左氧氟沙星与吡嗪酰胺治疗复治肺结核合并糖尿病的临床效果比较
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摘要
目的:比较左氧氟沙星与吡嗪酰胺用于复治肺结核合并糖尿病治疗的效果。方法:选取本院收治的复治涂阳肺结核合并2型糖尿病患者89例。根据治疗意愿将其分为A组(n=45)与B组(n=44)。两组抗结核治疗疗程均为9个月,全程用药为异烟肼、利福平、乙胺丁醇,其中A组前3个月在此基础上加用左氧氟沙星,B组加用吡嗪酰胺。比较两组治疗后的痰菌转阴率、空洞缩小率、病灶吸收率以及不良反应发生情况。结果:治疗后,A组痰菌阴转率、空洞缩小率、病灶吸收率均高于B组,比较差异均有统计学意义(P<0.05);A组不良反应率为8.89%,低于B组的25.00%,比较差异有统计学意义(P<0.05)。结论:与吡嗪酰胺相比,左氧氟沙星在复治肺结核合并糖尿病患者治疗中效果更为理想,且用药安全性较高。
Objective:To compare the clinical effect of Levofloxacin and Pyrazinamide in treatment of retreated pulmonary tuberculosis complicated with diabetes mellitus.Method:A total of 89 cases of retreated smear positive pulmonary tuberculosis with type 2 diabetes mellitus were selected.According to the treatment intention,they were divided into A group(n=45)and B group(n=44).Both groups were treated for 9 months with Isoniazid,Rifampicin and Ethambutol.In A group,Levofloxacin was added in the first three months,and Pyrazinamide was added in B group.The sputum negative conversion rate,cavity shrinkage rate,focus absorption rate after treatment and adverse reactions between two groups were compared.Result:After treatment,the sputum negative conversion rate,cavity shrinkage rate,focus absorption rate in A group were higher than those of B group,the differences were statistically significant(P<0.05).The adverse reaction rate of A group was 8.89%,which was lower than 25.00% of B group,the difference was statistically significant(P<0.05). Conclusion:Compared with Pyrazinamide,Levofloxacin in the treatment of retreated pulmonary tuberculosis complicated with diabetes mellitus could achieve better efficacy and higher safety.
Objective:To compare the clinical effect of Levofloxacin and Pyrazinamide in treatment of retreated pulmonary tuberculosis complicated with diabetes mellitus.Method:A total of 89 cases of retreated smear positive pulmonary tuberculosis with type 2 diabetes mellitus were selected.According to the treatment intention,they were divided into A group(n=45)and B group(n=44).Both groups were treated for 9 months with Isoniazid,Rifampicin and Ethambutol.In A group,Levofloxacin was added in the first three months,and Pyrazinamide was added in B group.The sputum negative conversion rate,cavity shrinkage rate,focus absorption rate after treatment and adverse reactions between two groups were compared.Result:After treatment,the sputum negative conversion rate,cavity shrinkage rate,focus absorption rate in A group were higher than those of B group,the differences were statistically significant(P<0.05).The adverse reaction rate of A group was 8.89%,which was lower than 25.00% of B group,the difference was statistically significant(P<0.05). Conclusion:Compared with Pyrazinamide,Levofloxacin in the treatment of retreated pulmonary tuberculosis complicated with diabetes mellitus could achieve better efficacy and higher safety.
引文
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[19]Ramachandran G,Kumar A K,Kannan T,et al.Low Serum Concentrations of Rifampicin and Pyrazinamide Associated with Poor Treatment Outcomes in Children with Tuberculosis Related to HIV Status[J].Pediatr Infect Dis J,2016,35(5):530-534.
[20]吴璇,王勃,毛晓辉,等.左氧氟沙星与吡嗪酰胺治疗肺结核合并糖尿病的临床比较[J].药物评价研究,2016,39(4):660-663.
[21]叶璐,甘能金.左旋氧氟沙星与吡嗪酰胺治疗肺结核合并2型糖尿病近期疗效及安全性分析[J].临床肺科杂志,2017,22(9):1659-1662.
[22]张春晓,王永亮,崔俊伟,等.左氧氟沙星与卷曲霉素联合治疗耐多药肺结核的疗效观察[J].中华医院感染学杂志,2016,26(9):1936-1938.
[23]朱刚.左氧氟沙星与莫西沙星治疗耐药性肺结核的疗效和安全性比较[J].中国药房,2016,27(18):2514-2516.
[24]周伟杰,王文,刘同杰.5937例结核病患者非结核分枝杆菌感染及其对抗结核药物耐药情况分析[J].山东医药,2016,56(12):72-73.
[25]李卫鸿,刚永桂,刘明,等.左氧氟沙星、胸腺五肽和四君子汤联合治疗重症肺结核的机制研究[J].中国中西医结合急救杂志,2017,24(1):44-48.
[26]罗大勇,柯英,陈鸿.左氧氟沙星替代吡嗪酰胺治疗老年性肺结核的临床观察[J].现代医学,2012,40(4):439-441.
[27]文文,刘玮,胡顺振,等.左氧氟沙星对大鼠气管黏膜和肺组织的损伤及氨溴索的保护作用[J].实用药物与临床,2016,19(9):1076-1080.
