胸腺肽联合抗结核药物治疗耐多药肺结核临床疗效  

Clinical efficacy of thymosin combined with chemotherapy drugs in treatment of multi-drug resistant pulmonary tuberculosis

作　　者：韩伟[1] 崔泰震[2] 黄健[1] 肖志坚[1] 崔秀琴[1] 

机构地区：[1]新乡医学院第一附属医院结核内二科,河南卫辉453100 [2]新乡医学院药学院,河南新乡453003

出　　处：《新乡医学院学报》2015年第12期1106-1109,共4页Journal of Xinxiang Medical University

摘　　要：目的研究免疫调节剂胸腺肽联合抗结核药物治疗耐多药肺结核(MDB-TB)的临床效果。方法 120例MDB-TB患者分为观察组62例和对照组58例。2组患者强化期3个月,给予对氨基水杨酸钠异烟肼片、丙硫异烟胺、左氧氟沙星、硫酸阿米卡星及乙胺丁醇治疗;巩固期18个月,给予对氨基水杨酸钠异烟肼片、丙硫异烟胺、左氧氟沙星及乙胺丁醇治疗(3Pa Th VAE/18Pa Th VE)。观察组患者在抗结核治疗基础上联合胸腺肽治疗,对照组患者仅给予抗结核治疗。比较2组患者临床症状消失率、双肺阴影吸收情况、痰结核菌阴转率、肺部病灶治疗有效率、空洞治疗有效率及不良反应发生情况。另选择同期体检健康者50例为健康对照组。检测并比较3组受试者外周血T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)。结果观察组患者的临床症状消失率、痰结核菌阴转率、肺部病灶治疗有效率及肺部空洞治疗有效率分别为90.3%、87.1%、91.9%和91.9%,对照组患者分别为63.8%、62.1%、63.8%和65.5%,观察组患者的临床症状消失率、痰结核菌阴转率、肺部病灶治疗有效率及肺部空洞治疗有效率均显著高于对照组(P<0.05)。与健康对照组比较,2组患者CD3+、CD4+细胞百分比及CD4+/CD8+均显著降低,而CD8+细胞百分比显著升高(P<0.05)。观察组患者治疗后外周血CD3+、CD4+细胞百分比以及CD4+/CD8+均较治疗前显著升高(P<0.05),而CD8+细胞较治疗前显著降低(P<0.05)。对照组患者治疗前后CD3+、CD4+、CD8+细胞及CD4+/CD8+比较差异均无统计学意义(P>0.05)。治疗后观察组患者外周血CD3+、CD4+细胞及CD4+/CD8+与对照组比较显著升高,而CD8+细胞较对照组显著下降,差异均有统计学意义(P<0.05)。结论胸腺肽联合抗结核药物治疗MDB-TB疗效佳,且无明显不良反应。Objective To study the efficacy of thymosin combined with chemical medication in the treatment of multidrug resistant pulmonary tuberculosis（ MDB-TB）. Methods A total of 120 patients with MDB-TB were divided into observation group（ 62 cases） and control group（ 58 cases）. All the patients were treated with isoniazid aminosalicylate,protionamide,amikacin,levofloxacin and ethambutol in the intensive phase of three months and with isoniazid aminosalicylate,protionamide,levofloxacin and ethambutol in the consolidation phase of followed eighteen months（ 3Pa Th VAE /18 Pa Th VE）. The observation group were given 3Pa Th VAE /18 Pa Th VE combined with thymosin. The control group only received the 3Pa Th VAE /18 Pa Th VE.Improvement of clinical symptoms,radiographic improvement,negative conversion of sputum,cavity closing rate and side effect were observed. At the same time,another fifty cases of health peoper were chosen as health controls. The changes of lymphocyte subpopulation of the blood such as CD3＋,CD4＋,CD8＋and CD4＋/ CD8＋were observed in the three groups. Results By the end of treatment,the rate of improvement rate of clinical symptoms,tubercle bacillus negative conversion rate of sputum,effective rate of lung lesion and cavity were 90. 3%,87. 1%,91. 9% and 91. 9%,resectively in the observation group,while all these indications were 63. 8%,62. 1%,63. 8% and 65. 5%,resectively in the control group. The rate of improvement of clinical symptoms,negative conversionof sputum,effective rate of lung lesion and cavity were significantly higher than those in the control group（ P〈0. 05）. Compared with healthy controls,the level of CD3＋,CD4＋and CD4＋/ CD8＋decreased significantly in observation group and control group,while the level of CD8＋increased significantly（ P〈0. 05）. After treatment,the level of CD3＋,CD4＋and CD4＋/ CD8＋was all significantly higher and the level of CD8＋was significantly lower than that before treatment in the observation group（ P〈0. 05）. Sign

关 键 词：肺结核 耐多药 胸腺肽 免疫治疗 

分 类 号：R521[医药卫生—内科学]