不同抗结核方案治疗结核性脑膜炎的疗效比较

The comparison of the efficacy of different anti -tuberculosis schemes in the treatment of tuberculous meningitis

目的：探讨改良抗结核方案治疗结核性脑膜炎的疗效与安全性。方法对60例结核性脑膜炎患者采用随机数字表法分为两组，每组30例，传统抗结核组采用异烟肼、利福平、吡嗪酰胺、链霉素等传统抗结核方案治疗，改良抗结核组采用含异烟肼、利福平、吡嗪酰胺、左氧氟沙星的抗结核方案进行12个月的治疗，通过临床表现和辅助检查、脑脊液动态变化、统计学方法等手段评价其疗效与安全性。结果改良抗结核组总有效率明显高于传统抗结核组（86．6％比63．3％，χ2＝4．36，P ＜0．05）；改良抗结核组治疗后脑脊液常规及生化指标明显优于传统抗结核组（均 P ＜0．05）；两组不良反应发生率差异无统计学意义（26．6％比16.7％，χ2＝0．88，P ＞0．05）。结论左氧氟沙星联合其他一线抗结核药，并结合激素、脱水、改善脑功能等综合措施治疗结核性脑膜炎是值得推荐的抗结核方案。

Objective To evaluate the clinical efficacy and safety of modified anti -tuberculosis scheme in the treatment of tuberculous meningitis.Methods 60 cases with tuberculous meningitis were randomly divided into two groups.We enrolled 30 patients in each group.The traditional anti -tuberculosis group used traditional anti -tuberculosis scheme with isoniazid,rifampicin,pyrazinamide,streptomycin,and the modified anti -tuberculosis group was given isoniazid,rifampicin,pyrazinamide,levofloxacin,the treatment course of tuberculous meningitis was 12 months.The efficacy and safety through clinical manifestations and laboratory examinations,the dynamic changes of cerebrospinal fluid were evaluated by statistical methods.Results The total effective rate of the modified anti -tuberculosis group was significantly higher than the traditional anti -tuberculosis group（86.6% vs.63.3%,χ2 =4.36,P 〈0.05）.The cerebrospinal fluid routine and biochemical index in the modified anti -tuberculosis group were obviously superior to the traditional anti -tuberculosis group after treatment（all P 〈0.05）.There was no significant difference in the incidence of adverse reactions between the two groups（26.6% vs.16.7%,χ2 =0.88,P 〉0.05）.Conclusion Levofloxacin combined with other first -line anti -tuberculosis drugs,glucocorticoids,dehydration and other comprehensive measures improved brain function for the treatment of tuberculous meningitis is recommended.