李冶

[摘要] 目的 探討莫西沙星联合卷曲霉素治疗耐多药肺结核的疗效。 方法 选取沈阳市第十人民医院肺癌诊疗一体化中心2018年2月至2019年4月收诊的耐多药肺结核患者184例为研究对象，以电脑随机法分为两组，对照组92例患者应用常规抗痨化疗方案+左氧氟沙星+阿米卡星治疗，观察组92例患者应用常规抗痨化疗方案+莫西沙星+卷曲霉素治疗，对比两组的痰菌转阴率、病灶吸收率、肝功能指标、不良反应发生率及免疫功能指标。 结果 治疗3、6个月后的痰菌转阴率比较，观察组均高于对照组（P<0.05）;观察组治疗6个月后的病灶吸收率高于对照组（P<0.05）;治疗6个月后的免疫功能指标比较，观察组的CD4+、IgA、IgG、IgM水平均高于对照组，且观察组的CD8+水平低于对照组（P<0.05）;两组的肝功能指标（ALT、AST、STB）治疗前后比较，差异均无统计学意义（P>0.05）;两组治疗后的ALT、AST、STB水平均较治疗前有所提高，但尚处于正常范围内;治疗期间两组不良反应发生率比较，差异无统计学意义（P>0.05）。 结论 莫西沙星联合卷曲霉素在耐多药肺结核患者中应用有助于促进免疫功能改善，提高抗痨治疗效果，且用药安全性高，值得推广。

[关键词] 耐多药肺结核;莫西沙星;左氧氟沙星;卷曲霉素;阿米卡星;抗痨化疗方案;肝功能;免疫功能

[中图分类号] R521.1          [文献标识码] B          [文章编号] 1673-9701（2021）36-0101-04

Analysis on the clinical efficacy of moxifloxacin combined with capreomycin in the treatment of multi-drug resistant pulmonary tuberculosis

LI Ye

Integrated Lung Cancer Center， Shenyang Tenth People′s Hospital， Shenyang   110044， China

[Abstract] Objective To explore the therapeutic efficacy of moxifloxacin combined with capreomycin in the treatment of multi-drug resistant pulmonary tuberculosis. Methods A total of 184 patients with multi-drug resistant pulmonary tuberculosis admitted to the Shenyang Tenth People′s Hospital from February 2018 to April 2019 were selected as the study objects. They were divided into the control group（n=92） and the observation group（n=92） according to the computer random method. The control group was treated with conventional antituberculosis chemotherapy scheme，combined with levofloxacin and amikacin， while the observation group was treated with conventional antituberculosis chemotherapy scheme， ombined with moxifloxacin and capreomycin.The sputum negative conversion rate，lesion absorption rate， hepatic function indices，incidence of adverse reactions （ADRs） and immunologic function indices of the two groups were compared. Results After 3 months and 6 months of treatment， the sputum negative conversion rate of the observation group was both higher than those of the control group（P<0.05）.After 6 months of treatment，the lesion absorption rate in the observation group was higher than that in the control group（P<0.05）.After 6 months of treatment， the immunologic function indices， such as the levels of CD4+， IgA， IgG and IgM in the observation group were all higher than those in the control group， and the level of CD8+ in the observation group was lower than that in the control group（P<0.05）. Before and after treatment，there were no statistically significant differences in hepatic function indices，such as ALT， AST and STB between the two groups（P>0.05）. After treatment，the levels of ALT， AST and STB in the two groups were all higher than those before treatment， but they were still in the normal range. There was no statistically significant difference in the incidence of ADRs between the two groups during treatment（P>0.05）. Conclusion The application of moxifloxacin combined with capreomycin in the treatment of multi-drug resistant pulmonary tuberculosis is helpful to improve the immunologic function，increase the antituberculosis therapeutic efficacy.Meanwhile，it is safe to use.Therefore，it is worthy of promotion.

[Key words] Multi-drug resistant pulmonary tuberculosis; Moxifloxacin; Levofloxacin; Capreomycin; Amikacin; Antituberculosis chemotherapy scheme; Hepatic function; Immunologic function

耐多药肺结核（Multidrug resistance tuberculosis，MDR-TB）指的是至少对利福平、异烟肼两种及以上单抗结核药物产生耐药的肺结核，是肺结核患者中的治疗难点，具有疗程长、治疗难度大、治愈率低等特点[1-3]。近年来，临床上的耐多药肺结核患者逐渐增多，许多患者的化疗疗程长达20个月或更长，但治疗效果不满意，病死率高。……