目的: 探讨纤维支气管镜药物灌注联合莫西沙星在耐多药肺结核中应用效果。方法: 选取我院97
例耐多药肺结核病人，按照随机数字表法分组，对照组48 例，观察组49 例，均给予常规药物治疗，对照组加用左
氧氟沙星治疗，观察组加用莫西沙星联合纤维支气管镜药物灌注治疗，观察比较两组治疗3mo、6mo、9mo 痰菌转
阴率及治疗9mo 后病灶吸收率，并统计两组T 淋巴细胞亚群( CD4+、CD3+、CD8+ ) 及血清降钙素原( PCT) 水平
变化情况、不良反应发生率。结果: 观察组治疗6mo、9mo 痰菌转阴率分别为73．47%( 36 /49) 、85．71%( 42 /49) ，
均高于对照组54．17%( 26 /48) 、66．67%( 32 /48) ，差异具有统计学意义( P＜0．05) ; 观察组病灶吸收率为87．76%
( 43 /49) ，高于对照组64．58%( 31 /48) ，差异具有统计学意义( P＜0．05) ; 治疗9mo 后观察组血清CD4+ 及CD3+ 水
平均高于对照组，差异具有统计学意义( P＜0．05) ; 治疗9mo 后观察组血清PCT 水平低于对照组，差异具有统计
学意义( P＜0．05) ; 观察组不良反应发生率为14．29%( 7 /49) ，对照组为12．50%( 6 /48) ，组间对比差异无统计学意
义( P＞0．05) 。结论: 莫西沙星结合纤维支气管镜药物灌注可提高耐多药肺结核病人痰菌转阴率及病灶吸收率，
改善血清T 细胞亚群、PCT 水平，且安全性高。

Objective: To evaluate the effect of fiberbronchoscope drug perfusion combined with
moxifloxacin on sputum negative rate and serum T lymphocyte subsets and PCT levels in patients with
multiple drug resistant pulmonary tuberculosis．Methods: 97 cases of multiple drug resistant pulmonary
tuberculosis in our hospital were randomly divided into 2 groups，48 cases in the control group and 49
cases in the observation group．On the basis of the routine medication， the control group was treated with
levofloxacin，and the observation group was treated with fiberbronchoscope drug perfusion combined
with moxifloxacin．The sputum negative rate after 3，6
and 9months of treatment and the rate of absorption
of the lesions after 9months were compared between the two groups．The changes of T lymphocyte
subsets( CD4+，CD3+，CD8+ ) and serum PCT levels in two groups were observed and the incidence of
adverse reactions was observed．Ｒesults: The sputum negative rate in the observation group was 73．47%
( 36 /49) and 85．71%( 42 /49) at the 6 th month and 9 th month respectively，all higher than those of
the control group 54．17%( 26 /48) and 66．67%( 32 /48) ( P＜0．05) ．The rate of absorption of the lesions
in the observation group was 87．76%( 43 /49) ，higher than that in the control group( 64．58%) ( 31 /48)
( P＜0．05) ．After 9months treatment， the serum levels of CD4+ and CD3+ in the observation group were
higher than those in the control group( P＜0．05) ，and the serum PCT level of the observation group was
lower than that of the control group( P＜0．05) ．There was insignificant difference in the incidence of adverse
reactions between the observation group 14．29%( 7 /49) and the control group 12．50%( 6 /48) ( P
＞0．05) ．Conclusion: Moxifloxacin combined with fiberbronchoscope drug perfusion can improve the
sputum negative rate and the rate of absorption of the lesions in patients with multiple drug resistant
pulmonary tuberculosis， improve the serum T lymphocyte subsets and PCT levels with high safety．

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 收稿日期: 2017－10－19; 修回日期: 2017－12－23
基金项目: 内蒙古自然科学基金( 2017MS08113)
作者简介: 王哲( 1981－) ，男，湖北省潜江市中心医院感染性疾病科主治医师。
通讯作者: 贾海玉，主任医师，E－mail: nmjiahaiyu@ qq．com 内蒙古医科大学附属医院保A 病区， 010050