加味定喘汤联合抗痨治疗对重症肺结核患者的临床疗效及对免疫功能的影响  

Clinical Effects of Modified Dingchuan Decoction Combined with Anti-tuberculosis Treatment for Severe Tuberculosis Patients and Its Influence on Immune Function

作　　者：龚惠莉 陈艳 张燕玲 冯明玉 Gong Huili;Chen Yan;Zhang Yanling;Feng Mingyu(Shanghai Pudong New Area Pulmonary Hospital,Shanghai 201209,China)

机构地区：[1]上海市浦东新区肺科医院,上海201209

出　　处：《世界中医药》2018年第12期3066-3069,共4页World Chinese Medicine

基　　金：上海市浦东新区卫生系统学科带头人培养计划项目(PWRd2015-04)

摘　　要：目的:探究加味定喘汤联合抗痨治疗对重症肺结核患者的临床疗效及对免疫功能的影响。方法:选取2015年4月至2017年10月浦东新区肺科医院收治的重症肺结核患者79例,按照随机数字表法随机分为观察组(n=40)和对照组(n=39),对照组给予西医抗痨治疗,观察组在对照组的基础上给予加味定喘汤治疗,2组均连续治疗2月。检测2组患者治疗前后T淋巴细胞亚群、炎性因子水平及中医证候积分;统计2组临床疗效及痰菌转阴率,并记录2组治疗期间不良反应发生情况。结果:与治疗前比较,治疗后2组全血CD3^+、CD4^+比例及观察组CD4^+/CD8^+显著升高,且观察组显著高于对照组(P <0. 01),2组CD8+比例显著降低(P <0. 01),且观察组显著低于对照组(P <0. 01); 2组血清TNF-α、IL-6、hs-CRP水平显著降低,且观察组上述炎性因子指标均低于对照组(P <0. 01); 2组盗汗、发热、咳痰、乏力、食欲下降积分及总分显著降低(P <0. 05或P <0. 01),且观察组显著低于对照组(P <0. 01);观察组临床总有效率为95. 56%,显著高于对照组的70. 45%(P <0. 05);治疗2个月后,对照组痰菌转阴率为43. 59%,显著低于观察组的67. 50%(P <0. 01);治疗期间观察组未发生不良反应,对照组不良反应发生率为5. 13%,2组间不良反应发生率差异无统计学意义(P> 0. 05)。结论:加味定喘汤联合抗痨可有效缓解重症肺结核患者临床症状,提高免疫功能,减轻炎性反应,安全性高,且疗效显著优于单独西医抗痨治疗。Objective:To explore the clinical effects of Modified Dingchuan Decoction combined with anti-tuberculosis treatment for severe tuberculosis patients and its influence on immune function.Methods:A total of 79 cases of severe tuberculosis patients were selected and divided randomly into control group(n=39)and observation group(n=40)according to random number table method.The control group was treated with western medicine anti-tuberculosis,and the observation group was treated with Modified Dingchuan Decoction on the basis of control group,and 2 groups were treated continuously for 6 months.T lymphocyte subsets,inflammatory factors and Traditional Chinese Medicine(TCM)syndromes in 2 groups were detected before and after treatment;the clinical curative effect and the sputum bacterium negative conversion rate in 2 groups were statistically analyzed,and the adverse reactions occurrence in 2 groups were recorded.Results:Compared with before treatment,the proportion of whole blood CD3+and CD4+in 2 groups and CD4+/CD8+in observation group increased significantly after treatment(P<0.01),and observation group was significantly higher than control group(P<0.01),the proportion of CD8+in 2 groups decreased significantly(P<0.01),and observation group was significantly lower than control group(P<0.01);the serum TNF-α,IL-6 and hs-CRP levels in 2 groups significantly decreased after treatment,and the above inflammatory factor index in observation group was significantly lower than those in control group(P<0.01);the night sweats,fever,expectoration,debilitation,loss of appetite scores and total scores in 2 groups significantly decreased(P<0.05 or P<0.01),and observation group was significantly lower than control group(P<0.01);the total clinical efficiency of observation group was 95.56%,which was significantly higher than 70.45%of control group after treatment(P<0.05);the sputum bacterium negative conversion rate of control group 6 months after treatment was 43.59%,which was significantly lower than 67.50%of study group(P<0.01).D

关 键 词：重症肺结核 加味定喘汤 抗痨治疗 临床疗效 炎性因子 免疫功能 

分 类 号：R256.17[医药卫生—中医内科学]