【摘要】 目的评价结核丸辅助治疗耐多药肺结核的临床疗效和对免疫功能的影响。方法对80例耐多药肺结核患者,采用随机、平行对照的方法,分为治疗组和对照组各40例,采用中国全球基金耐多药结核病项目标准化方案6 Z Km Lfx Pto PAS(CS)/18 Z Lfx Pto PAS(CS)治疗(Z:吡嗪酰胺、Km:卡那霉素、Lfx:左氧氟沙星、Pto:丙硫异烟胺、PAS:对氨基水杨酸、CS:环丝氨酸),治疗组在强化期加用中药结核丸口服6个月。结果共有77例患者完成疗程。强化期治疗结束时(6个月)咳嗽、咳痰、盗汗、胸痛、呼吸困难、乏力等临床症状有改善;治疗组改善程度大于对照组。治疗组和对照组痰抗酸菌涂片阴性同时痰结核分枝杆菌培养阴性(涂阴培阴)分别为64.1%(25/39)和60.5%(23/38)(χ2=0.105,P>0.05),两组比较差异无统计学意义。X线影像结果表明,两组的病灶显效率分别为71.8%(28/39)和50.0%(19/38),差异有统计学意义(χ2=3.384,P<0.05);有效率分别为82.1%(32/39)和76.3%(29/38),差异无统计学意义(χ2=0.385,P>0.05);空洞闭合率分别为28.2%(11/39)和23.7%(9/38)(F=1.86,P>0.05)。与对照组比较,治疗组强化期治疗6个月末CD3+、CD4+细胞和IFN-γ水平含量变化值均明显升高(P<0.05),CD8+细胞和IL-4水平含量变化值明显降低(P<0.05),差异有统计学意义(P<0.05)。中药结核丸口服无严重不良反应。结论中药结核丸能调整T淋巴细胞亚群,增强细胞免疫功能,治疗耐多药结核病具有协同作用,是一种安全、有效的中成药。更多还原

【Abstract】 【Objective】 To evaluate the clinical efficacy and immunotherapeutic effects of Jie-he-wan as an adjunctive therapy for the multi-drug resistant pulmonary tuberculosis. 【Methods】 80 patients with multi- drug resistant pulmonary tuberculosis were randomized into treatment group ﹝40 cases treated with 6 Z Km Lfx Pto PAS(CS) + Jie-he-wan /18 Z Lfx Pto PAS(CS)﹞ and contrast group ﹝40 cases treated with 6 Z Km Lfx Pto PAS(CS) /18 Z Lfx Pto PAS(CS) ﹞ Chinese Herbal Medicines Jie-he-wan was used by authority or- ganization in Strengthening phase of the treatment group for six months. 【Results】 39 cases in the treat group and 38 cases in the control group completed the treatment course. At the end of the Strengthening phase, the symptom of cough, expectoration, night sweating, chest pain, hypodynamia were improved in the treatment group better than those in contrast group; the sputum negative conversion rate(smear negative, cul- ture negative) was 64.1%(25 / 39) in the treatment group, and was 60.5%(23 / 38) in the contrast group.There was no statistically significant difference between groups(χ2=0.105, P >0.05). The marked effective rates of chest X-ray in the treatment group and the contrast group were 71.8%(28 / 39) and 50.0%(19 / 38) with statistically significant difference(χ2=3.384, P <0.05), and the effective rates were 82.1%(32 / 39) and 76.3%(29 / 38) without statistically significant difference(χ2=0.385, P >0.05) between two groups. The cavity closure rates were 28.2%(11 / 39) and 23.7%(9 / 38) without statistically significant difference(F =1.86, P >0.05). Compared with the contrast group, CD3+, CD4+count and the levels of IFN-γ were improved statistically sig- nificant difference after 6 months treatment in the treatment group; CD8+count and the levels of IL-4 were decreased statistically significant difference after 6 months in the treatment group. There were no adverse ef- fects of jie he wan therapy. 【Conclusion】 As an effective and relatively safe Chinese Herbal Medicines, jie he wan can be used to adjuvant therapy in multidrug resistant pulmonary tuberculosis by improving the cell medicated immunity and promoting activation of T lymphocyte subpopulation.更多还原