莫西沙星与四联抗结核药物治疗难治性结核性脑膜炎的临床效果

王龚奋飞 贾林·巴合提 米亚赛尔·阿布来提

[摘要] 目的 探討在难治性结核性脑膜炎患者的临床治疗中采用莫西沙星与四联抗结核药物联合治疗的可行性。方法 选取2017年1月至2019年12月间我院确诊罹患难治性结核性脑膜炎的78例患者作为研究对象，采用随机数字表法分为对照组和实验组，每组各39例。对照组采用四联抗结核药予以对症治疗，实验组基于对照组治疗基础上加用莫西沙星联合治疗。比较两组疗效、脑脊液指标与神经生长因子（NGF）、神经元特异性烯醇化酶（NSE）的差异。 结果 两组治疗后的WBC、PR、CSFP、NGF、NSE水平均低于治疗前，GLU、CL水平高于治疗前，差异有统计学意义（P<0.05）。治疗前两组的WBC、GLU、CL、PR、CSFP、NGF、NSE比较，差异无统计学意义（P>0.05）;治疗后，实验组WBC、PR、CSFP、NGF、NSE水平低于对照组，GLU、CL水平高于对照组，且实验组治疗优良率（97.44%）高于对照组（84.62%），差异有统计学意义（P<0.05）。 结论 难治性结核性脑膜炎患者接受莫西沙星联合四联抗结核药物治疗，能够进一步改善机体脑脊液指标，加快神经功能恢复，整体疗效好。

[关键词] 莫西沙星;四联抗结核药物;难治性结核性脑膜炎;神经系统;肺外结核

[Abstract] Objective To analyze the feasibility of moxifloxacin combined with quadruple anti-tuberculosis drugs in the clinical treatment of refractory tuberculous meningitis. Methods A total of 78 patients diagnosed with refractory tuberculous meningitis between January 2017 and December 2019 were included as study samples and divided into the experimental group（n=39） and the control group（n=39） according to the random number table method. The control group was treated with quadruple anti-tuberculosis drugs， while the experimental group was additionally treated with moxifloxacin on the basis of the control group. The efficacy， cerebrospinal fluid index， nerve growth factor（NGF） and neuron specific enolase（NSE） were compared between the two groups. Results The levels of WBC， PR， CSFP， NGF and NSE in the two groups after treatment were all lower than those before treatment， and the levels of GLU and CL were higher than those before treatment， with statistically significant differences（P<0.05）. White blood cell count（WBC）， glucose（GLU）， chloride（CL）， protein（PR）， pressure（CSFP）， NGF and NSE were compared between the two groups before treatment， and the differences were not statistically significant（P>0.05）. After treatment， the levels of WBC， PR， CSFP， NGF and NSE were lower and the levels of GLU and CL were higher in the experimental group than those in the control group， respectively. Moreover， the excellent and good rate of treatment in the experimental group（97.44%） was higher than that in the control group（84.62%）， with statistically significant differences（P<0.05）. Conclusion Moxifloxacin combined with quadruple anti-tuberculosis drugs in the treatment of patients with refractory tuberculous meningitis can further improve the cerebrospinal fluid index of patients and accelerate their recovery of neurological function， which have a good overall efficacy.

[Key words] Moxifloxacin; Quadruple anti-tuberculosis drugs; Refractory tuberculous meningitis; Nervous system; Extrapulmonary tuberculosis

结核病虽高发于肺脏，但亦可在他处发病，即临床所称的“肺外结核”。当人体感染结核分枝杆菌时，经淋巴或血传播至其他组织，可造成肺外结核。结核性脑膜炎正是临床一类典型的肺外结核病，症状早期隐匿，难以察觉，因此治疗难度大[1-2]。中晚期阶段，患者会出现脑神经障碍、发热、头痛等症状，情节严重者甚至直接损害人体中枢神经，具有较高的致残、致死率[3-4]。针对普通结核性脑膜炎患者，临床主流治疗方案为“乙胺丁醇+吡嗪酰胺+利福平+异烟肼”四联抗结核药物治法，但对于难治性结核性脑膜炎患者，继续沿用常规的四联治法收效难以令人满意。……