利奈唑胺与左氧氟沙星在结核性脑膜炎强化期应用的临床研究
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摘要
目的探讨利奈唑胺联合左氧氟沙星在结核性脑膜炎强化期应用的疗效和安全性。方法选取该院2016年9月—2018年2月收治的的经确诊为TBM患者68例,根据抽签方式将其分为研究组与对照组各组34例,对照组患者给予强化期方案治疗,研究组患者在对照组基础上再给予利耐唑胺联合左氧氟沙星治疗,对比治疗后第7、15、30、60天的CSF指标,对比治疗60 d后死亡率、神经系统后遗症率,对比不良反应发生率。结果对照组治疗第15、30、60天的白细胞计数为(119±41)×10~6/L、(49±16)×10~6/L、(19±10)×10~6/L,研究组为(97±27)×10~6/L、(32±8)×10~6/L、(12±4)×10~6/L,两组相比(t=6.613 1、5.541 3、3.789 7,P<0.05);对照组治疗第15、30、60天的葡萄糖比值为(0.29±0.03)、(0.35±0.03)、(0.42±0.04),研究组为(0.31±0.02)、(0.38±0.02)、(0.45±0.03)(t=3.234 4、4.851 6、3.498 6,P<0.05);对照组治疗第30、60天的蛋白定量为(1.25±0.37)、(0.94±0.27)mg/L,研究组为(1.03±0.35)、(0.79±0.19)mg/L(t=2.518 7、2.649 2,P<0.05)。Ⅱ期、Ⅲ期患者才发生死亡和神经系统后遗症情况。对照组中有3例死亡,有5例发生神经系统后遗症;研究组中有1例死亡,有2例发生神经系统后遗症。研究组死亡、神经系统后遗症总发生率为8.82%(3/34)显著低于对照组23.53%(8/34),组间差异有统计学意义(χ~2=7.979 5,P=0.004 7)。研究组不良反应总发生率(38.24%)与对照组(41.18%)相比差异无统计学意义(χ~2=0.1805,P=0.6709)。结论对TBM患者在强化期治疗基础上再给予利奈唑胺联合左氧氟沙星治疗能帮助患者的CSF指标得以改善,并且能有效减少死亡、神经系统后遗症发生情况,且不会提高患者不良反应发生率,安全性高,具有临床推广价值。
Objective To investigate the efficacy and safety of linezolid combined with levofloxacin in the intensive phase of tuberculous meningitis. Methods A total of 68 patients with TBM diagnosed in our hospital from September2016 to February 2018 were enrolled. According to the method of drawing, 34 patients were divided into study group and control group. The control group received intensive treatment. The patients in the study group were treated with licarbazol and levofloxacin on the basis of the control group. The CSF indexes at 7 th, 15 th, 30 th, and 60 th after treatment were compared. The mortality and neurological sequelae were compared after 60 days of treatment, and the incidence of adverse reactions was compared. Results The white blood cell counts of the control group on the 15 th,30 th, and 60 th day were(119±41)×10~6/L,(49±16)×10~6/L,(19±10)×10~6/L, and the study group was(97±27)×10~6/L,(32±8) ×10~6/L,(12 ±4) ×10~6/L, compared with the two groups,the difference was statistically significant(t =6.6131, 5.5413,3.7897, P <0.05); the glucose ratio of the control group on the 15 th, 30 th, and 60 th was(0.29 ±0.03),(0.35 ±0.03),(0.42±0.04), the study group was(0.31±0.02),(0.38±0.02),(0.45±0.03), compared with(t=3.2344, 4.8516, 3.4986, P<0.05); the protein of the control group on the 30 th and 60 th was(1.25±0.37),(0.94± 0.27)mg/L, the study group was(1.03±0.35)mg/L,(0.79±0.19)mg/L,(t=2.518 7, 2.649 2, P<0.05). Death and neurological sequelae occurred in patients with stage II and III. Three patients died in the control group, and five patients developed neurological sequelae; one patient died in the study group and two patients developed neurological sequelae. The total incidence of death and neurological sequelae in the study group was 8.82%(3/34), which was significantly lower than that in the control group 23.53%(8/34). The difference between the groups was statistically significant(χ~2=7.979 5, P=0.004 7). The overall incidence of adverse reactions in the study group(38.24%) was not significantly different from the control group(41.18%)(χ~2=0.180 5, P=0.670 9). Conclusion The combination of linezolid and levofloxacin in the treatment of patients with TBM can improve the CSF index and reduce the incidence of death and neurological sequelae, and it will not improve the incidence of adverse reactions, with high safety and clinical value.
