2019 年第 9 期 第 14 卷

莫西沙星联合纤维支气管镜药物灌注治疗耐多药肺结核的临床效果及对患者免疫功能和炎性因子水平的影响

Effect of moxifloxacin combined with drug infusion by fiberbronchoscope on immune function and inflammatory factors in patients with multi-drug resistant pulmonary tuberculosis

作者：杨惠卫李冬雷李润浦林振怀老景东王晓洁

英文作者：

单位：072750河北省保定市第二中心医院呼吸二科（杨惠卫），肿瘤内科（李冬雷、李润浦），呼吸内科（林振怀、王晓洁）；063000河北省唐山市弘慈医院呼吸内科（老景东）

英文单位：

关键词：耐多药肺结核；莫西沙星；纤维支气管镜；药物灌注；T细胞亚群

英文关键词：

• 摘要：

• 【摘要】目的    观察莫西沙星联合纤维支气管镜药物灌注治疗耐多药肺结核的临床效果及对患者免疫功能和炎性因子水平的影响。方法    选取2013年1月至2016年1月河北省保定市第二中心医院诊治的耐多药肺结核患者100例。完全随机分为对照组和观察组，各50例。对照组在常规药物治疗的基础上口服左氧氟沙星治疗；观察组在常规药物治疗的基础上口服莫西沙星联合纤维支气管镜药物灌注治疗。观察2组患者治疗3、6、9个月痰菌转阴率，治疗9个月病灶吸收率以及治疗前后患者血清中T细胞亚群CD+3、CD+4、CD+8、CD+4/CD+8比值和白细胞介素2（IL-2）、IL-6及C反应蛋白（CRP）水平的变化。结果    观察组治疗3个月、6个月、9个月的痰菌转阴率及治疗9个月病灶吸收率均明显高于对照组［50.0%（25/50）比42.0%（21/50）、72.0%（36/50）比52.0%（26/50）、86.0%（43/50）比62.0%（31/50）、90.0%（45/50）比60.0%（30/50）］，差异均有统计学意义（均P<0.05）。治疗后2组CD+3、CD+4和CD+4/CD+8比值水平明显升高，且观察组高于对照组；CD+8、IL-2、IL-6、CRP水平明显降低，且观察组低于对照组，差异均有统计学意义（均P<0.05）。结论    莫西沙星联合纤维支气管镜药物灌注治疗对耐多药肺结核患者痰菌转阴及病灶吸收效果优于左氧氟沙星治疗，且能有效调节血清中T细胞亚群和IL-2、IL-6及CRP的水平。

• 【Abstract】Objective    To observe the clinical efficacy of moxifloxacin combined with drug infusion by fiberbronchoscope in treatment of multi-drug resistant pulmonary tuberculosis and its influence on immune function and inflammatory factors. Methods    A total of 100 patients with multi-drug resistant pulmonary tuberculosis admitted to the Second Central Hospital of Baoding City, Hebei Province from January 2013 to January 2016 were randomly divided into control group and observation group, with 50 cases in each group. On the basis of routine drug treatment, the control group was given levofloxacin orally, while the observation group was given moxifloxacin orally combined with drug infusion by fiberbronchoscope. Clearance rate of bacteria in sputum was tested 3, 6, 9 months after treatment; absorption rate of lung foci in X-ray was observed 9 months after treatment. Serum contents of T cell subsets CD+3, CD+4, CD+8, CD+4/CD+8, interleukin(IL)-2, IL-6 and C-reactive protein(CRP) were analyzed before and after treatment. Results    The 3-, 6- and 9-month clearance rates of bacteria in sputum and the 9-month absorption rate of lung foci in X-ray in observation group were significantly higher than those in control group［50.0%(25/50) vs 42.0%(21/50), 72.0%(36/50) vs 52.0%(26/50), 86.0%(43/50) vs 62.0%(31/50), 90.0%(45/50) vs 60.0%(30/50)］ (all P<0.05). After treatment, serum levels of CD+3, CD+4 and CD+4/CD+8 increased in both groups; the levels in observation group were significantly higher than those in control group; serum levels of CD+8, IL-2, IL-6 and CRP decreased and the levels in observation group were significantly lower than those in control group(all P<0.05). Conclusion    Moxifloxacin combined with drug infusion by fiberbronchoscope shows better clinical effect than levofloxacin on sputum bacterial clearance and lung lesion recovery in treating multi-drug resistant pulmonary tuberculosis; it can also effectively regulate serum T cell subsets, IL-2, IL-6 and CRP levels.