母牛分支杆菌菌苗辅助治疗初治肺结核的临床研究  

Clinical study on Mycobacterium vaccae vaccine in initially treating pulmonary tuberculosis

作　　者：张国庆[1] 邢宝春[1] 刘素丽[1] 张丽娟[1] 孙凤霞[1] 徐小广[1] 

机构地区：[1]新乡医学院一附院结核内科,河南卫辉453100

出　　处：《临床荟萃》2004年第14期790-793,共4页Clinical Focus

摘　　要：目的　观察和评价母牛分支杆菌菌苗对初治肺结核患者免疫功能的影响和疗效。方法　采用随机配对分组法将 80例痰涂片阳性初治肺结核患者分为Ⅰ组 (4 0例 )和Ⅱ组 (4 0例 ) ,均采用 2个月异烟肼 (H)、利福平 (R)、吡嗪酰胺 (Z)、乙胺丁醇 (E)和 4个月异烟肼、利福平 (2HRZE/ 4HR)化疗方案治疗 ,Ⅰ组加用母牛分支杆菌菌苗治疗 6个月 ;观察治疗后临床症状改善、肺部病灶吸收、痰菌阴转及免疫功能改善情况。结果　Ⅰ、Ⅱ组临床改善情况比较 ,差异无统计学意义 (P >0 .0 5 ) ;Ⅰ组第 1个月痰涂片阴转率 30 .0 % ,痰培养阴转率 30 .0 % ,第 2个月痰涂片阴转率70 .0 % ,痰培养阴转率 70 .0 % ,Ⅱ组第 1个月痰涂片阴转率 2 5 .0 % ,痰培养阴转率 2 7.5 % ,第 2个月痰涂片阴转率4 5 .0 % ,痰培养阴转率 4 7.5 % ;初始 2个月痰菌阴转率Ⅰ组显著高于Ⅱ组 (P <0 .0 5 ) ;治疗 6个月后Ⅰ组痰涂片阴转率 97.5 % ,痰培养阴转率 97.5 % ,Ⅱ组痰涂片阴转率 95 .0 % ,痰培养阴转率 95 .0 % ,两组痰菌阴转率比较差异无统计学意义 (P >0 .0 5 ) ;Ⅰ组病灶吸收好转及空洞缩小关闭速度优于Ⅱ组 ;Ⅰ组的细胞免疫功能显著改善。结论　母牛分支杆菌菌苗能加快痰菌阴转、病灶吸收及空洞缩小关闭的速度 ,提高免疫细胞活性 。Objective To evaluate the effect of Mycobacterium vaccae vaccine(M. vaccae vaccine) on initially treated pulmonary tuberculosis. Method Eighty cases of initially treated pulmonary tuberculosis with smear and culture positive were divided into immunotherapy (group Ⅰ,40 cases) and control(group Ⅱ,40 cases) at random pair. Group Ⅰ was treated by chemotherapy with a regimen of 2HRZE/4HR and immunotherapy with M. vaccae vaccine for 6 months. Group Ⅱ was treated only by chemotherapy with a regimen of 2HRZE/4HR. The improvements of clinical symptoms, X-ray manifestation, immunity and the sputum-negative conversion rates after treatment were observed. Results There were no statistically significant differences between the two groups in clinical improvement(P> 0.05 ). The sputum smear-negative conversion rates in group Ⅰ 1,2 and 6 months after treatment were 30.0 %, 70.0 % and 97.5 % respectively; those in group Ⅱ were 25.0 %, 45.0 % and 95.0 % respectively. The sputum culture-negative conversion rates in group Ⅰ 1,2 and 6 months after treatment were 30.0 %, 70.0 % and 97.5 % respectively; those in group Ⅱ were 27.5 %, 47.5 % and 95.0 % respectively. The sputum-negative conversion rates of group Ⅰ were significantly higher than those of group Ⅱ after 1 and 2 months′ treatment (P< 0.01 ),but there was no statistically significant difference between the two groups at the end of 6 months′ treatment (P> 0.05 ). Compared with group Ⅱ, group Ⅰ was better in the improvement of X-ray manifestation, cell-mediated immunity and cavity closing(P< 0.01 ). Conclusions M. vaccae vaccine can be a good immunoregulator, which shows less side effects. As an adjunct to chemotherapy, immunotherapy with M. vaccae vaccine is helpful for the patients of initially treated pulmonary tuberculosis.

关 键 词：分支杆菌 牛 结核 肺 药物疗法 免疫疗法 

分 类 号：R521[医药卫生—内科学]