左氧氟沙星与吡嗪酰胺治疗肺结核合并糖尿病的临床比较

Clinical comparison on Pyrazinamide and Levofloxacin in treatment of tuberculosis combined with diabetes

目的对比分析吡嗪酰胺和左氧氟沙星治疗肺结核合并糖尿病的临床疗效。方法以入院病例号为编号,根据随机数字表,将169名肺结核合并糖尿病患者随机分成两组,对照组84例,观察组85例。对照组采用吡嗪酰胺治疗,观察组采用左氧氟沙星治疗。检测治疗前后尿素氮(BUN)、肌酐(Scr)、血尿酸(BUA)和血药峰浓度;取患者晨起清洁中断晨尿,检测尿微量白蛋白(m Alb)。进行痰涂片检查,观察痰菌减少情况。结果对照组患者治疗后BUA检测值明显高于治疗前(P<0.01);且治疗后观察组BUA检测值明显低于对照组(P<0.01)。对照组患者治疗后m Alb检测值明显高于治疗前(P<0.05);且治疗后观察组患者m Alb明显低于对照组(P<0.05)。治疗后观察组痰菌转阴率为81.18%,明显高于对照组的57.14%(P<0.05)。治疗后观察组血药峰浓度为(14.03±1.12)μg/m L,明显高于对照组的(9.12±2.34)μg/m L(P<0.05)。结论左氧氟沙星治疗肺结核合并糖尿病疗效显著,且较吡嗪酰胺治疗肾脏损伤小,但在血药峰浓度升高时应密切观察不良反应。

Objective To explore the clinical curative effect of Pyrazinamide and Levofloxacin in the treatment of tuberculosis combined with diabetes. Methods Totally 169 patients with pulmonary tuberculosis complicated with diabetes meltitus were randomly divided into control group and observation group. The patients in control group were given Pyrazinamide and the patients in observation group were given Levofloxacin. Before and after treatment, the concentration of urea nitrogen （BUN）, creatinine （Scr）, serum uric acid （BUA）, urine trace albumin （mAlb）, and serum peak was detected. Sputum smear examination were used to observe the situation of sputum bacteria. Results The detection value of BUA in the control group was significantly higher than that before treatment （P 〈 0.01）; and the BUA value of the observation group was significantly lower than that of the control group （P 〈 0.01）. The detection value of mAlb in the control group was significantly higher than that before treatment （P 〈 0.05）, and the mAlb in the observation group was significantly lower than that in the control group （P 〈 0.05）. After treatment, the sputum negative conversion rate in the observation group was 81.18%, which was significantly higher than that of 57.14% in the control group （P 〈 0.05）. After treatment, the blood concentration of the observation group was （14.03 ~ 1.12） Ixg/mL, which was significantly higher than that of the control group （9.12 ~ 2.34） txg/mL （P 〈 0.05）. Conclusion Levofloxacin shows better therapeutic effect and lower rate to cause kidney damage on tuberculosis combining with diabetes compared with Pyrazinamide, but the adverse reactions should be closely observed on the rising of peak concentration in blood.