左氧氟沙星与卷曲霉素联合治疗耐多药肺结核的疗效观察

Effect of levofloxacin combined with capreomycin on treatment of multidrug-resistant Mycobacterium tuberculosis

目的探讨左氧氟沙星与卷曲霉素联合治疗耐多药肺结核分枝杆菌的疗效及其对患者免疫功能、肝功能的影响,为该治疗方案的临床推广提供依据。方法选择2014年7月-2015年1月医院收治耐多药肺结核分枝杆菌患者103例为研究对象,将患者随机分为观察组53例和对照组50例,观察组给予3CVLPa/18VLPa治疗方案,对照组采用3SELPaZ/18ELPa治疗方案,比较两组患者治疗6个月后痰菌转阴率、治疗前及治疗4周免疫功能变化及对肝功能的影响。结果观察组与对照组的耐药构成比较,差异无统计学意义;治疗6月时,观察组痰菌转阴35例,转阴率66.04%,显著高于对照组(P<0.05);治疗4周后观察组CD4+、IgA、IgM、IgG较治疗前均显著升高,均显著高于对照组(P<0.05),CD8+水平显著降低,显著低于对照组(P<0.05),对照组治疗前后CD4+、CD8+、IgA、IgM、IgG均无显著变化;两组患者治疗4周后较治疗前ALP、ALT、AST及STB水平均显著升高,TP水平显著降低,组间比较差异均无统计学意义。结论左氧氟沙星与卷曲霉素联合治疗方案能够有效杀伤耐多药肺结核分枝杆菌,改善患者免疫功能,且不会对患者肝脏功能产生损伤。

OBJECTIVE To explore the effect of levofloxacin combined with capreomycin on treatment of multidrugresistant Mycobacterium tuberculosis and observe the influence on immune function and liver function of the patients so as to provide guidance for clinical promotion of the treatment program.METHODS A total of 103 patients with multidrug-resistant M.tuberculosis who were treated in the hospital from Jul 2014 to Jan 2015 were recruited as the study objects and randomly divided into the observation group with 53 cases and the control group with 50 cases.The observation group was treated with 3CVLPa/18 VLPa,and the control group was given 3SELPaZ/18 ELPa.The negative rate of sputum bacteria after the treatment for 6 months,immune function before the treatment and after the treatment for 4weeks,and influence on liver function were observed and compared between the two groups of patients.RESULTS There was no significant difference in the constituent ratio of drug resistance between the observation group and the control group.The negative rate of sputum bacteria of the observation group was 66.04%（35cases）after the treatment for 6months,significantly higher than that of the control group（P〈0.05）.The levels of CD4＋,IgA,IgM,and IgG of the observation group were remarkably elevated after the treatment for 4weeks,significantly higher than those of the control group（P〈0.05）;the level of CD8＋of the observation group was remarkably reduced,significantly lower than that of the control group（P〈0.05）.The levels of CD4＋,CD8＋,IgA,IgM,and IgG of the control group did not change significantly before and after the treatment.The levels of ALP,ALT,AST,and STB of the two groups of patients were remarkably elevated after the treatment for 4weeks,the level of TP was significantly reduced,and there was no significant between-group difference.CONCLUSIONLevofloxacin combined with capreomycin can effectively kill the multidrug-resistant M.tuberculosis and improve the immune function of the patients,without resulting in damage to the liver function.