摘要
目的观察黄芪联合抗结核药对肺结核合并糖尿病(PTB-DM)患者细胞免疫炎性反应、凝血功能的影响。方法将2016年1月—2017年12月中国人民解放军联勤保障部队第九八〇医院收治的80例PTB-DM患者患者随机分为对照组和观察组,每组40例。2组均给予常规四联抗结核治疗和胰岛素皮下注射,观察组在此基础上给予中药黄芪治疗,疗程为6个月。分别于治疗前后根据肺结核症状积分标准对患者咳嗽、咳痰、乏力、盗汗和食欲情况进行评分,观察2组治疗后痰液结核杆菌涂片转阴情况、空腹血糖(FPG)、细胞免疫指标(CD3+、CD4+、CD8+、CD4+/CD8+及Th1、Th2细胞水平和Th17、Treg细胞表达率)、炎性指标[单核细胞趋化蛋白-1(MCP-1)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和转化生长因子-β(TGF-β)]、凝血指标[凝血酶原时间(APTT)、血浆凝血酶原时间(PT)、血浆凝血酶时间(TT)、血小板(Plt)、纤维蛋白原(FIB)和D-二聚体(D-D)]的变化,比较2组治疗期间不良反应发生情况。结果治疗后2组咳嗽、咳痰、乏力、盗汗和发热评分均明显降低(P均<0.05),且观察组均明显低于对照组(P均<0.05)。治疗2个月和6个月观察组痰涂片结核杆菌转阴率均明显高于对照组(P均<0.05)。治疗2个月、6个月2组FPG均明显降低(P均<0.05),且观察组在治疗6个月时明显低于对照组(P<0.05)。治疗后2组CD3+、CD4+、Th1和Th17水平和CD4+/CD8+均升高(P均<0.05),且观察组明显高于对照组(P均<0.05);2组Th2、Treg水平及MCP-1、IL-6、TNF-α、TGF-β均明显下降(P均<0.05),且观察组明显低于对照组(P均<0.05)。治疗后2组APTT、PT、TT均明显缩短(P均<0.05),Plt、FIB、D-D水平明显降低(P均<0.05),且观察组缩短及降低程度明显大于对照组(P均<0.05)。治疗期间观察组胃肠道反应、肝功能受损、皮疹和白细胞降低发生率均明显低于对照组(P均<0.05)。结论黄芪联合抗结核药可以有效改善PTB-DM患者的临床症状,提高痰涂片转阴率,且不良反应少,可能与改善患者的细胞免疫状态和凝血功能、减轻炎性反应有关。
Objective It is to observe the effect of Huangqi injection combined with antituberculosis drugs on cellular immune inflammatory response and coagulation function in patients with pulmonary tuberculosis complicated with diabetes(PTB-DM).Methods Eighty patients with PTB-DM treated in our hospital from January 2016 to December 2017 were randomly divided into a control group and an observation group,with 40 patients in each group.Both groups were given conventional quadruple antituberculosis treatment and subcutaneous insulin injection.The observation group was treated with Huangqi injection/Huangqi granule for 6 months based on the above treatment.The scores of cough,expectoration,fatigue,night sweats,and appetite were evaluated according to the tuberculosis symptom standard evaluation before and after treatment.The negative conversion of sputum tuberculosis smear,and the changes of fasting blood glucose(FPG),cellular immune indicators(CD3+,CD4+,CD8+,CD4+/CD8+,Th1,Th2 and Th17,Treg cell expression rates),inflammatory indicators[monocyte chemotactic protein-1(MCP-1),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and transforming growth factor-β(TGF-β)],coagulation indicators[prothrombin time(APTT),plasma prothrombin time(PT),plasma thrombin time(TT),platelet(PLT),fibrinogen(FIB),and D-dimer(DD)]were observed after treatment,and the adverse reactions during the two groups were compared.Results The scores of cough,expectoration,fatigue,night sweats,and fever in the two groups were significantly reduced after treatment(P<0.05),and the scores in the observation group was significantly lower than the control group(P<0.05).The negative conversion rates of tuberculosis in the observation group at 2 and 6 months after treatment were significantly higher than those in the control group(P<0.05).After 2 months and 6 months of treatment,the FPG levels in the two groups were significantly reduced(P<0.05),and the observation group was significantly lower than the control group at 6 months(P<0.05).After treatment,the levels of CD3+,CD4+,Th1 and Th17 and CD4+/CD8+was increased in both groups(P<0.05),and the observation group was significantly higher than the control group(P<0.05);the levels of Th2,Treg,MCP-1,IL-6,TNF-α,and TGF-βwere significantly decreased(P<0.05),and the observation group was significantly lower than the control group(P<0.05).After treatment,the APTT,PT,and TT in both groups were significantly shortened(P<0.05),and the levels of PLT,FIB,D-D were significantly reduced(P<0.05),and the shortening and reduction in the observation group were more significant than those in the control group(P<0.05).The incidence of gastrointestinal reactions,impaired liver function,rash and leukopenia in the observation group were significantly lower than those in the control group during the treatment period(P<0.05).Conclusion Huangqi injection combined with antituberculosis drugs can effectively improve the clinical symptoms,increase the negative rate of sputum smears,and have fewer adverse reactions in patients with PTB-DM,the mechanism may be related to improving the cellular immune status and coagulation function,and reducing inflammatory reactions.
作者
李小月
张艳丽
曹光
杨卫
武丽
杨红叶
陈厦
LI Xiaoyue;ZHANG Yanli;CAO Guang;YANG Wei;WU Li;YANG Hongye;CHEN Xia(The 980th Hospital of Joint Service Support Force of the PLA, Shijiazhuang 050082, Hebei,China;Baoding Infectious Disease Hospital, Baoding 071000, Hebei,China;Qinhuangdao Health School, Qinhuangdao 066000, Hebei, China;Baoding First Central Hospital, Baoding 071000, Hebei, China;The Second Hospital of Hebei Medical University, Shijiazhuang 050000,Hebei,China)
出处
《现代中西医结合杂志》
CAS
2020年第9期945-949,共5页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
河北省中医药管理局科研计划项目(2019184)。
关键词
肺结核
糖尿病
黄芪
细胞免疫
凝血功能
tuberculosis
diabetes
astragalus
cell immunity
coagulation function
作者简介
李小月,女,硕士,主要从事结核病及常见热性病诊疗工作。
