左氧氟沙星及利福喷丁胶囊治疗老年初治肺结核患者的疗效及安全性分析

摘要

目的 探讨左氧氟沙星及利福喷丁治疗老年初治肺结核的疗效及安全性.方法 选取2015年1月～2016年1月温州市中心医院收治的120例老年初治肺结核患者随机分为A、B、C 3组,每组40例.A 组治疗方案:2HRZE/4HR,B组治疗方案:2RftHZE/4HRft,C组治疗方案:2RftHELfx/4HRft.比较3组患者临床症状、体征及药物不良反应,观察血常规、尿常规、肝肾功能变化,行影像学检查和细菌学检查,判断治疗效果.结果 A组患者中有5例、B组有1例因肝损害及严重胃肠道反应而放弃治疗,C组40例患者均无退出治疗.3组痰菌阴转率及病灶吸收情况比较差异无统计学意义,C组胃肠道反应及肝损害例数较A、B组明显减少( P <0.05),A组2例出现利福喷丁胶囊过敏而更换为左氧氟沙星治疗,其他2组无药物过敏出现.结论 左氧氟沙星及利福喷丁胶囊治疗老年初治肺结核疗效好,不良作用较少,老年肺结核患者初治方案宜个体化,可考虑使用不良反应较小的药物,以保证治疗的顺利进行.%Objective To investigate the efficacy and safety of levofloxacin and rifapentine for elderly initial treatment pulmonary tuberculosis.Methods 120 cases of elderly initial treatment pulmonary tuberculosis patients January 2015 to January 2016 in our hospital were randomly divided into A,B,C three groups,with 40 cases in each group.Treatment regimen of group A: 2HRZE/4HR; treatment regimen of group B: 2Rft(rifapentine capsules)HZE/4HRft; treatment regimen of group C: 2Rft(rifapentine capsules)HELfx/4HRft.The clinical symptoms,signs and adverse drug reactions were compared between the three groups of patients,observation the changes of blood,urine,liver and kidney function,perform imaging and bacteriological examination to determine the treatment effect.Results Five cases in group A and one case in group B abandoned treatment because of liver damage and severe gastrointestinal reaction,but no one in the 40 cases of group C abandoned treatment.There was no statistically significant difference among three groups in sputum negative conversion rate and focus absorption.The number of cases presenting gastrointestinal reaction and liver damage in group C was significantly smaller than that in group A and group B(P<0.05).Rifampicin was replaced by levofloxacin in two cases of group A as a result of allergy,and no allergy occurred in the other two groups.Conclusion Levofloxacin and rifapentine have good efficacy and few side effects for elderly initial treatment pulmonary tuberculosis,initial treatment regimen for elderly pulmonary tuberculosis patients should be individualized,drugs with few side effects can be used to guarantee smooth proceeding of treatment.