抗痨清脑汤联合地塞米松治疗结核性脑膜炎的疗效及对单核细胞TLR4、MyD88表达的影响  

The Effect of Kanglao Qingnao Decoction Combined with Dexamethasone in the Treatment of Tuberculous Meningitis and Its Influence on the Expression of TLR4 and MyD88 in Monocytes

作　　者：马喜迎 肖攀云 MA Xiying;XIAO Panyun(Tuberculosis Hospital of Shaanxi Province,Xi′an 710100,Shaanxi,China)

机构地区：[1]陕西省结核病防治院,西安710100

出　　处：《中西医结合心脑血管病杂志》2020年第4期557-560,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：陕西省社会发展科技攻关项目(No.2015SF098)。

摘　　要：目的探讨抗痨清脑汤联合地塞米松治疗结核性脑膜炎(TBM)的疗效及对病人单核细胞Toll样受体4(TLR4)、髓样分化因子88(MyD88)表达的影响。方法将我院2015年1月—2017年11月收治的88例TBM病人随机分为治疗组与对照组,各44例。两组均给予常规治疗,对照组给予地塞米松治疗,治疗组在对照组基础上联合抗痨清脑汤治疗。比较两组临床疗效、临床症状消失时间、住院时间、脑脊液生化指标、单核细胞TLR4 mRNA、MyD88 mRNA表达水平及TLR4、MyD88表达水平。结果治疗后,治疗组总有效率为93.18%高于对照组的75.00%(P<0.05)。治疗组头痛、发热、恶心呕吐等症状消失时间及住院时间均短于对照组(P<0.05)。治疗后,两组脑脊液细胞计数、蛋白较治疗前均降低(P<0.05),糖类与氯化物较治疗前均升高(P<0.05),且治疗组优于对照组(P<0.05)。治疗组单核细胞TLR4 mRNA、MyD88 mRNA、TLR4、MyD88表达明显低于对照组(P<0.05)。结论抗痨清脑汤联合地塞米松治疗TBM,临床疗效确切,可缓解病人临床症状,明显改善脑脊液生化指标,并降低单核细胞TLR4、MyD88表达水平。Objective To investigate the effect of Kanglao Qingnao Decoction combined with Dexamethasone in the treatment of tuberculous meningitis and its influence on the expression of toll like receptor 4(TLR4),myeloid differentiation factor 88(MyD88)in monocytes.Methods Eighty-eight patients with tuberculous meningitis were randomly divided into the treatment group and the control group,44 cases in each group.The two groups were treated with conventional treatment.The control group was treated with Dexamethasone,and the treatment group was given Kanglao Qingnao Decoction on the basis of the control group.The clinical efficacy,clinical symptoms disappeared time,hospitalization time,changes of cerebrospinal fluid biochemical parameters,the levels of TLR4 mRNA,MyD88 mRNA,TLR4 and MyD88 in hyaline leukocytes were compared between two groups.Results The clinical efficacy of the treatment group was significantly higher than that of the control group(93.18%vs 75.00%,P<0.05).The clinical symptoms disappeared time and hospitalization time in the treatment group were shorter than those in the control group(P<0.05).After treatment,the cell count and protein of the two groups were significantly lower than those before treatment(P<0.05),and the carbohydrate and chloride were significantly higher than those before treatment(P<0.05).The levels of TLR4 mRNA,MyD88 mRNA,TLR4,and MyD88 in hyaline leukocytes of the treatment group were lower than those of the control group(P<0.05).Conclusion Kanglao Qingnao Decoction combined with Dexamethasone in the treatment of tuberculous meningitis could quickly relieve the clinical symptoms of the patients,obviously improve the biochemical indexes of cerebrospinal fluid,significantly decrease the levels of TLR4 and MyD88 in hyaline leukocytes.

关 键 词：结核性脑膜炎 抗痨清脑汤 地塞米松 TOLL样受体4 髓样分化因子88 

分 类 号：R529.3[医药卫生—内科学] R289.5[医药卫生—临床医学]