纤维支气管镜早期介入治疗对炎症浸润型气管支气管结核的作用  

Effect of early interventional therapy with fiberoptic bronchoscope on inflammatory infiltrating tracheobronchial tuberculosis

作　　者：徐源 李明武 Xu Yuan;Li Mingwu(Department of Drug Resistance and Severe Tuberculosis,the Third People′s Hospital of Kunming City,Kunming 650041,China)

机构地区：[1]昆明市第三人民医院耐药与重症结核科,昆明650041

出　　处：《中国医师进修杂志》2023年第3期251-258,共8页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨纤维支气管镜早期介入治疗对炎症浸润型(Ⅰ型)气管支气管结核(TBTB)患者的作用。方法采用前瞻性研究的方法,选取2019年1月至2022年4月昆明市第三人民医院经纤维支气管镜检查确诊的Ⅰ型TBTB患者306例,按随机数字表法将患者分为观察组和对照组,每组153例。对照组给予常规抗结核化疗,观察组给予常规抗结核化疗联合纤维支气管镜早期介入治疗。治疗1、3和6个月末进行痰涂片检查和结核杆菌培养,记录痰菌阴转情况;治疗1、3、6个月末进行胸部X线片、肺功能和纤维支气管镜等检查,评价临床症状好转率、病灶有效吸收率和阻塞性肺炎有效吸收率;治疗前和治疗后检测CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)、干扰素γ(IFN-γ)、白细胞介素-6(IL-6)和C反应蛋白(CRP)。进行免疫炎症的随机行走模型评价。结果观察组治疗1、3和6个月末痰菌转阴率明显高于对照组[64.71%(99/153)比52.29%(80/153)、80.39%(123/153)比62.09%(95/153)和91.50%(140/153)比73.86%(113/153)],差异有统计学意义(P<0.05或<0.01)。观察组治疗1个月末临床症状好转率明显高于对照组[94.77%(145/153)比66.67%(102/153)],差异有统计学意义(P<0.01);两组治疗3和6个月末临床症状均消失。观察组治疗1和3个月末有效吸收率明显高于对照组[73.20%(112/153)比51.63%(79/153)和96.73%(148/153)比85.62%(131/153)],差异有统计学意义(P<0.01);两组治疗6个月末病灶全部吸收。观察组治疗1和3个月末阻塞性肺炎有效吸收率明显高于对照组[78.43%(120/153)比39.87%(61/153)和89.54%(137/153)比79.08%(121/153)],差异有统计学意义(P<0.01或<0.05);两组治疗6个月末阻塞性肺炎全部吸收。两组治疗前CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+)、IL-6、IFN-γ和CRP比较差异无统计学意义(P>0.05);观察组治疗后CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)和IFN-γ明显高于对照组[0.343±0.032比0.311±0.023、1.37±0.18比1.12±0.16和Objective To investigate the effect of early interventional therapy with fiberoptic bronchoscope in patients with inflammatory infiltrating type(Ⅰtype)tracheobronchial tuberculosis(TBTB).Methods Using prospective research methods,306 patients withⅠtype TBTB diagnosed by fiberoptic bronchoscopy in the Third People′s Hospital of Kunming City from January 2019 to April 2022 were selected.The patients were divided into observation group and control group according to the random number table method with 153 cases each.The patients in control group were given routine anti-tuberculosis chemotherapy,and the patients in observation group were given routine anti-tuberculosis chemotherapy combined with early interventional therapy with fiberoptic bronchoscope.Sputum smear examination and tuberculosis culture were performed at the end of 1,3 and 6 months of treatment,and the negative conversion of sputum culture was recorded.Chest X-ray,pulmonary function and fiberoptic bronchoscope were performed at the end of 1,3 and 6 months of treatment to evaluate the improvement rate of clinical symptoms,effective absorption rate of lesions and effective absorption rate of obstructive pneumonia.The CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+),interferonγ(IFN-γ),interleukin-6(IL-6)and C reactive protein(CRP)before and after treatment were detected.The random walking model of immune inflammation was evaluated.Results The sputum negative conversion rates at the end of 1,3 and 6 months of treatment in observation group were significantly higher than those in control group:64.71%(99/153)vs.52.29%(80/153),80.39%(123/153)vs.62.09%(95/153)and 91.50%(140/153)vs.73.86%(113/153),and there were statistical differences(P<0.05 or<0.01).The improvement rate of clinical symptoms at the end of 1 month of treatment in observation group was significantly higher than that in control group:94.77%(145/153)vs.66.67%(102/153),and there was statistical difference(P<0.01);the clinical symptoms disappeared in both groups at the end of 3 and 6 months of tr

关 键 词：气管支气管结核 支气管镜 治疗结果 介入治疗 

分 类 号：R523[医药卫生—内科学]