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目的:探讨标准抗结核治疗方案加用莫西沙星是否能缩短肺结核病人痰培养阴转的时间。方法:成年肺结核病人根据他们的选择被分成2个治疗组:标准方案(HRZE组)和标准方案在治疗的最初2个月加莫西沙星400 mg 1次/d(莫西沙星组)。在治疗开始的前8周,每周收集痰标本3次。通过计算倾向评分来估计进入莫西沙星组的条件概率。影响培养阴转时间的因素通过倾向评分分层采用Cox比例风险回归分析进行研究。结果:62例病人入选莫西沙星组,88例入选HRZE组,分别有51例和72例完成此项研究。2组分别有6例(12%)和12例(16%;P=0.47)在痰培养阴转前因不良反应更改治疗方案。莫西沙星组痰培养阴转时间缩短(HR 2.1,95%可信区间1.4～3.2)。治疗6周后的痰培养阴转率为82%和61%(P=0.011,<0.05/4,采用改良Bonferroni方法计算)。结论:标准抗结核方案在最初的2个月加用莫西沙星与缩短痰培养阴转时间、提高治疗6周的痰培养阴转率及降低肺结核的传播相关。
Objective: To investigate whether the standard anti-tuberculosis treatment plus moxifloxacin can shorten the time of sputum culture in patients with pulmonary tuberculosis. METHODS: Adult TB patients were divided into two treatment groups according to their choice: the standard regimen (HRZE group) and the standard regimen plus ganciclovir 400 mg once daily (moxifloxacin group) for the first 2 months of treatment. Sputum specimens were collected three times weekly for the first eight weeks of treatment. The conditional probability of entering the moxifloxacin group was estimated by calculating the propensity score. The factors influencing the time to culture negative conversion were studied by Cox proportional hazards regression analysis using propensity score stratification. RESULTS: Sixty-two patients were enrolled in the moxifloxacin group and 88 were enrolled in the HRZE group, 51 and 72 respectively. Six patients (12%) and 12 patients (16%; P = 0.47) in the two groups changed their treatment regimens as a result of adverse reactions before sputum culture was negative. Moxifloxacin group sputum culture time to reduce the negative transfer (HR 2.1, 95% confidence interval 1.4 to 3.2). Negative sputum cultures after 6 weeks of treatment had a negative conversion rate of 82% and 61% (P = 0.011, <0.05 / 4, calculated using the modified Bonferroni method). CONCLUSIONS: The standard anti-tuberculosis regimen combined with moxifloxacin in the first 2 months was associated with shortening the negative conversion time of sputum culture, increasing the negative conversion rate of sputum culture and reducing the spread of pulmonary tuberculosis in 6 weeks.