2020 年第 2 期 第 15 卷

吡嗪酰胺联合左氧氟沙星对耐多药肺结核的治疗效果及对患者生活质量的影响

Therapeutic efficacy of pyrazinamide combined with levofloxacin in treatment of multi-drug resistant pulmonary tuberculosis and the effect on quality of life

作者：高慧施理吴涛吴彪张秀春符娟林锋

英文作者：

单位：海南省人民医院感染科，海口570125

英文单位：

关键词：耐多药肺结核；吡嗪酰胺；左氧氟沙星

英文关键词：

• 摘要：

• 【摘要】目的    探究吡嗪酰胺联合左氧氟沙星对耐多药肺结核的治疗效果及对患者生活质量的影响。方法    选取2016年3月至2017年2月于海南省人民医院进行治疗的耐多药肺结核患者100例，按照数字随机法分为左氧氟沙星组和联合治疗组，每组50例。左氧氟沙星组在常规抗结核治疗基础上加服左氧氟沙星治疗6个月；联合治疗组在左氧氟沙星组治疗基础上加服吡嗪酰胺治疗6个月。治疗前后检测2组患者血清免疫球蛋白（Ig）A、IgG、IgM水平；检测肺功能指标，包括最大呼气流量（PEF）、第1秒用力呼气容积（FEV1）、FEV1占预计值百分比（FEV1%）；观察统计治疗后病灶吸收、空洞闭合、痰菌转阴情况；治疗前后分别进行生活质量评分；对比2组治疗效果及不良反应发生情况。结果    治疗前2组患者血清IgA、IgG、IgM水平、PEF、FEV1、FEV1%、生活质量评分比较，差异均无统计学意义（均P＞0.05）。治疗后2组IgA、IgG、IgM水平、PEF、FEV1、FEV1%均升高，且联合治疗组均明显高于左氧氟沙星组［（3.5±0.6）g/L比（3.2±0.5）g/L、（14.9±4.2）g/L比（12.2±3.8）g/L、（1.28±0.30）g/L比（1.12±0.19）g/L、（7.6±1.4）L/s比（6.4±1.3）L/s、（1.46±0.42）L比（1.18±0.25）L、（85±11）%比（76±9）%］，差异均有统计学意义（均P＜0.05）。治疗后2组患者生活质量均提升，且联合治疗组各项生活质量评分均明显高于左氧氟沙星组，差异均有统计学意义（均P＜0.05）。联合治疗组患者的病灶吸收率［92.0%（46/50）比76.0%（38/50）］、空洞闭合率［88.0%（44/50）比70.0%（35/50）］、痰菌转阴率［92.0%（46/50）比76.0%（38/50）］均明显高于左氧氟沙星组，差异均有统计学意义（均P＜0.05）。联合治疗组总有效率明显高于左氧氟沙星组［94.0%（47/50）比78.0%（39/50）］，差异有统计学意义（χ2＝5.32，P＝0.02）。联合治疗组不良反应发生率明显低于左氧氟沙星组［6.0%（3/50）比20.0%（10/50）］，差异有统计学意义（χ2＝4.33，P＝0.04）。结论    吡嗪酰胺联合左氧氟沙星治疗耐多药肺结核，能够明显改善患者生活质量，治疗效果明显且安全性较高。

• 【Abstract】Objective    To explore the effect of pyrazinamide combined with levofloxacin on multi-drug resistant pulmonary tuberculosis and patients′ quality of life. Methods    A total of 100 patients with multi-drug resistant pulmonary tuberculosis were enrolled from March 2016 to February 2017 in Hainan General Hospital. The patients were randomly assigned to have levofloxacin(levofloxacin group, 50 cases) and levofloxacin plus pyrazinamide group(combined treatment group, 50 cases) on the basis of routine anti-tuberculosis therapy. Both groups were treated for 6 months. Serum immunoglobulin(Ig)A, IgM, IgG, lung function indexes including peak expiratory flow（PEF）, forced expiratory volume in 1 second（FEV1） and FEV1 percentage of expected value（FEV1%） were detected before and after treatment. Lesion absorption, cavity coalescence and sputum bacterial culture turning to negative rate were observed after treatment. Score of life quality was assessed before and after treatment. The overall efficacy and incidence of adverse reactions were analyzed. Results    There were no significant differences of IgA, IgG, IgM, PEF, FEV1, FEV1% and life quality score between group before treatment（all P＞0.05）. After treatment, IgA, IgG, IgM, PEF, FEV1 and FEV1% significantly increased and the levels in combined treatment group were significantly higher than those in levofloxacin group［（3.5±0.6）g/L vs （3.2±0.5）g/L, （14.9±4.2）g/L vs （12.2±3.8）g/L, （1.28±0.30）g/L vs （1.12±0.19）g/L, （7.6±1.4）L/s vs （6.4±1.3）L/s, （1.46±0.42）L vs （1.18±0.25）L, （85±11）% vs （76±9）%］（all P＜0.05）. Quality of life was significantly improved after treatment; the scores in combined treatment group were significantly higher than those in levofloxacin group（all P＜0.05）. Lesion absorption rate［92.0%（46/50） vs 76.0%（38/50）］, cavity coalescence rate［88.0%（44/50） vs 70.0%（35/50）］ and sputum bacterial culture turning to negative rate［92.0%（46/50） vs 76.0%（38/50）］ in combined treatment group were significantly higher than those in levofloxacin group(all P＜0.05). The total effective rate in combined treatment group was significantly higher than that in levofloxacin group［94.0%（47/50） vs 78.0%（39/50）］（χ2＝5.32, P＝0.02）. Incidence of adverse reactions in combined treatment group was significantly lower than that in levofloxacin group［6.0%（3/50） vs 20.0%（10/50）］（χ2＝4.33, P＝0.04）. Conclusion    Pyrazinamide combined with levofloxacin is safe and effective in treating multi-drug resistant pulmonary tuberculosis and can significantly improve the quality of life.