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目的分析在常规化疗基础上加用莫西沙星及微卡治疗耐多药肺结核病的疗效及安全性。方法 2011年1月至2013年1月收治的112例耐多药肺结核患者,随机分为治疗组与对照组各56例。常规化疗药物为力克肺疾(D)、吡嗪酰胺(Z)、丙硫异烟胺(Pto)、丁胺卡那霉素(Am),化疗方案为8(D+Z+Pto+Am)/12(D+Z+Pto)。对照组给予常规化疗并全程给予莫西沙星治疗,治疗组在对照组的基础上加用微卡。两组疗程均为20个月(强化期8个月,巩固期12个月),比较两组患者治疗后2、4、6及12个月的痰菌阴转率;X线胸片检查病灶吸收情况;治疗后CD3+、CD4+、CD8+、CD4+/CD8+淋巴细胞亚群检测情况及患者不良反应发生情况。结果 (1)治疗组患者治疗后2、4、6、12个月的痰菌阴转率均高于对照组(P<0.05或P<0.01)。(2)治疗组病灶吸收总有效率高于对照组(83.9%vs 51.8%,P<0.01)。(3)治疗组CD3+、CD4+、CD8+、CD4+/CD8+水平均高于对照组(P均<0.05)。(4)两组均为轻微不良反应,对症处理后即消失,未影响治疗。结论莫西沙星和微卡联合应用方案治疗耐多药肺结核病,可提高临床痰菌转阴率,有助于病灶吸收,提高患者免疫力,同时不增加临床不良反应。
Objective To analyze the efficacy and safety of moxifloxacin and micro-card in the treatment of multidrug-resistant pulmonary tuberculosis based on conventional chemotherapy. Methods From January 2011 to January 2013, 112 patients with multidrug-resistant pulmonary tuberculosis were randomly divided into treatment group and control group, 56 cases each. The conventional chemotherapeutic drugs were Lectra Pulmonary Disease (D), Pyrazinamide (Z), Pto, Am Amine, and chemotherapy regimen of 8 (D + Z + Pto + Am) / 12 (D + Z + Pto). The control group was given conventional chemotherapy and the whole course of moxifloxacin treatment, the treatment group in the control group based on the use of micro-card. The two courses of treatment were 20 months (intensive 8 months, consolidation of 12 months), two groups of patients after treatment 2,4,6 and 12 months of sputum negative conversion rate; X-ray examination of lesions Absorption; The detection of CD3 +, CD4 +, CD8 +, CD4 + / CD8 + lymphocyte subsets and the occurrence of adverse reactions in patients after treatment. Results (1) The sputum negative conversion rate in the treatment group at 2, 4, 6 and 12 months after treatment was significantly higher than that in the control group (P <0.05 or P <0.01). (2) The total effective rate of the treatment group was higher than that of the control group (83.9% vs 51.8%, P <0.01). (3) The levels of CD3 +, CD4 +, CD8 + and CD4 + / CD8 + in the treatment group were significantly higher than those in the control group (all P <0.05). (4) Both groups were mild adverse reactions, disappeared after symptomatic treatment, did not affect the treatment. Conclusion Combination of moxifloxacin and micro-card treatment of multidrug-resistant pulmonary tuberculosis can increase the rate of clinical sputum negative conversion rate, help to absorb the lesion and improve the patient’s immunity, without increasing the clinical adverse reactions.