莫西沙星和左氧氟沙星在耐多药肺结核病治疗方案中的效果比较

Comparison of the effect of moxifloxacin and levofloxacin on treatment of multidrug resistant pulmonary tuberculosis

目的比较治疗耐多药肺结核病标准化联合方案中使用莫西沙星和左氧氟沙星的临床效果。方法选取自201 1年1月至2012年12月在浙江省玉环县人民医院治疗且病原学结果为耐多药肺结核病的连续病例,采用电脑生成随机数方式将108例患者分配入含莫西沙星治疗组和含左氧氟沙星治疗组。含莫西沙星组治疗方案:莫西沙星、帕司烟肼、吡嗪酰胺、丙硫异烟胺、利福喷丁、对氨基水杨酸钠、阿米卡星治疗3个月,随后用莫西沙星、帕司烟肼、吡嗪酰胺、丙硫异烟胺、利福喷丁治疗6个月,最后9个月用莫西沙星、利福喷丁、吡嗪酰胺、帕司烟肼治疗。含左氧氟沙星组治疗方案除将莫西沙星改为左氧氟沙星外,其他联合用药及疗程均与莫西沙星组相同。两组治疗时间均为18个月。结果含莫西沙星治疗组纳入53人,41人完成疗程;含左氧氟沙星治疗组纳入55人,44人完成疗程。两组病死率依次为9.4%(5/53)和9.1%(5/55),痰菌转阴率分别为87.8%(36/41)和84.1%(37/44),病灶吸收有效率分别为92.7%(38/41)和93.2%(41/44),空洞闭合率分别为39%(16/41)和43.2%(19/44),严重药物不良反应发生率分别为13.2%(7/53)和10.9%(6/55),两组间差异均无统计学意义。结论在多耐药肺结核病治疗方案中,莫西沙星与左氧氟沙星相比无明显临床优势。

Objective To compare the clinical effect of moxifloxacin and levofloxacin on treatment of multi-drug resistant pul- monary tuberculosis（TB）. Methods From Jan 2011 to Dec 2012,108 patients who were proved to be multi-drug resistant to tubercu- losis in Yuhuan County People＇s Hospital of Zhejiang Province were included in the study. The patients were divided into moxifloxacin treatment group or levofloxaein treatment group by computer-generated random number and randomly allocated method. The treatment regimens were as follows ： in moxifloxacin treatment group,the patients were given moxifloxacin, pasiniazid, pyrazinamide, protionamide, rifapentine,sodium aminosalicylate, and amikacin for 3 months, followed by 6 months treatment of moxifloxacin, pyrazinamide, pro- tionamide,pasiniazid and rifapentine,then moxifloxacin,rifapentine,pyrazinamide,andpasiniazid for9 months. In levofloxacin treatment group,moxifloxacin was replaced by levofloxacin, and other combinations were same as moxifloxacin group. The treatment time was 18 months in 2 groups. Results At the end of the study,41 of 53 patients finished the treatment in moxifloxacin-group and 44 of 55 pa- tients finished the treatment in levofloxacin-group. Mortalities were 9.4% （ 5/53 ） in moxifloxacin-group and 9.1% （5/55） in levofloxa- cin-group, respectively. The sputum negative rate was 87.8% （36/41） and 84.1% （37/44） in each group, respectively. The effec- tive rate of chest X ray was 92.7% （38/41） in moxifloxacin group and 93.2% （41/44） in levofloxacin group, and the cavity closure rate were 39% （ 16/41 ） and 43.2% （19/44）. The rate of serious adverse drug reactions was 13.2% （7/53） and 10.9% （6/55） ,re- spectively. There was no significant difference between 2 groups. Conclusion Moxifloxacin combined with other drugs to treat multi- drug-resistant TB had no significant advantages compared to levofloxacin combined with the same drugs.