中西医结合治疗耐多药肺结核的疗效及经济学评价  

Effect and Economic Evaluation of the Combination of Traditional Chinese and Western Medicine in Treatment of MDR-TB

作　　者：刘幸 欧阳兵 李娜 罗季 史旭芹[3] 陈洁 孙辉 李海雯 LIU Xing;OUYANG Bing;LI Na;LUO Ji;SHI Xu-qin;CHEN Jie;SUN Hui;LI Hai-wen(Dept,of Pharmacy,Kunming Third People's Hospital,Kunming Yunnan 650041;Dept,of Tuberculosis,Kunming Third People's Hospital,Kunming Yunnan 650041;Dept,ofPharmaceutical Analysis,Nanjing University of Traditional Chinese Medicine,Nanjing Jiangsu 210023;Kunming Third People's Hospital Science and Education Section,Kunming Yunnan 650041,China)

机构地区：[1]昆明市第三人民医院药剂科,云南昆明650041 [2]昆明市第三人民医院结核科,云南昆明650041 [3]南京中医药大学药物分析教研室,江苏南京210023 [4]昆明市第三人民医院科教科,云南昆明650041

出　　处：《昆明医科大学学报》2020年第11期49-55,共7页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(81603257);昆明市科技计划重点项目(2017-1-S-16355,2017-1-S-14333);昆明市卫生科技计划项目(2020-16-01-001)。

摘　　要：目的探究中西医结合治疗耐多药肺结核的疗效及成本-效果比,寻找最佳治疗方案。方法收集昆明市第三人民医院2017年04月至2019年10月期间收治耐多药肺结核患者400例,通过随机数字法分为观察组(200例)和对照组(200例)。对照组采用西医抗结核方案:4D(Pto)LZEV(Mfx)AmkCsCfz/8D(Pto)LZEV(Mfx)CsCfz(D:对氨基水杨酸异烟肼,Pro:丙硫异烟胺,L:利福喷丁,Z:吡嗪酰胺,E:乙胺丁醇,V:左氧氟沙星,Mfx:莫西沙星,Amk:阿米卡星,Cs:环丝氨酸,Cfz:氯法齐明);观察组在对照组的基础上,根据症候类型联合使用抗痨补肺汤。比较两组治疗后的外周血T淋巴细胞亚群CD3^+、CD4^+、CD8^+绝对值的变化,痰菌阴转率、病灶吸收有效率、空洞闭合率、中医症候改善率、不良反应发生率和治疗总有效率,并采用成本-效果分析法进行经济学评价。结果在治疗结束后,观察组的外周血T淋巴细胞亚群CD3^+、CD4^+、CD8^+绝对值均显著性增高,并高于对照组(P<0.05);观察组与对照组的痰菌阴转率分别为86.5%/60.5%,病灶吸收有效率分别为88.5%/58.0%,空洞闭合率分别为52.0%/34.5%,中医症候改善率分别为90.5%/67.0%,治疗总有效率分别为93.5%/80.0%,两组间比较差异有统计学意义(P<0.01);观察组与对照组的不良反应发生率分别为5.0%/9.0%,两组间比较差异无统计学意义(P>0.05)。在经济学评价中,观察组与对照组的成本-效果比(C/E)分别为31205.9元/31746.4元,增量成本-效果比(ΔC/ΔE)为28002.9元,敏感度分析结果支持其成本-效果比结果。结论中西医结合治疗耐多药肺结核在提高疗效方面和经济学评价方面均优于西医抗结核方案,值得临床推广。Objective To explore the effect and cost-effectiveness ratio of Integrated Chinese and Western medicine in the treatment of MDR-TB,and to find the best treatment plan.Methods Four hundreds cases of MDR-TB patients in Kunming Third People’s Hospital from April 2017 to October 2019 were collected and randomly divided into observation group(200 cases)and control group(200 cases).The control group was treated with Western Medicine Anti Tuberculosis Program:4D(Pto)LZEV(Mfx)AmkCsCfz/8 D(Pto)LZEV(Mfx)CsCfz(D:Isoniazidp-aminosalicylate,Pro:propylthioisoniamine,L:rifapentine,Z:pyrazinamide,E:ethambutol,V:levofloxacin,MFX:moxifloxacin,AMK:amikacin,CS:cycloserine,CFZ:clofazimine).On the basis of the control group,the observation group used antituberculosis Bufei Decoction according to the type of symptoms.The absolute values of CD3^+,CD4^+,CD8^+in peripheral blood T-lymphocyte subsets,the negative conversion rate of sputum bacteria,the effective rate of focus absorption,the rate of cavity closure,the improvement rate of symptoms in traditional Chinese medicine,the incidence of adverse reactions and the total effective rate of treatment were compared between the two groups after treatment,and the economic evaluation was made by cost-effectiveness analysis.Results At the end of treatment,the absolute values of CD3^+,CD4^+,CD8^+in the peripheral blood T lymphocyte subsets of the observation group were significantly higher than those of the control group(P<0.05).The negative rate of sputum bacteria was 86.5%in the observation group and 60.5%in the control group.The effective rate of absorption was 88.5%in the observation group and 58.0%in the control group.The cavity closure rate of the observation group and the control group was 52.0%/34.5%respectively.The improvement rate of TCM symptoms in the observation group and the control group was 90.5%/67.0%respectively.The total effective rate of the observation group and the control group was 93.5%/80.0%respectively.There was significant difference between the two groups(P<0.01).T

关 键 词：中西医结合 耐多药 肺结核 疗效 成本-效果比 

分 类 号：R521[医药卫生—内科学]