目的 探讨与评价左氧氟沙星联合抗结核药方案治疗重症结核性腹膜炎的临床疗效。方法 选择2015年8月-2018年5月在西安市胸科医院诊治的重症结核性腹膜炎患者140例作为研究对象，根据入院顺序随机均分为对照组（70例）和观察组（70例）。对照组给予常规抗结核药物治疗，患者口服异烟肼片0.3 g，利福平胶囊0.45 g；吡嗪酰胺片1.5 g；盐酸乙胺丁醇片0.75 g，1次/d。观察组在对照组治疗的基础上口服乳酸左氧氟沙星片，0.4 g/次，1次/d。两组均治疗3个月。观察两组患者的临床疗效、腹腔积液情况和不良反应发生情况，同时比较两组治疗前后的血清腺苷脱氨酶（ADA）、乳酸脱氢酶（LDH）水平。结果 治疗后，观察组的总有效率为95.7%，显著高于对照组84.3%（P<0.05）。治疗后，观察组的抽腹腔积液次数与腹腔积液吸收时间均显著少于对照组（P<0.05）。两组治疗后的血清ADA与LDH水平均低于治疗前（P<0.05），且观察组ADA与LDH水平显著低于对照组（P<0.05）。两组治疗期间的不良反应发生率对比无显著差异。结论 左氧氟沙星联合抗结核药方案治疗重症结核性腹膜炎能抑制ADA与LDH的释放，缩短抽腹腔积液次数与腹腔积液吸收时间，从而提高治疗效果，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