含左氧氟沙星及卷曲霉素方案治疗耐多药肺结核近期疗效分析

A study on the clinical efficacy of a combination regimen with levofloxacin and capreomycin in the treatment of multi-drug resistant pulmonary tuberculosis

目的 观察和评价含左氧氟沙星和卷曲霉素联合化疗方案在耐多药肺结核 (MDR PTB)治疗中的疗效。方法 将 177例MDR PTB患者分为治疗组 88例和对照组 89例。化疗方案 :治疗组以左氧氟沙星和卷曲霉素为主 ,联合利福喷汀、异烟肼、对氨基水杨酸钠、吡嗪酰胺 ;对照组用链霉素、乙胺丁醇 ,联用药物同治疗组 ,疗程均为 2 1个月。结果 共有 16 1例患者完成化疗疗程 ,治疗组 82例 ,痰菌阴转率 83% ;对照组 79例 ,痰菌阴转率 5 8% ;痰菌阴转率治疗组明显高于对照组 (P <0 0 1) ;治疗组病灶显效率 5 0 % ,空洞闭合率 6 3% ,治疗组优于对照组 (P <0 0 1) ;治疗组的药物不良反应率为 31% ,对照组为 35 % ,两组比较差异无显著性 (P >0 0 5 )。结论 含左氧氟沙星和卷曲霉素的方案治疗MDR PTB ,有助于痰菌阴转和病变吸收好转 ,药物不良反应低 。

Objective To study the clinical efficacy of a combination therapy with levofloxacin(LVFX), capreomycin(CPM) and other second-line antituberculosis drugs in the treatment of multi-drug resistant pulmonary tuberculosis(MDR-TB). Methods 177 patients with MDR-TB were assigned to a study group (88 cases), treated with LVFX, CPM, pyrazinamide(PZA), rifapentine(RFT) and pasiniazid(PSZ); or a control group, treated with streptomycin(SM), ethambutol (EMB),PZA,RFT and PSZ. The course of treatment was 21 months. Results 82 cases in the study group and 79 cases in the control group completed the treatment. The sputum negative conversion rate in the study group (83%) was significantly higher than that in the control group(58%) ( P<0.01).The radiographic improvement rate was 50% in the study group, significantly higher than that in the control group(28%)( P<0.01). The closure rate of the lung cavities in the study group(63%) was higher than that in the control group(42%)( P<0.05). No significant difference was found in side-effects between the two groups (31% in the study group, and 35% in the control group respectively)( P>0.05). Conclusion The regimen including LEVX、CPM and other second-line anti-TB drugs was effective and safe for patients with MDR-TB.