Objective To investigate the efficacy and safety of linezolid combined with levofloxacin in the intensive phase of tuberculous meningitis. Methods A total of 68 patients with TBM diagnosed in our hospital from September2016 to February 2018 were enrolled. According to the method of drawing, 34 patients were divided into study group and control group. The control group received intensive treatment. The patients in the study group were treated with licarbazol and levofloxacin on the basis of the control group. The CSF indexes at 7 th, 15 th, 30 th, and 60 th after treatment were compared. The mortality and neurological sequelae were compared after 60 days of treatment, and the incidence of adverse reactions was compared. Results The white blood cell counts of the control group on the 15 th,30 th, and 60 th day were(119±41)×10~6/L,(49±16)×10~6/L,(19±10)×10~6/L, and the study group was(97±27)×10~6/L,(32±8) ×10~6/L,(12 ±4) ×10~6/L, compared with the two groups,the difference was statistically significant(t =6.6131, 5.5413,3.7897, P <0.05); the glucose ratio of the control group on the 15 th, 30 th, and 60 th was(0.29 ±0.03),(0.35 ±0.03),(0.42±0.04), the study group was(0.31±0.02),(0.38±0.02),(0.45±0.03), compared with(t=3.2344, 4.8516, 3.4986, P<0.05); the protein of the control group on the 30 th and 60 th was(1.25±0.37),(0.94± 0.27)mg/L, the study group was(1.03±0.35)mg/L,(0.79±0.19)mg/L,(t=2.518 7, 2.649 2, P<0.05). Death and neurological sequelae occurred in patients with stage II and III. Three patients died in the control group, and five patients developed neurological sequelae; one patient died in the study group and two patients developed neurological sequelae. The total incidence of death and neurological sequelae in the study group was 8.82%(3/34), which was significantly lower than that in the control group 23.53%(8/34). The difference between the groups was statistically significant(χ~2=7.979 5, P=0.004 7). The overall incidence of adverse reactions in the study group(38.24%) was not significantly different from the control group(41.18%)(χ~2=0.180 5, P=0.670 9). Conclusion The combination of linezolid and levofloxacin in the treatment of patients with TBM can improve the CSF index and reduce the incidence of death and neurological sequelae, and it will not improve the incidence of adverse reactions, with high safety and clinical value.
引文
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[2]张萌涛,许优,马进宝.利奈唑胺联合环丝氨酸胶囊和左氧氟沙星治疗耐药肺结核的疗效及机制分析[J].河北医学,2018,24(8):1304-1307.
[3]曹雪萍,张贤华,陈慧芬,等.2015年至2017年上海地区无乳链球菌临床感染情况及耐药性分析[J].诊断学理论与实践,2018,17(3):308-310.
[4]李耘,吕媛,刘健,等.黄藤素与临床常用抗菌药物体外联合抗菌作用研究[J].中国临床药理学杂志,2018,34(7)821-823.
[5]陈晓红,吴国兰,林剑东,等.利奈唑胺治疗难治性耐药结核性脑膜炎1例及文献复习[J].临床药物治疗杂志2018,16(4):29-34.
[6]夏衣扎提·库尔曼,张君.加用利奈唑胺治疗重症结核性脑膜炎的疗效观察[J].中国医药指南,2017,15(10):127-128.
[7]罗志达.肺炎链球菌临床分离株的耐药性分析[J].实用医技杂志,2017,24(1):54-55.
[8]钟剑峰,沈斌,邱佳,等洪.利奈唑胺联合左氧氟沙星在结核性脑膜炎强化期应用的疗效和安全性研究[J].中国全科医学,2018,11(9):1-5.