涂片阳性初治失败空洞型肺结核采用左氧氟沙星经纤维支气管镜介入灌注治疗的疗效

Smear-positive initial treatment failure of hollow tuberculosis treated with levofloxacin by fiberoptic bronchoscopy

目的观察涂片阳性初治失败空洞型肺结核采用左氧氟沙星经纤维支气管镜介入灌注治疗的疗效。方法回顾性分析2017年4月至2018年4月在本院进行治疗的96例涂片阳性初治失败空洞型肺结核患者的临床资料,其中48例患者仅经过2HRZAmE/6HRE方案常规治疗作为对照组,48例患者采用左氧氟沙星经纤维支气管镜介入灌注治疗作为实验组。对比两组患者连续治疗6个月末的痰菌阴转率、空洞闭合率、病灶吸收率、症状改善率、外周血CD3+、CD4+、CD8+T淋巴细胞百分率、CD4+/CD8+比值、药物不良反应。结果治疗6个月末时实验组痰菌阴转率为89.58%显著高于对照组的54.17%(χ^2=14.890,P<0.01),空洞闭合率58.33%高于对照组的37.50%(χ^2=4.171,P<0.05),病灶吸收率为54.17%高于对照组的33.33%(χ^2=4.230,P<0.05),症状改善率83.33%高于对照组的64.58%(χ^2=4.361,P<0.05);实验组外周血CD3+、CD4+T淋巴细胞百分比率及CD4+/CD8+比值水平明显高于对照组(P<0.05),CD8+T淋巴细胞百分比率明显低于对照组(P<0.05);治疗期间两组药物不良反应发生率比较差异无统计学意义。结论涂片阳性初治失败空洞型肺结核采用左氧氟沙星经纤维支气管镜介入灌注治疗疗效显著,安全性好。

Objective To observe the efficacy of levofloxacin via fiberoptic bronchoscopy in the treatment of smear-positive primary cavity failure. Methods The clinical data of 96 patients with smear-positive initial failure cavitary pulmonary tuberculosis who were treated in our hospital from April 2017 to April 2018 were retrospectively analyzed. Among them, 48 patients were only treated with 2HRZAmE/6HRE regimen. The patients were included in the control group, 48 patients were treated with the interventional therapy of left ofloxacin via fiberoptic bronchoscopy as the experimental group. The sputum negative conversion rate, cavity closure rate, lesion absorption rate, symptom improvement rate, percentage of peripheral blood CD3+, CD4+, CD8+T lymphocytes, CD4+/CD8+ ratio, and adverse drug reactions of the two groups were compared at the end of 6 months of continuous treatment. Results At the end of 6 months, the negative conversion rate of sputum in the experimental group was 89.58%, which was significantly higher than that in the control group 54.17%(χ2=14.890, P<0.01), and the cavity closure rate was 58.33% higher than the control group 37.50%(χ2=4.171, P<0.05), the lesion absorption rate was 54.17% higher than that of the control group 33.33%(χ2=4.230, P<0.05), and the symptom improvement rate was 83.33% higher than the control group's 64.58%(χ2= 4.361, P<0.05);the percentage of CD3+, CD4+ T lymphocyte percentage and CD4+/CD8+ ratio in peripheral blood of the experimental group were significantly higher than that of the control group (P<0.05), and the percentage of CD8+ T lymphocytes was significantly lower than that of the control group (P<0.05);There was no significant difference in the incidence of adverse drug reactions between the two groups during the treatment period. Conclusion The smear-positive initial treatment of cavitary pulmonary tuberculosis with levofloxacin by fiberoptic bronchoscopy interventional therapy is effective and safe.