三种不同治疗方案治疗103例老年初治涂阳肺结核的疗效及安全性观察

目的观察与分析不同治疗方案治疗老年初治涂阳肺结核的疗效及安全性,评估左氧氟沙星对老年肺结核的有效性及安全性。方法选取老年初治涂阳肺结核患者103例,分为治疗组(Ⅰ组,2HL₂EV/10HL₂E)、对照组(Ⅱ组,2HL₂EZ/10 HL₂E),个体化组(Ⅲ组,18HLV或18HLE或18HEV),观察痰菌阴转率、X线好转率、1年复发率及药物不良反应。结果Ⅰ、Ⅱ、Ⅲ组疗程结束痰菌阴转率分别为97.4%、93.1%、95.0%(P>0.05);X线有效率分别为87.2%、89.7%、80.0%(P>0.05);空洞闭合率分别为35.3%、33.3%、31.3%(P>0.05);1年随访痰菌复发率分别为7.9%、3.7%、5.3%(P>0.05)。Ⅰ、Ⅱ组药物不良反应发生率分别为24.5%、54.8%,2组间有非常显著性差异(P<0.01)。结论含左氧氟沙星方案治疗老年初治涂阳肺结核取得了满意疗效,不良反应较小,吡嗪酰胺不良反应发生率高。个体化治疗方案也取得了满意疗效,有待进一步观察。

Therapeutic effect and safety of three different regimens to 103 eldly new pulmonary tuberculosis inpatients with smear-positive

Objective To observe and analyse the therapeutic effects and safety of different regiments to new pulmonary tuberculosis patients with smear-positive.To evaluate the validity and security of levofloxacin in elderly patients. Methods One hundred and three elderly new pulmonary tuberculosis patients with smearpositive were allocated into the treatment group（Ⅰ group,2HL₂EV/10HL₂E)）、control group（Ⅱ group,2HL₂EZ/10 HL₂E）and individualized group（Ⅲ group,18HL2E or 18HVE or 18HL2V）.The sputum conversion rates,chest X-ray improvement rates, one-year relapse rates and the side-effects of anti-tuberculosis drugs were observed. Result The sputum conversion rates at the end of therapeutic course in group Ⅰ,Ⅱ,Ⅲ were 97.4%,93.1%,95.0%,respectively（P>0.05）.The improving rates of chest X-ray were 87.2%,89.7%,80.0%,respectively（P>0.05）.The cavity closure rate was 35.3% in group Ⅰ,33.3% in group Ⅱ and 31.3% in group Ⅲ,（P>0.05）.One-year bacteriological relapse rate were 7.9%, 3.7%, 5.3%, respectively（P>0.05）.The side-effect rate was 24.5% in group I and 54.8% in group Ⅱ（P<0.01）. Conclusion The treatment effects of regimen including cravit was the same as that of regiment including pyrazimide.The cravit was safe to elderly patients.The side-effect rate caused by pyrazinamide was significant higher than that of cravit.The individualized regiment also has satisfied theraputic effect.