加替沙星联合治疗方案治疗耐多药肺结核疗效分析

Curative effect of combined treatment with gatifloxacin in treatment of multi-drug resistant pulmonary tuberculosis

目的评价加替沙星(Gatifloxacin)联合其他抗结核药物治疗耐多药结核的疗效。方法回顾性分析荆门市第二人民医院神经内科、消化感染科2011年7月—2017年1月收治的250例耐多药结核患者治疗情况,并随机分为治疗组与对照组,比较两组根据治疗方法治疗3月末、8月末、疗程结束时痰菌阴转率,疗程结束时肺部CT空洞吸收,不良反应事件及疗程结束Gfx、Lfx耐药等情况。结果治疗组及对照组治疗方案对耐多药结核均有效。治疗3月末两组痰菌阴转率分别为44%,40%、8月末分别为80%,64%、疗程结束时分别为88%,72%;疗程结束肺部CT病灶吸收率分别为84.8%,64.4%。两组同一时期同一项目数据间差异有统计学意义(P<0.05)。两组除了血糖紊乱差异有统计学意义(P<0.05),其余不良反应发生率差异无统计学意义(P>0.05);疗程结束Gfx再耐药率远低于Lfx。结论 Gfx联合其他抗结核药物治疗耐多药结核疗效显著,再耐药率低,不良反应发生率(除可能致血糖紊乱)低,值得临床备选使用。

Objective To evaluate the efficacy of gatifloxacin （Gfx） combined with other anti-tuberculosis drugs in the treatment of multi-drug resistant tuberculosis. Methods The data of 250 patients with multi drug-resistant tuberculosis were collected and analyzed retrospectively in the Department of Neurology and Department of Gastroenterology and Infectious diseases in Jingmen Second People＇s Hospital from July 2011 to January 2017. The treatment group and control group were compared at the end of the third month, the end of the eighth month, and the end of the whole treatment course, including the sputum negative conversion rate, lung cavity absorption （by the CT examinations） at the end of the treatment course, adverse events and Gfx and levofloxacin （Lfx） resistant situation at the end of the treatment course. Results The therapeutic schedules of the treatment group and control group were both effective in the treatment of multi-drug resistant tuberculosis. However, the sputum negative conversion rates of the treatment group and control group were 44% and 40% at the end of the third month, 80% and 64% at the end of the eighth month, and 88% and 72% at the end of the whole treatment course respectively. The absorption rates of lesions in the lung （by the CT examinations） of the treatment group and control group were 84.8% and 64.4% at the end of the whole treatment course respectively, and there were statistically significant differences between the two groups in the same item datum and in the same period （ all P〈0.05）. There were no significant differences between the two groups in the incidence of adverse reactions except for blood glucose disorder. The resistance rate of Gfx was much lower than that of Lfx. Conclusions Gfx combined with other anti-tuberculosis drugs has a significant curative effect in the treatment of multi-drug resistant tuberculosis. The drug resistance rate is low. Gfx does not significantly increase the incidence of adverse reactions except for possible blood glucose disorder.