摘要
目的近年肺结核特别是复治菌阳肺结核发病率明显升高,其防治措施尚未完全阐明。本研究旨在分析胸腺五肽联合2HZEs/7HE方案对复治菌阳肺结核患者症状改善及免疫功能影响,为临床确定合理防治方案提供参考。方法选取2016-10-01-2018-10-01漯河市传染病医院收治的89例复治菌阳肺结核患者为研究对象,按照组间匹配的原则分为对照组(n=44)和观察组(n=45)。对照组采用2HZEs/7HE方案(异烟肼+吡嗪酰胺+乙胺丁醇+链霉素)治疗;观察组在对照组基础上采用胸腺五肽治疗,连续治疗2个月。统计两组痰菌转阴率和症状改善率,比较治疗前后免疫功能和血清学变化,并于治疗后3和6个月随访两组复发率。免疫功能包括CD8+、CD3+和CD4+/CD8+,血清指标包括转化生长因子β(transforming growth factorβ,TGF-β)和白细胞介素-10(interleukin-10,IL-10)。结果观察组症状改善率为88.89%,高于对照组的65.91%,χ2=6.743,P=0.010;痰菌转阴率为91.11%,高于对照组的68.18%,χ2=7.250,P=0.007。治疗后观察组CD8+水平为(26.40±2.16)%,低于对照组的(30.14±3.15)%,t=6.545,P<0.001;CD4+/CD8+为(1.82±0.44)%,高于对照组的(1.36±0.25)%,t=6.045,P<0.001;CD3+水平为(68.24±9.11)%,高于对照组的(61.15±8.33)%,t=3.830,P<0.001。治疗后观察组血清IL-10水平为(0.42±0.04)ng/L,低于对照组的(0.61±0.07)ng/L,t=15.766,P<0.001;TGF-β水平为(32.22±6.05)pg/mL,高于对照组的(25.16±5.41)pg/mL,t=5.799,P<0.001。治疗后3和6个月观察组复发率与对照组比较,差异无统计学意义,均P>0.05。结论胸腺五肽联合2HZEs/7HE方案治疗复治菌阳肺结核,有助于调节血清IL-10和TGF-β水平,控制临床症状,促进痰菌转阴,增强机体免疫功能。
OBJECTIVE In recent years,the incidence rate of tuberculosis,especially the retreatment of bacteriological positive pulmonary tuberculosis,has increased significantly,and its prevention and treatment measures have not been fully elucidated.This study aims to analyze the application effect of thymic five peptide combined with 2HZEs/7HE program in this disease,and provide reference for clinical rational prevention and treatment.METHODS From October 1,2016 to October 1,2018,89 patients with retreated bacillary positive pulmonary tuberculosis in Luohe Infectious Disease Hospital were divided into groups according to the principle of matching between groups.Fourty-four cases in the control group were treated with 2HZEs/7HE scheme(isoniazid+pyrazinamide+ethambutol+streptomycin).Fourty-five cases in the observation group were treated with thymopentin based on the control group for 2 months.The sputum negative conversion rate and symptom improvement rate of the two groups were compared before and after treatment.The recurrence rate of the two groups was followed up 3 and 6 months after treatment.The immune function indexes includes CD8^+,CD3^+and CD4^+/CD8^+,and the serum indexes include transforming growth factorβ(TGF-β)and interleukin-10(IL-10).RESULTS The improvement rate of symptoms in the observation group was 88.89%,higher than 65.91%of the control group,χ~2=6.743,P=0.010.The negative conversion rate of sputum bacteria was 91.11%,higher than 68.18%of the control group,χ~2=7.250,P=0.007.After treatment,the CD8^+level of the observation group was(26.40±2.16)%,lower than that of the control group(30.14±3.15)%,t=6.545,P<0.001.CD4^+/CD8^+was(1.82±0.44)%,higher than the control group(1.36±0.25)%,t=6.045,P<0.001.CD3^+was(68.24±9.11)%,higher than that of the control group(61.15±8.33)%,t=3.830,P<0.001.The level of IL-10 in the observation group was(0.42±0.04)ng/L,lower than that in the control group(0.61±0.07)ng/L,t=15.766,P<0.001.The serum TGF-βlevel was(32.22±6.05)pg/ml,which was higher than that of the control group(25.16±5.41)pg/ml,t=5.799,P<0.001.There was no significant difference in the recurrence rate between the observation group and the control group at 3 and 6 months after treatment(all P>0.05).CONCLUSION Thymopentin combined with 2HZEs/7HE is helpful to regulate the levels of serum IL-10 and TGF-β,control clinical symptoms,promote the negative transformation of sputum bacteria and enhance the immune function of the body.
作者
朱红涛
任红伟
赵卫萍
尹光辉
陈瑛
ZHU Hong-tao;REN Hong-wei;ZHAO Wei-ping;YIN Guang-hui;CHEN Ying(No.2 Tuberculosis Ward,Luohe Infectious Diseases Hospital,Luohe 462000,P.R.China)
出处
《社区医学杂志》
2020年第17期1208-1211,共4页
Journal Of Community Medicine
