标题：吡嗪酰胺联合左氧氟沙星在复治耐药肺结核患者中的应用

      作者：黄大业 1，孟祥国 2，赵坚 1，郭琪 1    西安市胸科医院外科 1、结核合并症科 2，陕西 西安 710061

      卷次： 2022年33卷10期

      【摘要】 目的 探究吡嗪酰胺联合左氧氟沙星在复治耐药肺结核患者中的应用效果。方法 选取西安市胸科医院外科2018年1月至2020年1月期间收治的102例复治耐药肺结核患者为研究对象，按照随机数表法分为对照组和观察组，每组51例。对照组患者给予利福平、异烟肼、吡嗪酰胺治疗，观察组患者在此基础上加用左氧氟沙星治疗，两组均连续治疗12个月。比较两组患者治疗后的痰菌阴转情况、肺结核病灶吸收情况和空洞缩小情况，以及两组患者的治疗效果和不良反应发生情况。结果 治疗后 2个月和 4个月，观察组患者的痰菌阴转率分别为66.67%、84.31%，明显高于对照组的45.10%，60.78%，差异均有统计学意义(P<0.05)；治疗后，观察组患者的病灶吸收率和空洞闭合率分别为76.47%，70.59%，明显高于对照组的54.90%，50.98%，差异均有统计学意义(P<0.05)；观察组患者的治疗总有效率为80.39%，明显高于对照组的 60.78%，差异有统计学意义(P<0.05)；观察组患者治疗期间的不良反应总发生率为11.76%，略低于对照组的21.57%，但差异无统计学意义(P>0.05)。结论 吡嗪酰胺与左氧氟沙星联合用于治疗复治耐药肺结核效果明显，其能明显改善痰菌阴转、病灶吸收和空洞闭合情况，且安全性高，值得临床推广应用。
      【关键词】 复治耐药肺结核；吡嗪酰胺；左氧氟沙星；痰菌阴转；病灶吸收；治疗效果
      【中图分类号】 R521 【文献标识码】 A 【文章编号】 1003—6350（2022）10—1252—03

Application effect of pyrazinamide and levofloxacin in the treatment of relapse drug-resistant pulmonarytuberculosis.
HUANG Da-ye 1, MENG Xiang-guo 2, ZHAO Jian 1, GUO Qi 1. Department of Surgery 1, Department ofTuberculosis Complications 2, Xi'an Chest Hospital, Xi'an 710061, Shaanxi, CHINA
【Abstract】 Objective To explore the efficacy of pyrazinamide combined with levofloxacin in the treatment ofrelapse drug-resistant pulmonary tuberculosis. Methods A total of 102 patients with relapse drug-resistant pulmonarytuberculosis admitted to Department of Surgery, Xi'an Chest Hospital from January 2018 to January 2020 were selectedas the research objects. The patients were divided into a control group and an observation group according to randomnumber table method, with 51 patients in each group. Patients in the control group were treated with rifampicin, isonia-zid, and pyrazinamide, and those in the observation group were additionally treated with levofloxacin on this basis. Bothgroups were treated for 12 months. The negative conversion of sputum bacteria, focal absorption, and narrowing of cavi-ties were compared between the two groups after treatment, as well as the treatment effect and the occurrence of adversereactions. Results At 2 and 4 months after treatment, the negative conversion rate of sputum bacteria in the observationgroup was 66.67% and 84.31%, respectively, which were significantly higher than 45.10% and 60.78% in the controlgroup (P<0.05). After treatment, the focal absorption rate and cavity closure rate in the observation group were 76.47%and 70.59%, respectively, which were significantly higher than 54.90% and 50.98% in the control group (P<0.05). Thetotal effective rate of the observation group was 80.39%, significantly higher than 60.78% of the control group (P<0.05).The total incidence of adverse reactions in the observation group was 11.76%, slightly lower than 21.57% in controlgroup (P>0.05). Conclusion The combined use of pyrazinamide and levofloxacin in retreating drug-resistant pulmo-nary tuberculosis has significant effect, which can significantly improve the negative conversion of sputum bacteria, fo-cal absorption, and cavity closure, with high safety. It is worthy of clinical application.
      【Key words】 Relapse drug-resistant tuberculosis; Pyrazinamide; Levofloxacin; Negative conversion of sputumbacteria; Focal absorption; Treatment effect