目的 探討與評價左氧氟沙星聯(lián)合抗結(jié)核藥方案治療重癥結(jié)核性腹膜炎的臨床療效。方法 選擇2015年8月-2018年5月在西安市胸科醫(yī)院診治的重癥結(jié)核性腹膜炎患者140例作為研究對象，根據(jù)入院順序隨機均分為對照組（70例）和觀察組（70例）。對照組給予常規(guī)抗結(jié)核藥物治療，患者口服異煙肼片0.3 g，利福平膠囊0.45 g；吡嗪酰胺片1.5 g；鹽酸乙胺丁醇片0.75 g，1次/d。觀察組在對照組治療的基礎(chǔ)上口服乳酸左氧氟沙星片，0.4 g/次，1次/d。兩組均治療3個月。觀察兩組患者的臨床療效、腹腔積液情況和不良反應(yīng)發(fā)生情況，同時比較兩組治療前后的血清腺苷脫氨酶（ADA）、乳酸脫氫酶（LDH）水平。結(jié)果 治療后，觀察組的總有效率為95.7%，顯著高于對照組84.3%（P<0.05）。治療后，觀察組的抽腹腔積液次數(shù)與腹腔積液吸收時間均顯著少于對照組（P<0.05）。兩組治療后的血清ADA與LDH水平均低于治療前（P<0.05），且觀察組ADA與LDH水平顯著低于對照組（P<0.05）。兩組治療期間的不良反應(yīng)發(fā)生率對比無顯著差異。結(jié)論 左氧氟沙星聯(lián)合抗結(jié)核藥方案治療重癥結(jié)核性腹膜炎能抑制ADA與LDH的釋放，縮短抽腹腔積液次數(shù)與腹腔積液吸收時間，從而提高治療效果，且安全性好。

Objective To investigate and evaluate the clinical efficacy of levofloxacin combined with anti-tuberculous drug regimen in treatment of severe tuberculous peritonitis. Methods A total of 140 patients with severe tuberculous peritonitis treated in Xi'an Chest Hospital from August 2015 to May 2018 were selected as the study subjects, and randomly divided into control group (70 cases) and observation group (70 cases) according to the admission sequence. Patients in the control group was given routine antituberculosis drug treatment. Patients were po administered with Isoniazid Tablets 0.3 g, Rifampicin Capsules 0.45 g, Pyrazinamide Tablets 1.5 g, Ethambutol Hydrochloride Tablets 0.75 g, once daily. Patients in the observation group were po administered with Levofloxacin Lactate Tablets on the basis of control group, 0.4 g/time, once daily. Patients in two groups were treated for 3 months. After treatment, the clinical efficacy, peritoneal effusion, and adverse reactions in two groups were observed, and the serum levels of ADA and LDH before and after treatment in two groups were compared. Results After treatment, the total effective rate of the observation group was 95.7%, which was significantly higher than 84.3% of the control group (P<0.05). After treatment, the frequency of drainage and absorption time of abdominal effusion in the observation group were significantly lower than those in the control group (P<0.05). After treatment, the levels of serum ADA and LDH in two groups were significantly lower than those before treatment (P<0.05), and the levels of ADA and LDH in the observation group were significantly lower than those in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups during treatment. Conclusion Levofloxacin combined with anti-tuberculous drug regimen in treatment of severe tuberculous peritonitis can inhibit the release of ADA and LDH, shorten the frequency of aspiration of abdominal effusion and the absorption time of abdominal effusion, thus improving the therapeutic effect and ensuring good safety.

R978.3