莫西沙星联合卷曲霉素对耐多药肺结核的疗效及对患者免疫和肝功能的影响

Effect of Moxifloxacin Combined with Capreomycin on the Immunologic and Liver Function and the Clinical Efficacy in the Treatment of Patients with Multi-drug Resistant Tuberculosis

目的探讨莫西沙星联合卷曲霉素对耐多药肺结核的疗效及对患者免疫功能、肝功能的影响。方法选取我院收治的耐多药肺结核患者98例,随机分为对照组和实验组,各49例,两组均在常规治疗基础上,对照组加用左氧氟沙星联合卷曲霉素治疗,实验组加用莫西沙星联合卷曲霉素治疗。比较两组治疗后痰菌转阴情况,检测并比较两组治疗前后炎性因子水平、免疫功能指标及肝功能指标的变化。结果治疗后实验组痰菌转阴率(63.27%)高于对照组(32.65%)(P<0.05);治疗后两组患者CD4^+细胞数量、CD4^+/CD8^+比值、IgA、IgG、IgM水平均较治疗前升高(P<0.05或<0.01),且实验组高于对照组(P<0.05或<0.01);CD8^+细胞数量较治疗前下降(P<0.01),且实验组低于对照组(P<0.01);治疗后两组患者白细胞介素-1(IL-1)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平均较治疗前下降,且实验组低于对照组(P<0.01);两组患者治疗后IL-17水平较治疗前升高(P<0.01),且实验组高于对照组(P<0.01);治疗后两组碱性磷酸酶(ALP)、门冬氨酸转氨酶(ALT)、丙氨酸转氨酶(AST)、总胆红素(STB)水平均较治疗前升高(P<0.01),总蛋白(TP)水平较治疗前下降(P<0.01),但治疗前后两组患者肝功能指标均在正常范围内,且治疗前后两组间各指标差异无统计学意义(P>0.05)。结论莫西沙星联合卷曲霉素治疗耐多药肺结核患者疗效优于左氧氟沙星联合卷曲霉素方案,并能提高患者体液免疫和细胞免疫功能,且对肝脏功能影响较小,具有一定治疗优势。

Objective To explore the effect of moxifloxacin combined with capreomycin on the immunologic and liver function and the clinical efficacy in the treatment of patients with multi-drug resistant tuberculosis.Methods 98 cases with multi-drug resistant tuberculosis in our hospital were selected and were divided into control group and experiment group,49 cases for each group. Patients of two groups were treated with conventional therapy. Patients of control group were treated with levofloxacin combined with capreomycin on the basis of conventional therapy while patients of experiment group were treated with moxifloxacin combined with capreomycin on the basis of conventional therapy. The sputum bacterium turns shade were compared. The changes of the levels of inflammatory factor,immunologic function indexes and liver function indexes were detected and compared. Results The sputum bacterium turns shade rate of experiment group was 63.27%,which was significantly higher than 32.65% of control group（P〈0.05）. The number of CD4^＋,the proportion of CD4^＋/CD8^＋,levels of IgA,IgG,IgM increased significantly after treatment（P〈0.05 or 0.01）and those of experiment group was significantly higher than those of control group（P〈0.05 or 0.01）. The number of CD8^＋decreased significantly after treatment（P〈0.01）and that of experiment group was significantly lower than that of control group（P〈0.01）. The levels of IL-1,IL-6 and TNF-α of two groups after treatemnt decreased significantly（P〈0.01）,and that of experiment group was significantly lower than that of control group（P〈0.01）.The IL-17 levels of two groups after treatemnt increased significantly（P〈0.01）,and that of experiment group was significantly higher than that of control group（P〈0.01）. The liver function indexes of two groups before and after treatemnt were in the normal range. The ALP,ALT,AST and STB levels of two groups after treatemnt increased significantly（P〈0.01）. The TP levels of two groups after treatemnt decreased significantly（P〈0.01）,and the difference between two groups was not significant（P〈0.05）. Conclusion Moxifloxacin combined with capreomycin can increase the humoral immunity and cellular immunity of patients with multi-drug resistant tuberculosis. It can improve the inflammatory factor levels and liver function indexes. Levofloxacin combined with capreomycin is superior in treatment of multi-drug resistant tuberculosis.