结核丸联合常规抗结核方案治疗老年肺结核合并颈部淋巴结核的临床研究  

Combination of Jiehe pellet and the standardized anti-tuberculosis therapeutic regimen for pulmonary tuberculosis complicating cervical lymph node tuberculosis in the aged

作　　者：魏兰[1] 李玉琢[1] 贾新转[2] 李建行[1] 彭海军[1] 段小亮[1] 秦学博[1] 冯军鹏[1] 

机构地区：[1]河北省胸科医院胸三科,石家庄050041 [2]河北医科大学第四医院生殖医学科,石家庄050011

出　　处：《国际中医中药杂志》2015年第1期16-20,共5页International Journal of Traditional Chinese Medicine

基　　金：河北省医学科学研究课题计划（20130125）

摘　　要：目的：评价结核丸联合常规抗结核方案治疗老年肺结核合并颈部淋巴结核的临床疗效。方法2012年1月－2014年1月共纳入河北省胸科医院胸三科103例合并颈部淋巴结核老年肺结核患者，并按随机数字表法将患者随机分为常规抗结核方案组（对照组）51例和结核丸联合常规抗结核方案组（治疗组）52例。对照组采用常规抗结核方案（2HRZE/4HR）治疗；治疗组在对照组治疗基础上加服结核丸治疗。2组均先采用标准化抗结核药物治疗4周后，行颈淋巴结结核病灶摘（清）除术，脓肿性结节行切开引流术。2组均治疗6个月后检测痰涂片，流式细胞术检测外周血CD8细胞上自然杀伤（NK）T细胞表面受体NKG2D和NKG2A表达及血清白细胞介素（IL）-6、IL-10、肿瘤坏死因子-α（TNF-α）水平变化，并进行临床疗效评价。结果治疗组病灶吸收率为78.85%（41/52），显著高于对照组的58.82%（30/51）（χ2＝4.439，P＜0.05）；空洞闭合率为62.86%（22/35），也显著高于对照组的35.48%（11/31）（χ2＝3.893， P＜0.05）。治疗组2、4、6个月末累计痰菌阴转率显著高于对照组（χ2值分别为5.343、5.067和4.118， P均＜0.05）。治疗组治疗后表达 NKG2A的CD8细胞显著低于同组治疗前和对照组治疗后（t值分别为9.510、9.832，P均＜0.01）；表达NKG2D的CD8细胞显著高于同组治疗前和对照组治疗后（t值分别为10.622、10.433，P均＜0.01）。2组血清IL-6、TNF-α水平均较同组治疗前下降（治疗组t值分别为17.344、21.142，对照组t值分别为10.984、12.203，P均＜0.01），且治疗组治疗后低于对照组治疗后（t值分别为7.832、5.478，P均＜0.01）。2组血清IL-10水平均明显高于同组治疗前（t 治疗组＝12.454、t 对照组＝7.934， P均＜0.01），且治疗组治疗后高于对照组治疗后（t＝4.720，P＜0.01）。治疗组淋巴结核有效率（46/52，88.5%）高于对照�Objective To assess the efficacy of combination of Jiehe pellet and the standardized anti-tuberculosis therapeutic regimen for pulmonary tuberculosis complicating cervical lymph node tuberculosis in the aged. Methods A total of 103 aged patients with pulmonary tuberculosis complicating cervical lymph node tuberculosis were enrolled and randomly allocated to either a standardized anti-tuberculosis therapeutic regimen group （control group with 51 patients） or a standardized anti-tuberculosis therapeutic regimen plus Jiehe pellet group （treatment group with 52 patients）. The patients in the control group and the treatment group received the treatment with 2HRZE/4HR and 2HRZE/4HR plus Jiehe pellet for 6 months, respectively. The abscessed lymph nodes were treated by either total excision or incision and drainage after 4 weeks of medicine treatment in both groups. Sputum smear was examined for acid-fast bacilli. The CD8 cells expressing natural killer T cells receptors NKG2A, NKG2D in peripheral blood were detected by flow cytometry. The treatment outcome was measured at the end of treatment. Results The rates of lesion resolution （78.85%vs. 58.82%;χ2=4.439, P〈0.05） and cavity closure （62.86% vs. 35.48%;χ2=3.893, P〈0.05） in the treatment group were significantly higher than those in the control group. In the end of 2, 4 and 6 months of treatment, cumulative rates of sputum conversion from positive to negative in the treatment group were significantly higher than those in the control group （χ2 were 5.343, 5.067 and 4.118,all P〈0.05）. The CD8 cells expressing NKG2A after treatment in the treatment group were significantly lower than those before treatment in the treatment group （t=9.510, P〈0.01） and after treatment in the control group （t=9.832, P〈0.01）;the CD8 cells expressing NKG2D after treatment in the treatment group were significantly higher than those before treatment in the treatment group （t=10.622, P〈0.01） and after treatment in the control group （t=10.433, P〈

关 键 词：结核 肺 结核 淋巴结 抗结核药 治疗结果 结核丸 NKG2D受体 NKG2A受体 

分 类 号：R52[医药卫生—内科学]