摘要:
目的 探讨卷曲霉素联合莫西沙星对耐多药肺结核患者血清T细胞亚群、降钙素原(PCT)水平的影响。 方法 将82例耐多药肺结核患者随机分为2组,每组41例。对照组给予左氧氟沙星联合卷曲霉素,实验组给予莫西沙星联合卷曲霉素。比较2组痰菌转阴率、不良反应、血清T细胞亚群(CD4+CD25+/CD4+、CD4+CD25+CD127low/CD4+)变化、炎性因子指标［PCT、肿瘤坏死因子-α(TNF-α)、白细胞介素-17(IL-17)、白细胞介素-1(IL-1)］、肝功能指标［总蛋白(TP)、碱性磷酸酶(AKP)、丙氨酸转氨酶(ALT)］。 结果 实验组痰菌转阴率为90.24%, 显著高于对照组的70.73%(P<0.05)。2组心率过快、白细胞减少、肝功能损伤等不良反应发生率比较,差异无统计学意义(P>0.05)。治疗后, 2组CD4+CD25+CD127low/CD4+、CD4+CD25+/CD4+水平较治疗前显著降低,且实验组显著低于对照组(P<0.05)。治疗后, 2组IL-17、TNF-α、IL-1、PCT水平较治疗前显著改善,且实验组TNF-α、IL-1、PCT水平显著低于对照组, IL-17水平显著高于对照组(P<0.05)。治疗后, 2组ALT、AKP水平显著高于治疗前,TP水平显著低于治疗前,但2组组间比较,差异无统计学意义(P>0.05)。 结论 耐多药肺结核患者采用莫西沙星联合卷曲霉素治疗安全、有效,可提高痰菌转阴率,调节血清T细胞亚群水平,降低血清PCT水平。
Abstract:
Objective To explore the effects of capreomycin combined with moxifloxacin on serum T cell subsets and procalcitonin(PCT)levels in pulmonary tuberculosis patients with multi-drug resistance. Methods A total of 82 pulmonary tuberculosis patients with multi-drug resistance were randomly divided into two groups, with 41 cases in each group. The control group was treated with levofloxacin and capreomycin, and the experimental group was treated with moxifloxacin and capreomycin. The clearance rate of sputum bacteria, adverse reactions, changes of serum T cell subsets(CD4+CD25+/CD4+, CD4+CD25+CD127low/CD4+), inflammatory factor indexes ［PCT, tumor necrosis factor-α(TNF-α), interleukin-17(IL-17), interleukin-1(IL-1)］, and liver function indexes［total protein(TP), alkaline phosphatase(AKP), alanine aminotransferase(ALT)］were compared between the two groups. Results The clearance rate of sputum bacteria in the experimental group was 90.24%, which was significantly higher than 70.73% in the control group(P<0.05). There were no significant differences in the incidence of adverse reactions such as tachycardia, leukopenia and liver function damage(P>0.05). After treatment, the levels of CD4+CD25+CD127low/CD4+, CD4+CD25+/CD4+ in both groups decreased significantly, and were significantly lower in the experimental - group than those in the control group(P<0.05). After treatment, the levels of IL-17, TNF-α, IL-1 and PCT in both groups were significantly improved, and the levels of TNF-α, IL-1 and PCT in the experimental group were significantly lower than those in the control group, while the level of IL-17 in the experimental group was significantly higher than that in the control group(P<0.05). After treatment, ALT and AKP levels in both groups were significantly higher than those before treatment, while TP level was significantly lower than that before treatment, but there were no significant differences in these indexes between the two groups(P>0.05). Conclusion Moxifloxacin combined with capreomycin is effective and safe in treatment of pulmonary tuberculosis patients with multi-drug resistance, which can increase the clearance rate of sputum bacteria, regulate the levels of serum T cell subsets, and reduce the serum PCT level.
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