左氧氟沙星替代吡嗪酰胺治疗初治菌阳老年肺结核的效果及安全性

Efficacy and Safety of Levofloxacin Instead of Pyrazinamide in the Treatment of Elderly Pulmonary Tuberculosis with Positive Bacteria Initially Treated

目的:观察左氧氟沙星替代吡嗪酰胺治疗初治菌阳老年肺结核的效果。方法:回顾性选取2019年7月-2020年1月238例广州市胸科医院收治的菌阳老年肺结核的初治患者。其中126例患者常规接受吡嗪酰胺治疗为对照组,112例患者则接受左氧氟沙星替代治疗为研究组。比较两组治疗1、2、4、6个月的菌阳转阴率,治疗后病变部位病灶吸收情况及不良反应。结果:研究组治疗1、2、4、6个月菌阳转阴率高于对照组,但差异无统计学意义(P>0.05)。研究组治疗后病变部位病灶总吸收率高于对照组(P<0.05)。研究组肝损伤、肾损伤、恶心呕吐、高尿酸血症、神经系统症状、皮肤异常反应发生率均低于对照组(P<0.05)。结论:在初治菌阳老年肺结核患者的治疗中,以左氧氟沙星替代吡嗪酰胺治疗,可帮助患者增加病灶吸收的范围,并在整个治疗过程中,减少不良反应的发生,可为患者提供效果更佳的治疗方案。

Objective:To observe the effect of Levofloxacin instead of Pyrazinamide in the treatment of elderly pulmonary tuberculosis with positive bacteria initially treated.Method:From July 2019 to January 2020,a total of 238 cases of elderly pulmonary tuberculosis with positive bacteria initially treated in Guangzhou Chest Hospital were retrospectively selected.Among them,126 patients received routine Pyrazinamide treatment as the control group and 112 patients received Levofloxacin instead of Pyrazinamide treatment as the study group.The rate of bacterial positive turn to negative 1,2,4 and 6 months of treatment,absorption condition of lesions after treatment and adverse reactions were compared between the two groups.Result:In the study group,the rate of positive turn to negative of bacteria 1,2,4 and 6 months of treatment was higher than that in the control group,but the difference was not statistically significant(P>0.05).After treatment,the total absorption rate of lesions in the study group was higher than that in the control group(P<0.05).The incidences of liver injury,kidney injury,nausea and vomiting,hyperuricemia,neurological symptoms and abnormal skin reactions in the study group were lower than those in the control group(P<0.05).Conclusion:In the treatment of patients with elderly pulmonary tuberculosis with positive bacteria initially treated,Levofloxacin instead of Pyrazinamide treatment can help patients increase the scope of lesions absorption,reduce the occurrence of adverse reactions in the whole treatment process,and provide better treatment schemes for patients.