气管镜腔内冷冻联合药物注射治疗溃疡坏死型和/或肉芽增殖型支气管结核的临床疗效  

Clinical Effect of Bronchoscopic Cryosurgery Combined with Medicine Injection on Endobronchial Tuberculosis Categorized as Ulcerative Necrosis and/or Granulation Hyperplasia

作　　者：赵磊[1] 薛剑[1] 王瑜玲[1] 傅秀慧 秦焕[1] 王栋[2] 王琳[2] 杨贵敏[3] ZHAO Lei;XUE Jian;WANG Yu-ling;FU Xiu-hui;QIN Huan;WANG Dong;WANG Lin;YANG Gui-min(The Fifth Hospital of Shijiazhuang(Tuberculosis Research Institute of Shijiazhuang),Shijiazhuang 050000,China;Tuberculosis Department,the Affiliated Hospital of Hebei University,Baoding 071000,China;Children's Hospital of Baoding,Baoding 071000,China)

机构地区：[1]河北省石家庄市第五医院石家庄市结核病研究所,050000 [2]河北大学附属医院结核科,河北省保定市071000 [3]保定市儿童医院,河北省保定市071000

出　　处：《实用心脑肺血管病杂志》2018年第10期107-110,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：河北省医学科学研究重点课题计划项目(20160788)

摘　　要：目的观察支气管镜腔内冷冻联合药物注射治疗溃疡坏死型和/或肉芽增殖型支气管结核(EBTB)的临床疗效。方法选取2015—2017年石家庄市第五医院结核科收治的溃疡坏死型和/或肉芽增殖型EBTB患者86例,采用随机数字表法分为对照组和观察组,每组43例。两组患者均给予3HRZE/15HR抗结核方案,对照组患者给予支气管镜腔内冷冻及静脉滴注阿米卡星治疗3周,观察组患者给予支气管镜腔内冷冻联合药物注射治疗3周。比较两组患者随访1、3、6个月痰菌转阴率,临床症状及体征消失时间、痰菌转阴时间,治疗前和治疗3周后炎性因子;观察两组患者治疗期间毒副作用发生情况。结果 (1)随访1、3、6个月观察组患者痰菌转阴率高于对照组(P<0.05)。(2)观察组患者发热、咳嗽和咳痰、全身乏力消失时间及痰菌转阴时间均短于对照组(P<0.05)。(3)两组患者治疗前C反应蛋白(CRP)、降钙素原(PCT)及白介素6(IL-6)水平比较,差异无统计学意义(P>0.05);观察组患者治疗3周后CRP、PCT及IL-6水平低于对照组(P<0.05)。(4)两组患者治疗期间毒副作用发生率比较,差异无统计学意义(P>0.05)。结论支气管镜腔内冷冻联合药物注射能有效提高溃疡坏死型和/或肉芽增殖型EBTB患者痰菌转阴率,改善临床症状及体征,缩短痰菌转阴时间,减轻局部炎性反应,且安全性较高。Objective To observe the clinical effect of bronchoscopic cryosurgery combined with medicine injection on endobronchial tuberculosis categorized as ulcerative necrosis and/or granulation hyperplasia.Methods From2015to2017,a total of86endobronchial tuberculosis patients categorized as ulcerative necrosis and/or granulation hyperplasia were selected in Tuberculosis Department,the Fifth Hospital of Shijiazhuang,and they were divided into control group and observation group according to random number table,each of43cases.Based on anti-TB programme of3HRZE/15HR,patients in control group received bronchoscopic cryosurgery combined with intravenous drip of amikacin for3weeks,while patients in observation group received bronchoscopic cryosurgery combined with medicine injection for3weeks.Sputum negative conversion rate1month,3and6months after follow-up,disappearance time of clinical symptoms and signs,sputum negative conversion time,inflammatory cytokines before treatment and3weeks after treatment were compared between the two groups,and incidence of toxic and side effects was observed during treatment.Results(1)Sputum negative conversion rate in observation group was statistically significantly higher than that in control group1month,3and6months after follow-up(P<0.05).(2)Disappearance time of fever,cough and expectoration,lacking in strength,and sputum negative conversion time in observation group were statistically significantly shorter than those in control group(P<0.05).(3)No statistically significant differences of levels of CRP,PCT or IL-6was found between the two groups before treatment(P>0.05),while levels of CRP,PCT and IL-6in observation group were statistically significantly lower than those in control group3weeks after treatment(P<0.05).(4)No statistically significant differences of incidence of toxic and side effects was found between the two groups during treatment(P>0.05).Conclusion In endobronchial tuberculosis patients categorized as ulcerative necrosis and/or granulation hyperplasia,bronchoscopic cryos

关 键 词：支气管结核 支气管镜 冷冻疗法 阿米卡星 异烟肼 炎性因子 

分 类 号：R52[医药卫生—内科学]