目的 探討不同療程左氧氟沙星聯(lián)合四聯(lián)抗結(jié)核療法治療結(jié)核性滲出性胸膜炎的療效。方法 選擇2015年6月-2018年6月西安市胸科醫(yī)院治療的結(jié)核性滲出性胸膜炎患者260例作為研究對象，根據(jù)隨機數(shù)字表法分為對照組和觀察組，每組各130例。所有患者均行左氧氟沙星聯(lián)合四聯(lián)抗結(jié)核方案治療，四聯(lián)抗結(jié)核方案中，肌注硫酸鏈霉素注射液0.75 g，1次/d；口服異煙肼片0.3 g，1次/d；口服利福平片0.45 g，1次/d；口服吡嗪酰胺片1.5 g，1次/d。同時靜滴鹽酸左氧氟沙星注射液500 mg，靜滴時間≥ 60 min，1次/d。對照組連續(xù)治療4周，觀察組連續(xù)治療2周。觀察兩組患者的臨床療效、臨床癥狀及不良反應(yīng)發(fā)生情況，同時比較兩組治療前后的CD4⁺CD25⁺T細胞水平。結(jié)果 治療后，兩組的治療總有效率比較無統(tǒng)計學(xué)意義。兩組的積液消失時間、引流流量、穿刺次數(shù)、完全退熱時間對比無統(tǒng)計學(xué)意義。兩組治療后的CD4⁺ CD25⁺ T細胞比例顯著高于治療前（P<0.05），觀察組顯著高于對照組（P<0.05）。觀察組治療期間的胃腸道反應(yīng)、關(guān)節(jié)痛、血小板減少、白細胞減少等發(fā)生率為1.5%，低于對照組的9.2%（P<0.05）。結(jié)論 相對于長療程，短療程左氧氟沙星聯(lián)合四聯(lián)抗結(jié)核療法治療結(jié)核性滲出性胸膜炎也具有很好的療效，能促進緩解患者的臨床癥狀，且能減少不良反應(yīng)的發(fā)生，促進恢復(fù)患者的免疫功能。

Objective To investigate the efficacy of levofloxacin combined with quadruple anti-tuberculosis therapy for tuberculous exudative pleurisy. Methods 260 patients with tuberculous exudative pleurisy treated in Xi'an Chest Hospital from June 2015 to June 2018 were selected as the study subjects, and were divided into control group and observation group according to the random number table method, with 130 patients in each group. All patients were treated with levofloxacin combined with quadruplex antituberculosis regimen. In the quadruplex anti-tuberculosis regimen, patients were performed intramuscular injection of Streptomycin Sulfate Injection for 0.75 g, once daily, po administered with Isoniazid Tablets 0.3 g, once daily, Rifampicin Tablets for 0.45 g, once daily, and Pyrazinamide Tablets 1.5 g, once daily. At the same time, Levofloxacin Hydrochloride Injection was given for 500 mg, intravenous drip time less than 60 min, once daily. The control group received continuous treatment for 4 weeks, and the observation group received continuous treatment for 2 weeks. The clinical efficacy, clinical symptoms, and adverse reactions of two groups were observed, and the levels of CD4⁺ CD25⁺ T cells before and after treatment were compared. Results After treatment, the total effective rate of two groups was not statistically significant. There was no significant difference in the disappearance time of effusion, drainage flow rate, puncture times and complete antipyretic time between two groups. The proportion of CD4⁺ CD25⁺ T cells in two groups after treatment was significantly higher than that before treatment (P<0.05), and that in the observation group was significantly higher than that in the control group (P<0.05). The incidence of gastrointestinal reaction, joint pain, thrombocytopenia and leucopenia in the observation group was 1.5%, which was lower than 9.2% of the control group (P<0.05). Conclusion Compared with the long course of treatment, the short course of levofloxacin combined with quadruple anti tuberculosis therapy in treatment of tuberculous exudative pleurisy also has a good effect, can promote the relief of clinical symptoms of patients, and can reduce the occurrence of adverse events, promote the recovery of immune function of patients.

R978.3

陜西省重點研發(fā)計劃項目（2018SF-222）