多西环素与阿奇霉素对恙虫病并肝损伤患者的临床疗效及其安全性分析

摘要/Abstract

摘要： 目的评估多西环素与阿奇霉素在治疗恙虫病并肝损伤患者中的疗效及对症状改善状况和肝功能的影响,并分析两种药物的安全性。方法选取2019年1月—2023年12月在宿迁市第一人民医院治疗的90例恙虫病并肝损伤患者,采用分层随机抽样法分为试验组(45例)和对照组(45例),在对照组中,患者通过服用阿奇霉素进行治疗;试验组的患者则采用多西环素治疗。比较两组在疗效、症状改善状况、肝功能指标、血清细胞因子、不良反应上的差异。结果在试验组中,临床治疗的总有效率达到了95.55%,而对照组的有效率为91.11%。尽管试验组的效果略高,但差异无统计学意义(χ²=0.714,P=0.398)。治疗7 d后,试验组退热时间、头痛消失时间、结痂消失时间、淋巴结肿大消失时间、皮疹消失时间、肝损伤恢复时间为(2.22±1.13)d、(3.22±1.12)d、(3.69±0.47)d、(6.46±1.35)d、(6.23±1.35)d、(3.75±1.03)d,短于对照组的(4.22±2.13)d、(5.56±2.91)d、(5.82±0.99)d、(9.21±2.94)d、(9.20±2.93)d、(6.86±1.27)d,差异均有统计学意义(t=5.466,4.715,12.283,5.527,5.566,12.184,均P<0.05);两组患者的ALT和AST水平在治疗后均有所下降,但组间对比差异无统计学意义(P>0.05);治疗后,试验组TNF-α、IL-6和INF-γ水平为(32.59±10.61)ng/L、(52.31±16.31)ng/L、(1.14±0.52)ng/mL低于对照组的(58.39±11.79)ng/L、(88.57±20.46)ng/L、(2.48±0.72)ng/mL,差异均有统计学意义(t=10.912,9.296,10.561,均P<0.05);试验组腹痛、腹泻、恶心呕吐、头痛、嗜睡、眩晕的总发生率为4.44%,低于对照组的15.55%,但差异无统计学意义(χ²=3.086,P=0.079)。结论多西环素在治疗恙虫病并肝损伤患者中表现出快速改善症状和降低炎症因子水平的效果,虽总有效率与阿奇霉素相近,但在加速症状消退和安全性方面显示出轻微优势。这表明多西环素是一个有效且安全的治疗选项。

关键词: 多西环素, 阿奇霉素, 恙虫病, 肝损伤, 血清细胞因子, 疗效, 安全性

Abstract: Objective To evaluate the efficacy, symptom improvement, and the impact on liver function of doxycycline versus azithromycin in patients with scrub typhus and hepatic impairment, and to analyze the safety of both drugs. Methods A total of 90 patients diagnosed with scrub typhus and hepatic impairment treated from January 2019 to December 2023 at the First People's Hospital of Suqian City were included in the study. Stratified random sampling was used to divide the patients into a trial group (45 patients) and a control group (45 patients). Patients in the control group received azithromycin, while those in the trial group were treated with doxycycline. The two groups were compared in terms of efficacy, symptom improvement, liver function, serum cytokine levels, and adverse reactions. Results The total effective rate of clinical treatment was 95.55% in the experimental group and 91.11% in the control group. Although the experimental group showed slightly better results, the difference was not statistically significant (χ²=0.714, P=0.398). After 7 days of treatment, the experimental group showed significantly shorter durations for fever resolution, headache relief, scab disappearance, reduction of lymph node swelling, rash disappearance, and liver damage recovery, with times of (2.22 ± 1.13) d, (3.22 ± 1.12) d, (3.69 ± 0.47) d, (6.46 ± 1.35) d, (6.23 ± 1.35) d, and (3.75 ± 1.03) d respectively, compared to the control group (4.22 ± 2.13) d, (5.56 ± 2.91) d, (5.82 ± 0.99) d, (9.21 ± 2.94) d, (9.20 ± 2.93) d, and (6.86 ± 1.27) d; all differences were statistically significant (t=5.466, 4.715, 12.283, 5.527, 5.566, 12.184, all P<0.05). Both groups showed a reduction in ALT and AST levels post-trearment, but there was no significant difference between groups (P>0.05). Post-treatment TNF-α, IL-6, and INF-γ levels were significantly lower in the experimental group at (32.59 ± 10.61) ng/L, (52.31 ± 16.31) ng/L, and (1.14 ± 0.52) ng/mL compared to the control group (58.39 ± 11.79) ng/L, (88.57 ± 20.46) ng/L, and (2.48 ± 0.72) ng/mL, respectively (t=10.912, 9.296, 10.561, all P<0.05). The total incidence of adverse reactions such as abdominal pain, diarrhea, nausea, vomiting, headache, somnolence, and dizziness was 4.44% in the experimental group, lower than 15.55% in the control group, although this difference was not statistically significant (χ²=3.086, P=0.079). Conclusion Doxycycline shows rapid improvement in symptoms and decreases in inflammatory markers in patients with scrub typhus and hepatic impairment. Although the overall efficacy is similar to azithromycin, doxycycline shows slight advantages in speeding symptom resolution and safety, making it an effective and safe treatment option.

Key words: Doxycycline, Azithromycin, Scrub typhus, Liver damage, Serum cytokines, Efficacy, Safety

钟香梅, 卫黎君. 多西环素与阿奇霉素对恙虫病并肝损伤患者的临床疗效及其安全性分析[J]. 肝脏, 2025, 30(2): 253-257.

ZHONG Xiang-mei, WEI Li-jun. Analysis of the clinical efficacy and safety of doxycycline and azithromycin in patients with scrub typhus and hepatic damage[J]. Chinese Hepatolgy, 2025, 30(2): 253-257.

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