氯霉素与多西环素治疗恙虫病的疗效及不良反应比较

Comparison of the efficacy and adverse reactions of chloramphenicol and doxycycline in the treatment of tsutsuga-mushi disease

目的比较氯霉素与多西环素治疗恙虫病的疗效及不良反应。方法选取2018年8月-2020年6月于广东省高州市人民医院接受治疗的恙虫病患者60例,根据随机数字表法分为氯霉素组和多西环素组各30例。氯霉素组采用氯霉素治疗,多西环素组采用多西环素治疗。比较2组临床疗效、症状改善时间、治疗前后血清细胞因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、粒细胞-集落刺激因子(C-CSF)]水平、不良反应。结果多西环素组临床总有效率为93.33%,高于氯霉素组的73.33%(x^(2)=4.320,P=0.038);多西环素组退热时间、结痂消失时间、淋巴结肿大消失时间及肝损害恢复时间均短于氯霉素组(P<0.01);治疗后,2组血清IL-6、TNF-α、C-CSF水平均下降,且多西环素组低于氯霉素组(P<0.01);2组不良反应总发生率比较差异无统计学意义(x^(2)=0.162,P=0.688)。结论相较于氯霉素,多西环素可明显缩短恙虫病患者症状消失时间,提高临床疗效,降低机体炎性细胞因子水平,且不增加不良反应,是一种有效、安全的治疗方案。

Objective To compare the curative effects and adverse reactions of chloramphenicol and doxycycline in the treatment of tsutsugamushi disease.Methods A total of 60 patients with tsutsugamushi who were treated in the People’s Hospital of Gaozhou,Guangdong Province from August 2018 to June 2020 were selected,and they were divided into chloramphenicol group and doxycycline group with 30 cases according to the random number table method.The chloramphenicol group was treated with chloramphenicol,and the doxycycline group was treated with doxycycline.Compared the clinical efficacy,time of symptom improvement,serum cytokines[lnterleukin-6(IL-6),tumor necrosis factor-α(TNF-α),granulocyte colony stimulating factor(C-CSF)]levels before and after treatment,and adverse reactions of two groups.Results The total clinical effective rate of doxycycline group was 93.33%,which was higher than 73.33%of chloramphenicol group(x^(2)=4.320,P=0.038).The antipyretic time,the disappearance time of scab,the disappearance time of lymph node enlargement and the recovery time of liver damage in the doxycycline group were shorter than those in the chloramphenicol group(P<0.01).After treatment,the levels of serum IL-6,TNF-α and C-CSF in the two groups decreased,and the doxycycline group was lower than the chloramphenicol group(P<0.01).There was no significant difference in the total incidence of adverse reactions between the two groups(x^(2)=0.162,P=0.688).Conclusion Compared with chloramphenicol,doxycycline can significantly shorten the disappearance time of tsutsugamushi disease symptoms,improve clinical efficacy,reduce the level of inflammatory cytokines in the body,and do not increase adverse reactions,it is an effective and safe treatment plan.