胸腺五肽联合莫西沙星对复治菌阳肺结核患者血清炎性因子水平及预后的影响  

Effects of thymopentin combined with moxifloxacin on serum inflammatory factor levels and prognosis in patients with retreatment bacteria-positive pulmonary tuberculosis

作　　者：蒋进述[1] 陈耀华[2] 

机构地区：[1]大竹县疾病预防控制中心综合门诊部,四川达州635100 [2]达州市中心医院呼吸内科,四川达州635099

出　　处：《中国临床研究》2018年第1期18-21,共4页Chinese Journal of Clinical Research

基　　金：四川省卫生厅科研基金项目(130083)

摘　　要：目的探讨在常规抗结核治疗基础上,采用胸腺五肽联合莫西沙星治疗复治菌阳肺结核对血清炎性因子[白细胞介素-6(IL-6)、干扰素γ(INFγ)、转化生长因子β(TGFβ)]和T淋巴细胞亚群水平变化及预后的影响。方法选取2013年10月至2016年1月由大竹县疾病预防控制中心转诊达州市中心医院72例复治菌阳肺结核患者,按随机数字表法分为对照组与研究组,各36例。强化期常规抗结核治疗(HRZE方案)基础上,对照组仅加用莫西沙星,研究组加用莫西沙星+胸腺五肽治疗,两组均持续治疗2个月。强化期疗程结束后对比两组临床疗效、不良反应发生率、入院时及疗程结束后血清炎性因子(IL-6、INFγ、TGFβ)水平及T淋巴细胞亚群指标(CD3+、CD4+、CD8+、CD4+/CD8+)水平变化情况。强化期后两组给予巩固期HRE方案持续治疗6个月。1年后随访,对比疾病复发率。结果强化期2个月结束后比较,研究组总有效率(86.11%)明显高于对照组(58.33%,P<0.01);两组血清炎性因子水平较治疗前改善,且研究组血清IL-6、INFγ水平低于对照组,血清TGFβ水平高于对照组,差异有统计学意义(P均<0.01);两组T淋巴细胞亚群指标较治疗前均有不同程度改善,且研究组CD3+、CD4+、CD4+/CD8+高于对照组,CD8+低于对照组,差异有统计学意义(P均<0.01)。研究组不良反应总发生率(16.67%)与对照组(13.90%)比较差异无统计学意义(P>0.05);1年后随访,研究组结核复发率(5.56%)明显低于对照组(36.11%,P<0.01)。结论在常规抗结核治疗基础上,联合采用胸腺五肽及莫西沙星治疗复治菌阳肺结核效果显著,可有效改善患者血清IL-6及INFγ、TGFβ水平,提高机体免疫功能,降低疾病复发率,改善预后。Objective To investigate the influence of thymopentin combined with moxifloxacin on serum inflammatory factors and T lymphocyte subsets levels and prognosis of patients with retreatment bacteria-positive pulmonary tuberculosis. Methods Seventy-two patients with retreatment bacteria-positive pulmonary tuberculosis who were transfered from Dazhu County Center for Disease Control and Prevention to Dazhou Center Hospital between October 2013 and January 2016 were enrolled in this study. The patients were divided into control group and study group by random number table method （ n = 36 each）. In reinforcement period for 2 months, moxifloxacin was given alone in control group, and moxifloxaein plus thymopentin were given in study group on the basis of routine antitubereulosis treatment of HRZE regimen （ combined isoniazid, rifampiein, pyrazinamide and ethambutol）. After finishing the course of 2 months, the clinical efficacy, incidence of adverse reactions and the serum inflammatory factors （ IL-6, INFγ, TGFβ ） levels and T lymphocyte subsets （ CD3^＋ , CD4^＋, CD8^＋ , CD4^＋/CD8^＋ ） changes at admission and after the end of the course were compared between two groups. After reinforcement period, HRE regimen （ combined isoniazid, rifampicin and ethambutol） was given for 6 months in consolidation period in both two groups. The recurrence rate after 1 year of fallow-up was compared between two groups. Results After finishing the treatment of 2 months reinforcement period, the total effective rate in study group was significantly higher than that in control group （86. 11% vs 58. 33% , P 〈 0. 01 ）. Compared with pre-treatment, serum inflammatory factors levels significantly improved after the end of the course of reinforcement period in two groups in which IL-6 and INF-γ levels in study group were significantly lower than those in control group, and TGFβ level in study group was significantly higher than that in control group（ all P 〈 0.01 ）. Compared with pre-treatment, there wer

关 键 词：胸腺五肽 莫西沙星 肺结核 复治 菌阳 炎性因子 T淋巴细胞亚群 复发率 

分 类 号：R521[医药卫生—内科学]