喹诺酮类药物在肺结核治疗中的效果及患者用药毒副反应观察

张秀鑫

[摘要] 目的 分析喹诺酮类药物在肺结核患者中的应用效果及毒副反应发生情况。 方法 选择2018年2月至2019年7月我院结核科诊治的肺结核患者159例为对象，以随机数字表法分组，对照组患者应用常规抗结核方案（异烟肼+利福平+乙胺丁醇+吡嗪酰胺+硫酸阿米卡星注射液）治疗，实验组患者在对照组基础上加用喹诺酮类药物（左氧氟沙星）治疗，对比两组患者的治疗总有效率、毒副反应总发生率、痰菌转阴率和炎症因子（IL-6、IL-18、IL-10、TNF-α、IFN-γ）水平。 结果 实验组患者的总有效率（96.21%）高于对照组总有效率（82.50%）（P<0.05）;实验组的毒副反应总发生率（7.59%）略低于对照组毒副反应总发生率（10.00%）（P>0.05），均未影响治疗疗程;实验组治疗3个月后、6个月后、10个月后的痰菌转阴率均高于对照組（P<0.05）;实验组治疗3个月后的炎症因子水平（IL-6、IL-18、IL-10、TNF-α、IFN-γ）均低于对照组（P<0.01）。 结论 喹诺酮类药物联合抗结核药物在肺结核患者中应用疗效肯定，促进炎症反应控制，促进结核分枝杆菌的清除，且用药安全性高，不会增加毒副反应发生，值得推广。

[关键词] 喹诺酮类药物;左氧氟沙星;肺结核;抗结核治疗;毒副反应

[中图分类号] R521          [文献标识码] A          [文章编号] 1673-9701（2021）12-0035-04

Observation on the effect of quinolones in the treatment of tuberculosis and the side effects of the patients

ZHANG Xiuxin

Department of Tuberculosis， Shenyang Chest Hospital， Shenyang   110044， China

[Abstract] Objective To analyze the application effect of quinolones in pulmonary tuberculosis patients and the occurrence of toxic and side effects. Methods A total of 159 cases of tuberculosis patients diagnosed and treated from February 2018 to July 2019 in our hospital′s tuberculosis department were selected as subjects. They were grouped by a random number table. The control group was treated with a conventional anti-tuberculosis regimen（isoniazid+rifampicin+ethambutol+pyrazinamide+amikacin sulfate injection）. The experimental group was treated with quinolone drugs（levofloxacin） based on the treatment in the control group. The total effective treatment rate， the total incidence of toxic and side effects， the negative rate of sputum bacteria， and inflammatory factors（IL-6， IL-18， IL-10， TNF-α， IFN-γ） between the two groups were compared. Results The total effective rate of the experimental group（96.21%） was higher than that of the control group（82.50%）（P<0.05）. The total incidence of toxic and side effects in the experimental group（7.59%） was slightly lower than that（10.00%） in the control group（P>0.05）. Both did not affect the course of treatment. The negative conversion rate of sputum bacteria in the experimental group after three months， six months， and ten months were higher than those of the control group（P<0.05）. After three months of treatment， the levels of inflammatory factors （IL-6， IL-18， IL-10， TNF-α， IFN-γ） in the experimental group were lower than those in the control group（P<0.01）. Conclusion Quinolones combined with anti-tuberculosis drugs positively affect pulmonary tuberculosis patients， promote inflammatory response control， promote the elimination of Mycobacterium tuberculosis， which have high drug safety and will not increase toxic side effects. It is worthy of promotion.

[Key words] Quinolones; Levofloxacin; Tuberculosis; Anti-tuberculosis treatment; Toxic and side effects

肺结核是我国的常见呼吸系统慢性传染病，是由肺部感染结核分枝杆菌引起的慢性传染病，多数患者在感染结核分枝杆菌后不会立刻发病，当免疫力低下时才会出现明显症状，主要表现为咳嗽、咳痰、咳血、发热、乏力等[1-2]。随着对肺结核认识的日益深入，肺结核的治疗药物越来越多，异烟肼、利福平、吡嗪酰胺、盐酸乙胺丁醇等是常用于肺结核患者的一线治疗药物，也是短程抗结核化疗药物，疗效满意[3]。但是受到抗生素的广泛应用、环境恶化等因素的影响，肺结核患者的耐药问题日益突出。喹诺酮类药物在上世纪80年代被证实对抗结核分枝杆菌有活性，目前已成为肺结核的二线治疗药物，尤其是在耐药、耐多药肺结核、复治肺结核和对一线药物不能耐受的初治肺结核患者中应用广泛[4-5]。……