母牛分枝杆菌菌苗辅助抗结核方案治疗肺结核对患者免疫功能及疾病转归的影响  

Effect of anti-tuberculosis regimen supplemented with mycobacterium vaccae vaccine on immune function and prognosis in patients with pulmonary tuberculosis

作　　者：方刚 顾小燕 尹小芳 FANG Gang;GU Xiao-yan;YIN Xiao-fang(Department of Tuberculosis,Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210003,China)

机构地区：[1]南京中医药大学附属南京医院结核科,江苏南京210003 [2]南京市中医院ICU,江苏南京210001

出　　处：《中国临床研究》2020年第4期501-504,共4页Chinese Journal of Clinical Research

摘　　要：目的探讨母牛分枝杆菌菌苗辅助抗结核方案在肺结核治疗中的应用价值。方法选取2016年12月至2018年8月收治的82例肺结核患者,根据随机数字表法分为对照组与观察组,每组41例;另选80例同期健康体检者(健康组),均于入院后检测外周血T淋巴细胞亚群(CD3^+、CD4^+、CD4^+/CD8^+)水平。对照组给予2HRZE/4HR(异烟肼+利福平+吡嗪酰胺+乙胺丁醇)抗结核方案;观察组在与对照组同样抗结核基础上,给予母牛分枝杆菌菌苗。对比两组入院时一般资料及治疗4周后病灶吸收率、外周血CD3^+、CD4^+、CD4^+/CD8^+水平、相关细胞因子[肿瘤坏死因子(TNF)-α、干扰素(IFN)-γ、白细胞介素(IL)-10],并与健康组进行淋巴细胞亚群对比。结果(1)入院时肺结核患者CD3^+、CD4^+、CD4^+/CD8^+水平低于健康组(P均<0.01);(2)观察组与对照组性别构成、年龄、病程均衡(P均>0.05);(3)治疗4周后观察组病灶吸收率为95.12%,高于对照组的80.49%(P<0.05);(4)治疗4周后观察组外周血CD3^+、CD4^+、CD4^+/CD8^+水平高于对照组(P<0.05,P<0.01);(5)治疗4周后观察组血清IFN-γ水平高于对照组,TNF-α、IL-10水平低于对照组(P<0.05,P<0.01)。结论母牛分枝杆菌菌苗辅助抗结核方案应用于肺结核患者,可调节外周血T淋巴细胞及细胞因子水平,增强机体免疫功能,促进病灶吸收。Objective To explore the application value of mycobacterium vaccae vaccine assisted antituberculosis regimen in the treatment of pulmonary tuberculosis.Methods Eighty-two patients with pulmonary tuberculosis treated from December 2016 to August 2018 were selected and were randomly divided into control group and observation group(n=41,each).In the same period,80 healthy individuals were served as healthy group.The levels of T lymphocyte subsets(CD3^+,CD4^+,CD4^+/CD8^+)in peripheral blood were detected after admission.Anti-tuberculosis therapy with isoniazide,rifampicine,pyrazinamide and ethambutol(2HRZE/4HR)was given in control group,and mycobacterium vaccae vaccine was added in observation group on the basis of the same anti-TB regimen as control group.The general data,the lesions absorption rate,the levels of CD3^+,CD4^+,CD4^+/CD8^+before and after 4 weeks of treatment and the related cytokines(TNF-α,IFN-γ,IL-10)were compared between two groups,and the lymphocyte subsets were compared with those in healthy group.Results The levels of CD3^+,CD4^+,CD4^+/CD8^+in pulmonary tuberculosis patients were significantly lower than those in healthy group(all P<0.01).There were no significant differences in gender composition,age and course of disease between control group and observation group(all P>0.05).The lesions absorption rate in observation group was statistically higher than that in control group(95.12%vs 80.49%,P<0.05).After 4 weeks of treatment,the levels of CD3^+,CD4^+,CD4^+/CD8^+and IFN-γin observation group were higher than those in control group(P<0.05,P<0.01),while the levels of TNF-αand IL-10 were lower than those in control group(P<0.01).Conclusion Mycobacterium vaccae vaccine assisted anti-tuberculosis regimen can regulate the levels of T lymphocyte and cytokines in peripheral blood,enhance the immune function and promote focus absorption in the treatment for patients with pulmonary tuberculosis.

关 键 词：肺结核 母牛分枝杆菌菌苗 异烟肼 利福平 乙胺丁醇 吡嗪酰胺 T淋巴细胞亚群 细胞因子 

分 类 号：R521[医药卫生—内科学]