标题：卷曲霉素联合左氧氟沙星治疗耐多药肺结核疗效观察

      作者：杜培 1，方坚 2，廖亮 1，阳华湘 2    安康市中心医院呼吸与危重症医学科 1、感染性疾病科 2，陕西 安康 725000

      卷次： 2021年32卷15期

      【摘要】 目的 观察卷曲霉素联合左氧氟沙星治疗耐多药肺结核患者的临床疗效。方法 选取2017年2月至2018年12月安康市中心医院呼吸与危重症医学科收治的86例耐多药肺结核患者作为研究对象。采用随机数表法将患者分为对照组和观察组各43例。对照组采用常规治疗，观察组采用卷曲霉素联合左氧氟沙星治疗，均治疗12个月。治疗结束后，比较两组患者的治疗效果及治疗前后的肝功能[血清碱性磷酸酶(ALP)、门冬氨酸转氨酶(ALT)、丙氨酸转氨酶(AST)]、血清炎症因子[白细胞介素-17 (IL-17)、肿瘤坏死因子-α (TNF-α)、白细胞介素-6(IL-6)]、免疫功能[免疫球蛋白A (IgA)、免疫球蛋白G (IgG)、免疫球蛋白M (IgM)]水平，以及不良反应。结果 治疗后，观察组患者的治疗总有效率为95.35%，明显高于对照组的76.74%，差异有统计学意义(P<0.05)；治疗后，两组患者的ALP、ALT、AST水平均升高，且观察组上述各指标[(122.45±11.27) U/L、(32.15±5.41) U/L、(39.12±4.11) U/L]明显高于对照组[(105.45±10.78) U/L、(24.12±4.78) U/L、(30.18±3.80) U/L]，差异均有统计学意义(P<0.05)；治疗后，两组患者的 IL-7水平较治疗前均升高，且观察组为(19.12±2.10) ng/mL，明显高于对照组的(16.25±1.78) ng/mL，差异均有统计学意义(P<0.05)；治疗后，两组患者的 IL-6、TNF-α水平较治疗前均降低，且观察组[(89.12±5.11) ng/mL、(127.12±12.25) ng/mL]明显低于对照组[(98.12±4.23) ng/mL、(165.20±13.70) ng/mL]，差异均有统计学意义(P<0.05)；治疗后，两组患者的 IgA、IgG、IgM均升高，且观察组[(4.02±0.47) g/L、(18.12±2.15) g/L、(2.89±0.37) g/L]明显高于对照组[(3.52±0.36) g/L、(14.18±3.21) g/L、(2.15±0.21) g/L]，差异均有统计学意义(P<0.05)；观察组患者的不良反应发生率为6.99%，明显低于对照组的23.26%，差异有统计学意义(P<0.05)。结论 卷曲霉素联结合左氧氟沙星治疗耐多药肺结核患者疗效确切，其不仅可增强患者的免疫功能，抑制炎症因子水平，而且对肝功能影响小，安全性高。
      【关键词】 耐多药肺结核；卷曲霉素；左氧氟沙星；免疫功能；肝功能；不良反应
      【中图分类号】 R521 【文献标识码】 A 【文章编号】 1003—6350（2021）15—1958—04

Effect of capreomycin combined with levofloxacin in the treatment of patients with multidrug-resistanttuberculosis.
DU Pei 1, FANG Jian 2, LIAO Liang 1, YANG Hua-xiang 2. Department of Respiratory and Critical CareMedicine 1, Department of Infectious Diseases 2, Ankang Central Hospital, Ankang 725000, Shaanxi, CHINA
【Abstract】 Objective To investigate the effect of capreomycin combined with levofloxacin on the efficacy andprognosis of patients with multidrug-resistant tuberculosis, and to provide evidence for clinical diagnosis and treatment.Methods A total of 86 patients with multi-drug resistant tuberculosis, who admitted to the Department of Respiratoryand Critical Care Medicine, Ankang Central Hospital from February 2017 to December 2018, were selected and dividedinto the control group and observation group according to random number table method, with 43 patients in each group.The control group was treated with conventional treatment, and the observation group was treated with capreomycincombined with levofloxacin for 12 months. After the treatment, the treatment effect of the two groups of patients and theliver function (serum alkaline phosphatase [ALP], aspartate aminotransferase [ALT], alanine aminotransferase [AST])before and after treatment, serum inflammatory factors (interleukin-17 [IL-17], tumor necrosis factor-α (TNF-α), inter-leukin-6 [IL-6]), immune function (immunoglobulin A [IgA], immunoglobulin G [IgG] , Immunoglobulin M [IgM]) lev-els were compared, and adverse reactions were recorded. Results After treatment, the total effective rate of treatmentin the observation group was 95.35%, which was significantly higher than 76.74% in the control group (P<0.05); ALP,ALT, and AST levels of the two groups of patients increased, and the above indicators of the observation group were(122.45±11.27) U/L, (32.15±5.41) U/L, (39.12±4.11) U/L, respectively, which were significantly higher than correspond-ing (105.45±10.78) U/L, (24.12±4.78) U/L, (30.18±3.80) U/L in the control group (all P<0.05); IL-7 in both groups in-creased, the observation group was (19.12±2.10) ng/mL, which was significantly higher than (16.25±1.78) ng/mL in thecontrol group (P<0.05); while IL-6 and TNF-α decreased, IL-6 and TNF-α in the observation group were (89.12±5.11) ng/mL, (127.12 ± 12.25) ng/mL, which were significantly lower than corresponding (98.12 ± 4.23) ng/mL and(165.20±13.70) ng/mL in the control group (P<0.05); IgA, IgG and IgM of the two groups of patients increased, and theobservation group were (4.02±0.47) g/L, (18.12±2.15) g/L, (2.89±0.37) g/L, respectively, which were significantly high-er corresponding (3.52±0.36) g/L, (14.18±3.21) g/L, (2.15±0.21) g/L in the control group (all P<0.05). The incidence of