左氧氟沙星联合利福喷丁对复治涂阳肺结核患者疗效及对痰菌转阴率、免疫功能指标的影响研究

Study on the influence of levofloxacin combined with rifapentine on the curative effects,sputum negative conversion rate and immune function indicators of recurrent smear-positive pulmonary tuberculosis patients

目的研究左氧氟沙星^(+)利福喷丁运用于复治涂阳肺结核中的价值。方法选择2019年3月-2020年11月本院收治的74例复治涂阳肺结核患者作为研究对象,按随机数表法分为甲组和乙组两组,每组各37例。甲组患者接受左氧氟沙星^(+)利福喷丁,乙组患者接受链霉素^(+)利福喷丁。对两组患者治疗总有效率进行测评,对比两组患者用药2个月、4个月、6个月后的痰转阴率以及用药6个月后的复发率。用药前、用药6个月后测定两组患者的免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、辅助性T细胞(CD4^(+))、细胞毒性T细胞(CD8^(+))、白介素-6(IL-6)、白介素-10(IL-10)、白介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)指标,并进行生活质量(QOL)评分调查,统计不良反应的发生率。结果甲组患者治疗总有效率高于乙组,差异有统计学意义(P<0.05);用药2个月、4个月、6个月后,甲组患者的痰转阴率高于乙组,差异有统计学意义(P<0.05);用药6个月后,甲组患者的复发率低于乙组,差异有统计学意义(P<0.05);用药前,两组患者的IgA、IgG、IgM、CD4^(+)、CD8^(+)指标水平比较,差异无统计学意义(P>0.05);用药6个月后,甲组患者的IgA、IgG、IgM、CD4^(+)指标水平高于乙组、CD8^(+)指标水平则低于乙组,差异具有统计学意义(P<0.05);用药前,两组患者的IL-6、IL-10、IL-18、TNF-α指标水平比较,差异无统计学意义(P>0.05);用药6个月后,甲组患者的IL-6、IL-10、IL-18、TNF-α指标水平均低于乙组,差异具有统计学意义(P<0.05);用药前,两组患者的日常生活、精神、食欲、疲乏、睡眠评分比较,差异无统计学意义(P>0.05);用药后,甲组的日常生活、精神、食欲、疲乏、睡眠评分高于乙组,差异具有统计学意义(P<0.05);甲组患者不良反应发生率低于乙组,差异有统计学意义(P<0.05)。结论左氧氟沙星^(+)利福喷丁的疗效更好,可促进痰转阴率增多,并减少不良反应及复发情况出现,促进免疫功能恢复,清除炎性反应,提升生活质量,值得推广。

Objective To study the clinical value of levofloxacin and rifapentine in recurrent smear-positive pulmonary tuberculosis patients.Methods 74 recurrent smear-positive pulmonary tuberculosis patients those were admitted to our hospital from March 2019 to November 2020 were selected as study objects and they were randomly divided into two groups of group A and group B,37 cases in each group.Group A took Levofloxacin and Rifapentine;group B took Streptomycin and Rifapentine.The total effectiverate of treatment was evaluated;sputum negative conversion rate after 2months,4months and 6months,and recurrence rate after 6months were compared between the two groups.Immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM),helper T cell(CD4^(+)),cytotoxic T cell(CD8^(+)),interleukin-6(IL-6),interleukin-10(IL-10),interleukin-18(IL-18)and tumor necrosis factor-α(TNF-α)of the two groups were detected before medication and at 6months aftermedication.Quality of life(QOL)score survey was conducted,adverse drug reactions was counted.Results The total effective treatment rate in group A was higher than that of group B(P<0.05);After 2m,4m and 6m of medication,the sputum negative conversion rate in group A was higher than that of group B,but the recurrence rate in group A was lower than that of group B(P<0.05).Before medication,there were no significantly difference inthe immune function indicators including IgA,IgG,IgM,CD4^(+),and CD8^(+)between the two groups(P>0.05);six months after medication,IgA,IgG,IgM and CD4^(+)levels in group A were higher than those of group B,but CD8^(+)values were lower than those of group B(P<0.05).Before medication,there were no significantly difference in the inflammatory factors of IL-6,IL-10,IL-18,and TNF-αbetween the two groups(P>0.05);six months after medication,IL-6,IL-10,IL-18 and TNF-αlevels in group A were lower than those of group B(P<0.05).Before medication,there were no significant differences in scores of daily life,spirit,appetite,fatigue and sleep between 2 groups(P>0.05).After medication,scores of daily life,spirit,appetite,fatigue and sleep in group A were higher than those in group B,and the differences were statistically significant(P<0.05).The adverse drug rate in group A was lower than that of group B(P<0.05).Conclusions Levofloxacin combined with rifapentine could achieve better efficacy,it increases the sputum negative conversion rate,reduces the adverse drug reactions and recurrence rate,improves the recovery ofimmune function,clears inflammatory response improves the quality of life.It is worthy of promotion.