左氧氟沙星联合头孢唑肟钠治疗急性单纯性上尿路感染的单中心回顾性研究

A single-center retrospective clinical study of levofloxacin combined with cefzoxime sodium for acute simple upper urinary tract infection

目的探讨左氧氟沙星联合头孢唑肟钠治疗急性单纯性上尿路感染的临床应用价值。方法回顾性分析2019年6月至2023年6月铜陵市人民医院急诊内科收治的急性单纯性上尿路感染患者86例病例资料,按治疗方案不同分为左氧氟沙星组(n=29)、头孢唑肟钠组(n=30)及联合组(n=27)。左氧氟沙星组予以初始剂量0.5 g乳酸左氧氟沙星氯化钠注射液静脉输注,1次/d。头孢唑肟钠组予以初始剂量2.0 g注射用头孢唑肟钠混合100 mL 0.9%氯化钠溶液静脉输注,2次/d。两组均待3 d病情稳定且经药物敏感试验培养呈阴性,继续口服用药治疗2周。联合组即在左氧氟沙星治疗基础上联合头孢唑肟钠治疗,治疗方法同左氧氟沙星组及头孢唑肟钠组。比较3组的临床疗效,症状改善情况,治疗前、治疗2周后的炎症因子[肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)及白细胞介素-6(IL-6)]水平及不良反应。结果联合组总有效率为96.30%,均高于左氧氟沙星组(65.51%)、头孢唑肟钠组(66.67%),差异有统计学意义(P<0.05)。联合组的腰痛消失时间、尿路刺激征消失时间及退热时间分别为(9.46±2.61)、(5.49±1.52)、(3.19±0.96)d,均短于左氧氟沙星组[(12.05±3.58)、(7.24±1.86)、(4.12±1.09)d]及头孢唑肟钠组[(11.86±3.75)、(7.19±1.93)、(4.05±1.01)d],差异均有统计学意义(P<0.05)。3组治疗2周后的TNF-α、CRP及IL-6水平均较治疗前有所降低,且联合组治疗后TNF-α、CRP及IL-6水平分别为(23.37±7.62)pg/mL、(6.82±1.02)mg/L、(51.67±8.92)ng/L,均低于左氧氟沙星组[(39.40±8.26)pg/mL、(8.21±1.41)mg/L、(70.24±10.38)ng/L]及头孢唑肟钠组[(38.72±8.17)pg/mL、(8.05±1.36)mg/L、(71.25±10.24)ng/L],差异均有统计学意义(P<0.05)。3组总不良反应发生率比较,差异无统计学意义(P>0.05)。结论急性单纯性上尿路感染患者应用左氧氟沙星联合头孢唑肟钠可有效改善临床症状,减轻炎症反应,且不增加并发症发生风险,具有一定安全性。

Objective To investigate the clinical value of levofloxacin combined with cefazoxime sodium in the treatment of acute simple upper urinary tract infection.Methods A retrospective study was conducted on 86 patients with acute simple upper urinary tract infection admitted to Department of Emergency Intenal Medicine,Tongling People's Hospital from June 2019 to June 2023,who were divided into the levofloxacin group(n=29),the cefazoxime sodium group(n=30)and the combined group(n=27)according to treatment regimen.The levofloxacin group was given an initial dose of 0.5 g lactate levofloxacin sodium chloride injection intravenously,once a day.The ceftriaxone sodium group was given an initial dose of 2.0 g injection of ceftriaxone sodium mixed with 100 mL of 0.9%sodium chloride solution intravenously,twice a day.Both groups remained stable for 3 days and tested negative for drug sensitivity in culture.They continued to receive oral medication for 2 weeks.The combination group was a combination of levofloxacin treatment and ceftriaxone sodium treatment,with the same treatment method as the levofloxacin group and ceftriaxone sodium group.The clinical efficacy,symptom improvement,the levels of inflammatory factors[tumor necrosis factor alpha(TNF-α),C-reactive protein(CRP),and interleukin-6(IL-6)]before treatment and after 2 weeks of treatment,and adverse reactions of the three groups were compared.Results The total effective rate of the combination group was 96.30%,which was higher than that of the levofloxacin group(65.51%)and the ceftriaxone sodium group(66.67%),and the difference was statistically significant(P<0.05).The disappearance time of lower back pain,urinary tract irritation sign,and fever in the combination group were(9.46±2.61),5.49±1.52),and(3.19±0.96)d,respectively,which were shorter than those in the levofloxacin group[(12.0±3.58),(7.24±1.86),(4.12±1.09)d]and the ceftriaxone sodium group[(11.86±3.75),(7.19±1.93),and(4.05±1.01)d],and the differences were statistically significant(P<0.05).After 2 weeks of treatment,the levels of TNF-α,CRP,and IL-6 in the three groups were lower than those before treatment,and the levels of TNF-α,CRP,and IL-6 in the combination group were(23.37±7.62)pg/mL,(6.82±1.02)mg/L,and(51.67±8.92)ng/L,respectively,which were lower than those in the levofloxacin group[(39.40±8.26)pg/L,(8.21±1.41)mg/L,(70.24±10.38)ng/L]and the ceftriaxone sodium group[(38.72±8.17)pg/mL,(8.05±1.36)mg/L,and(71.25±10.24)ng/L],the differences were statistically significant(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions among the three groups(P>0.05).Conclusion Levofloxacin combined with cefazoxime sodium can effectively improve clinical symptoms and reduce inflammatory response in patients with acute simple upper urinary tract infection,without increasing the risk of complications,and has a certain safety.