卷曲霉素辅助治疗耐多药肺结核的疗效及对生活质量和免疫功能的影响  

Curative effect of capreomycin in adjuvant treatment of multidrug-resistant pulmonary tuberculosis and its effect on quality of life and immune function

作　　者：韩娜[1] 刘凡平[1] 郎伟明 张晨钰[1] 田彦卿[1] 王倩 监士宁[2] 朱建光 HAN Na;LIU Fan-ping;LANG Wei-ming;ZHANG Chen-yu;TIAN Yan-qing;WANG Qian;JIAN Shi-ning;ZHU Jian-guang(Department of Tuberculosis,Affiliated Hospital of Hebei University,Baoding,Hebei 071000,China;Department of Respiratory,Baoding First Central Hospital,Baoding,Hebei 071000,China;Department of Otolaryngology,the 82nd Army Group Hospital,Baoding,Hebei 071000,China)

机构地区：[1]河北大学附属医院结核科,河北保定071000 [2]保定市第一中心医院呼吸科,河北保定071000 [3]陆军第82集团军医院耳鼻喉科,河北保定071000

出　　处：《中国热带医学》2023年第3期246-250,共5页China Tropical Medicine

基　　金：河北省卫生健康委员会资助项目(No.20190937)。

摘　　要：目的探讨卷曲霉素辅助治疗耐多药肺结核(MDR-TB)的疗效及对生活质量、免疫功能的影响。方法选取2019年10月—2020年10月收治MDR-TB患者88例,按随机数字表法分两组,对照组应用4~6Am-Mfx(Lfx)-Pto-Cfz-Z-Hhigh-dose-E/5 Mfx(Lfx)-Cfz-Z-E,研究组在对照组基础上联合应用卷曲霉素。对比两组6分钟步行试验(6MWT)实测值/预计值、生活质量评分、安全性评价、胸部CT空洞与病灶吸收率、痰培养转阴,治疗前后均检测血清PCT表达水平及免疫功能。结果研究组和对照组的治疗前后6MWT实测值/预计值分别为0.48±0.11、0.64±0.13和0.51±0.12、0.58±0.14,两组的治疗前后差异有统计学意义(t=6.23,2.520,P<0.05),治疗后两组6MWT实测值/预计值均增大。与同组治疗前比较,治疗后两组SF-36各维度评分均增高(P<0.01)。研究组和对照组的治疗前后血清PCT分别为(0.37±0.09)ng/mL、(0.12±0.03)ng/mL和(0.36±0.11)ng/mL、(0.21±0.06)ng/mL,两组的治疗前后差异有统计学意义(t=17.480,7.940,P<0.01),与同组治疗前比较,治疗后两组的血清PCT表达水平均下降。与同组治疗前比较,治疗后两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均升高(P<0.05或P<0.01),与治疗后对照组比较,治疗后研究组的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)明显升高(t=4.21,8.02,2.04,P<0.05)。研究组的胸部CT空洞与病灶吸收率88.64%(39/44)、痰培养转阴率81.82%(36/44)均高于对照组63.64%(28/44)和61.36%(27/44)(P<0.05)。结论卷曲霉素能改善MDR-TB患者生活质量,延长6MWT步行距离,调节血清PCT表达水平及免疫功能,促进胸部CT空洞与病灶吸收、痰培养转阴,且安全性尚可。Objective To investigate the efficacy of capreomycin adjuvant therapy for multidrug-resistant pulmonary tuberculosis(MDR-TB)and its effect on quality of life and immune function.Methods Eighty-eight elderly pulmonary tuberculosis patients admitted to Affiliated Hospital of Hebei University from October 2019 to October 2020 were selected and divided into two groups according to the random number table method.The control group(n=44)used 4-6Am-Mfx(Lfx)-Pto-Cfz-Z-Hhigh-dose-E/5 Mfx(Lfx)-Cfz-Z-E,the research group(n=44)used capreomycin on the basis of the control group.The 6-Minute Walk Test(6MWT)measured value/predicted value and quality of life[36-Item Short Form Health Survey Questionnaire(SF-36)]scores,safety evaluation results,chest CT cavity and lesion absorption rate and sputum culture turned negative were compared between the two groups,and the serum procalcitonin(PCT)expression levels and immune function were detected before and after treatment.Results The 6MWT measured value/predicted value of the research group and control group before the treatment were(0.48±0.11)and(0.64±0.13),which were significantly higher than corresponding(0.51±0.12)and(0.58±0.14)after treatment(t=6.23,2.520,P<0.05),the measured/expected value of 6MWT increased in both groups after treatment.Compared with the same group before treatment,the SF-36 scores for each dimension increased in both groups after treatment(P<0.01).The expression levels of serum PCT in the research group and control group before the treatment were(0.37±0.09)ng/mL and(0.12±0.03)ng/mL versus(0.36±0.11)ng/mL and(0.21±0.06)ng/mL after treatment(t=17.480,7.940,P<0.01).Compared with the same group before treatment,serum PCT expression levels decreased in both groups after treatment.Compared with the same group before treatment,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)were elevated in both groups after treatment(P<0.05 or P<0.01);after treatment,CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)were significantly higher in research group compared to the control group(t=4.21,8.02,2.04

关 键 词：耐多药肺结核 卷曲霉素 6分钟步行试验 生活质量 

分 类 号：R521.1[医药卫生—内科学]