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目的确定莫西沙星在治疗耐多药肺结核中的地位。方法对2003—2005年间在广州市胸科医院诊断的65例至少耐异烟肼和利福平的耐多药肺结核病人随机分组,分别接受含莫西沙星每日0.4 g 或左旋氧氟沙星每日0.6 g 的六联耐多药化疗方案治疗.其他药物有丁胺卡那霉素或链霉素、帕司烟肼、丙硫异烟胺、吡嗪酰胺、克拉霉素和乙胺丁醇,治疗半年后进行疗效评估。结果莫西沙星组35例中治愈27例,治愈率77.1%;左氧氟沙星组30例中19例治愈,治愈率63.3%,两组比较 x~2=1.489;P=0.222。两组治愈病例中痰菌阴转时间莫西沙星组(1.9±0.7)个月;左氧氟沙星组(3.0±1.8)个月,P=0.035,而痰菌对左氧氟沙星敏感、患者依从性好、肺部病变范围局限和应用莫西沙星是具独立影响疗效的四大因素。莫西沙星组有4例6次出现恶心、腹胀腹痛的消化系统不良事件。结论莫西沙星具有良好的体内抗结核分支杆菌活性,副反应小,对耐多药肺结核疗效明显优于左氧氟沙星,有较高的临床应用价值。
Objective To determine the role of moxifloxacin in the treatment of multidrug-resistant pulmonary tuberculosis. Methods 65 cases of MDR-TB patients resistant to isoniazid and rifampin diagnosed in Guangzhou Thoracic Hospital between 2003 and 2005 were randomized to receive 0.4 g / day of moxifloxacin or levofloxacin 0.6 g per day of six multi-drug resistant chemotherapy regimens. Other drugs are amikacin or streptomycin, basal hydrazide, prothiocarb, pyrazinamide, clarithromycin and ethidium Alcohol, six months after the treatment efficacy evaluation. Results In the moxifloxacin group of 35 cases, 27 cases were cured and the cure rate was 77.1%. In the levofloxacin group, 19 cases were cured and the cure rate was 63.3%. The two groups were x ~ 2 = 1.489; P = 0.222. In the two groups, sputum negative conversion time was (1.9 ± 0.7) months for the sputum negative conversion and 3.0 ± 1.8 months for the levofloxacin group (P = 0.035). However, sputum was sensitive to levofloxacin, The limitations of the lesion and the application of moxifloxacin is an independent impact on the efficacy of the four major factors. Moxifloxacin group had 4 cases of nausea, abdominal distension abdominal pain in 6 cases of digestive system adverse events. Conclusion Moxifloxacin has a good activity in vivo against Mycobacterium tuberculosis, the side reaction is small, the efficacy of multidrug-resistant pulmonary tuberculosis is superior to that of levofloxacin, which has high clinical value.