[2]陈其琛,谭守勇,薛植强,等.广州市肺结核流行病学抽样调查[J].实用预防医学,2014,21(4):437-440.
[3]张雨.肺结核合并糖尿病营养、氧化应激状况及生存质量影响因素研究[D].青岛:青岛大学,2017.
[4]陈玮,雷世光,李杨,等.1749例肺结核患者治疗依从性特点及影响因素分析[J].现代预防医学,2016,43(2):346-349.
[5]李丽.结核病合并糖尿病免疫特征研究进展[J].中华微生物学和免疫学杂志,2016,36(7):549-554.
[6]马艳,谢忠尧,张丽娜,等.涂阳肺结核患者抗结核药物不良反应发生影响因素分析[J].中国人兽共患病学报,2016,32(12):1070-1076.
[7]肖海霞,汪春蕾,胡永峰,等.武汉市某区肺结核患者抗结核治疗的药物不良反应分析[J].现代预防医学,2017,44(8):1514-1516.
[8]蒋博峰,马晨晨,陈阳贵,等.抗结核药物不良反应发生率及其影响因素分析[J].中华疾病控制杂志,2017,21(2):160-163.
[9]陈茹,王晶,唐少文,等.抗结核治疗队列人群药物性肝损害的易感基因多态性研究[J].中华流行病学杂志,2016,37(7):925-929.
[10]娄群,陈兆杰,姜琦,等.老年糖尿病肾病发病机制、诊断及治疗的研究进展[J].中国老年学杂志,2018,38(1):244-247.
[11]王永胜,杨丽霞,程涛,等.糖尿病肾病的炎症致病机制与中药防治[J].中国实验方剂学杂志,2018,24(2):200-207.
[12]盛云峰,邱美华,鲍志坚,等.耐多药肺结核合并糖尿病患者肺部感染病原菌与危险因素分析[J].中华医院感染学杂志,2016,26(9):1939-1941.
[13]何春喜,杨旭,曹剑昆.左氧氟沙星联合阿莫西林克拉维酸钾治疗耐多药肺结核疗效观察[J].临床内科杂志,2014,31(4):267-268.
[14]Mase S R,Jereb J A,Gonzalez D,et al.Pharmacokinetics and Dosing of Levofloxacin in Children Treated for Active or Latent Multidrug-resistant Tuberculosis,Federated States of Micronesia and Republic of the Marshall Islands[J].Pediatr Infect Dis J,2016,35(4):414-421.
[15]谷蕴婷,黄海荣.结核分枝杆菌对吡嗪酰胺耐药相关研究进展[J].中华结核和呼吸杂志,2016,39(10):814-817.
[16]黄盛晶,饶运帷,谭守勇.吡嗪酰胺耐药对初治菌阳肺结核复发的影响[J].实用医学杂志,2016,32(13):2224-2226.
[17]覃红娟,谭守勇,邝浩斌,等.吡嗪酰胺与抗结核药物肝损伤的相关性[J].实用医学杂志,2016,32(12):1948-1951.
[18]罗振华,钱雪琴,范齐文,等.结核分枝杆菌吡嗪酰胺耐药相关分子特征分析[J].中华微生物学和免疫学杂志,2015,35(9):660-665.
[19]Ramachandran G,Kumar A K,Kannan T,et al.Low Serum Concentrations of Rifampicin and Pyrazinamide Associated with Poor Treatment Outcomes in Children with Tuberculosis Related to HIV Status[J].Pediatr Infect Dis J,2016,35(5):530-534.
[20]吴璇,王勃,毛晓辉,等.左氧氟沙星与吡嗪酰胺治疗肺结核合并糖尿病的临床比较[J].药物评价研究,2016,39(4):660-663.
[21]叶璐,甘能金.左旋氧氟沙星与吡嗪酰胺治疗肺结核合并2型糖尿病近期疗效及安全性分析[J].临床肺科杂志,2017,22(9):1659-1662.
[22]张春晓,王永亮,崔俊伟,等.左氧氟沙星与卷曲霉素联合治疗耐多药肺结核的疗效观察[J].中华医院感染学杂志,2016,26(9):1936-1938.
[23]朱刚.左氧氟沙星与莫西沙星治疗耐药性肺结核的疗效和安全性比较[J].中国药房,2016,27(18):2514-2516.
[24]周伟杰,王文,刘同杰.5937例结核病患者非结核分枝杆菌感染及其对抗结核药物耐药情况分析[J].山东医药,2016,56(12):72-73.
[25]李卫鸿,刚永桂,刘明,等.左氧氟沙星、胸腺五肽和四君子汤联合治疗重症肺结核的机制研究[J].中国中西医结合急救杂志,2017,24(1):44-48.
[26]罗大勇,柯英,陈鸿.左氧氟沙星替代吡嗪酰胺治疗老年性肺结核的临床观察[J].现代医学,2012,40(4):439-441.
[27]文文,刘玮,胡顺振,等.左氧氟沙星对大鼠气管黏膜和肺组织的损伤及氨溴索的保护作用[J].实用药物与临床,2016,19(9):1076-1080.