含环丙沙星及卷曲霉素方案治疗耐多药肺结核近期疗效分析

目的观察和评价含环丙沙星(CPFX)和卷曲霉素(CPM)联合化疗方案在耐多药肺结核(MDR-PTB)治疗中的效果。方法将186例MDR-PTB患者随机分为治疗组92例和对照组94例。化疗方案:治疗组以CPFX和CPM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21个月。结果共有170例患者完成化疗疗程,治疗组86例,痰菌阴转率为83%,对照组84例,痰菌阴转率为58%,痰菌阴转率治疗组与对照组比较差异有统计学意义(P<0.01);治疗组病灶显著吸收率为50%,空洞闭合率为64%,治疗组与对照组比较差异有统计学意义(P<0.01或<0.05);治疗组的药物不良反应率为32%,对照组为34%,两组比较差异无统计学意义(P>0.05)。结论含CPFX和CPM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,值得在临床上推广应用。

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

objective To study the clinical efficacy of a combination therapy with ciprofloxacin(CPFX),capreomycin(CPM) and other second-line antituberculosis drugs in the treatment of multi-drug resistant pulmonary tuberculosis(MDR-PTB). Methods One hundred and eighty-six patients with MDR-PTB were assigned to a study group 92 cases, treated with CPFX, CPM, rifapentine (RFT), pyrazinamide(PZA) and pasiniazid (PSZ); or a control group 94 cases,treated with streptomycin(SM), ethambutol(EMB),PZA,RFT and PSZ.The course of treatment was 21 months in each group. Results Eighty-six cases in the study group and 84 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 (27%)(P<0.01),the closure rate of the lung cavities in the study group (64%)was higher than that in the control group (43%)(P<0.05). No significant differences were found in side-effects between the two groups (32% in the study group ,and 34% in the control group respectively ) (P>0.05). Conclusion The regimen including CPFX, CPM and other second-line anti-TB drugs is effective and safe for patients with MDR-PTB.