摘要
目的探讨中医辅助治疗对耐多药肺结核（multidrug resistance pulmonary tuberculosis，MDR-PTB）患者细胞免疫状态改善后的临床疗效及预后。方法搜集2009年7月至2012年12月上海市徐汇区中心医院收治的40例MDR-PTB患者，用SAS统计分析系统随机数字表法分为研究组20例和对照组20例，两组均予以西药抗结核治疗为基础，总疗程22个月；研究组在西药治疗的同时辅以中医辨证施治，中药扶正疗法。观察两组患者T淋巴细胞亚群绝对值水平在治疗前后的变化，应用SPSS17．0统计软件对计量资料采用t检验，计数资料采用卡方检验，比较细胞免疫状态提升对两组患者疗效及不良反应的影响，P〈0．05为差异有统计学意义。结果研究组在治疗结束时血T淋巴细胞亚群CD3＋、CD4＋、CD8’绝对值水平及CD4＋／CD8＋分别为（1412．8士349．5）个／μl、（735．O土164．2）个／μl、（598．8±180．9）个／μl、1．66±0．14，均明显高于治疗前[（760．9土158．3）个／μl、（423．2士74．7）个／μl、（284．3±106．1）个／sl、1．29±0．07]，差异有统计学意义（t值分别为-11．62、-10．49、-9．22和-2．51，P值均〈o．05）；治疗结束时血T淋巴细胞亚群CD3＋、CD4＋、CD8’绝对值水平也明显高于对照组治疗结束时[（1143．1±302．6）个／μl、（621．2土144．1）个／μl、（473．5±153．7）个／μl]，差异有统计学意义（t值分别为2．61、2．33、2．36，P值均〈O．05）。两组综合疗效比较，研究组总有效率为85．0％（17／20），明显优于对照组[55．0％（11／20）]，差异有统计学意义（X2=4．286，P〈0．05）；研究组患者中医证候改善有效率为[90．O％a8／20）]、痰菌阴转率为E80．0％（16／20）]、肺部病灶吸收率为E85．O％（17／20）]，均高于对照组[分别为60．0％（12／20）、50．0％（10／20）、55．0％（11／20）]，差异有统计学意义（X2值分别为4．80、3．96、4．29，P值均〈O．05）；研究组的药物不良反应总发生率为[35．0％（7／20）]明显低于对照组E65．0％（13／20）]，差异有统计学意义（X2=3．626，P〈0．05）。结论中医扶正疗法可以提升MDR-PTB患者的细胞免疫状态，随着细胞免疫状态改善有助于促进患者临床症状的缓解、痰菌转阴、肺部病灶的吸收、减少药物的不良反应、提高患者的治疗依从性和治疗效果。
Objective To investigate the clinical effect and prognosis of the patients with multi drug resistant pulmonary tuberculosis after the improvement of cellular immunity treated by traditional Chinese medicine combined with chemotherapy. Methods From July 2009 to December 2012, 40 patients with multi drug resistant tuberculosis were randomly divided into study group （20 cases） and control group （20 cases） in numeration table. Two groups were treated with anti tuberculosis drugs with total course of 22 months, the study group treated by traditional Chinese medicine combined with chemotherapy. Statistical analysis was done by SPSS 17. 0 comparison the absolute value of T lymphocyte subsets before and after treatmentand the efficacy and adverse reactions between the two groups. Results The serum absolute levels of T lymphocyte subsets CD3＋ ,CD4＋ ,CD8＋ （1412.8＋349. 5）/μl, （9735.0±164.2）/μl, （598. 8±180. 9）/μl and CD4＋/CD8＋ （1.66±0.14） in the study group patients had a sig- nificantly increased after treatment than before （760. 9 ± 158. 3）μl, （423. 2 ± 74. 7）/μl, （284.3 ± 106.1）/bd, 1.29±0.07 （t=-ll. 62,-10. 49,-9. 22,-2. 51,P〈0. 05）. The absolute levels of T lymphocyte subsets CD3＋ ,CD4＋ , CD8＋ was significantly higher than the control group （1143. l±302.6）/tal, （621.2 ± 144. 1）/μl, （473.5 ± 153.7）/μl （t=2.61, 2.33, 2.36,P〈0. 05） at the end of treatment. The total effective rate in study group was 85.0 % （17/20）, which was significantly better than that in control group （55.0%, 11/20） （X2 = 4. 286,P%0.05）. The syndrome improvement rate 90.0% （18/20）, the sputum negative conversion rate 80. 0% （16/20） and the focus absorption rate 85.0%（17/20） of in the patients of study group were significantly higher than that of the control group respectinely 60. 0% （12/20）, 50.0% （10/20）, 55.0% （11/20） （X2 =4. 80,3.96,4.29,P〈0. 05）. The rate of adverse drug reactions in the study group was 35.0K （7/20）, significantly lower than that in the control group 65.0K （13/20）（X2=3. 626,P〈0.05）. Conclusion TCM treatment can improve cellular immune status of pul- monary tuberculosis patients with multi drug resistance and promote the symptoms improvement, sputum negative conversionand of lung lesions absorption. Meanwhile, TCM treatment can also reduce adverse drug reactionsand im- prove the curative effect.
出处
《中国防痨杂志》
CAS
2016年第1期32-37,共6页
Chinese Journal of Antituberculosis
关键词
免疫
细胞
医学
中国传统
抗药性
多种
细菌
结核
肺/治疗
Immunity, Cellular
Medicine, Chinese traditional
Drug resistance, Multiple
Tuberculosis, pulmonary/therapy
作者简介
通信作者：周颖，Email：yingzhouwu@hotmail．com
