价卷曲霉素、左氧氟沙星及对氨基水杨酸钠联合化疗方案在耐多药肺结核（MDR-PTB）治疗中的效果。方法将120例MDR-PTB患者分为治疗组和对照组各60例。治疗方案：治疗组以卷曲霉素、左氧氟沙星及对氨基水杨酸钠为主，联合利福喷丁、异烟肼、吡嗪酰胺治疗；对照组用阿米卡星、乙胺丁醇，联合用药同治疗组，疗程均为16个月。结果120例患者均完成化疗疗程，治疗组痰菌阴转率为83．33％，明显高于对照组的65．00％（X2=5．26，P=0．02）；治疗组病灶吸收率为90．00％，空洞闭合率为71．43％，显著高于对照组的病灶吸收率66．67％，空洞闭合率31．25％（分别X2=9．62，P=0．00；X2=10．82，P=0．00）；治疗组药物不良反应率为35．00％，对照组为33．33％，两组差异无显著性（X2=0．04，P=0．85）。结论卷曲霉素、左氧氟沙星及对氨基水杨酸钠的联合化疗方案治疗MDR-PTB，痰菌阴转和病灶吸收好转较优，药物不良反应并未增加，值得临床推广应用。

Objective To evaluate the clinical efficacy of a combination therapy with eapreomycin, levofloxacin and sodium aminosalicylate in the treatment of multi-drug resistant pulmonary tuberculosis （MDR-PTB）. Methyls One hundred and twenty patients with MDR-PTB were divided into treatment group（60 cases） and control group（60 cases）. In the treatment group, patients mainly received treatment of capreomycin, tevofloxacin and sodium aminosalicylate, and combined with rifapentine, isoniazid and pyrazinamide; in control group, patients mainly received treatment of amikacin, ethambutol, combined treatment was the same with that of treatment group, the course of treatment were both 16 months. Results All patients received 16 months treatment, the sputum negative conver sion rate of the treatment group was 83.33%, which was significantly higher than 65.00% of control group （X2= 5.26, P = 0. 02） . The focal absorption rate and cavity closure rate in treatment group was 90. 0% and 71.43% respectively, which was obviously higher than 66. 67% and 31.25% of control group respectively （X2 = 9. 62, P = 0. 00; X2 = 10. 82, P = 0. 00） ; Adverse effects in treatment group and control group was 35.00% and 33.33% re spectively, there was no significant difference between two groups （X2 = 0. 04, P = 0. 85）. Concision The combi nation treatment of capreomycin, levofloxaein and sodium aminosalicylate is effective and safe for patients with MDR-PTB.