【作者】 吴碧彤； 谭守勇； 林兆原； 彭德虎； 胡锦兴；

【Author】 Guangzhou Chest Hospital,510095,China Wu Bitong,Tan Shouyong,Lin Zhaoyuan,et al.

【机构】 广州市胸科医院；

【摘要】 目的通过循证医学方法观察和评价母牛分枝杆菌菌苗对于细胞免疫功能状况不同的老年初治免疫功能低下肺结核患者的疗效及安全性。方法采用前瞻性研究方法,将80例老年初治菌阳肺结核患者随机分入化疗联合母牛分枝杆菌菌苗（微卡）的治疗组和单纯化疗对照组各40例;同时,根据老年患者治疗前外周血CD⁴⁺T淋巴细胞状况分为低下组（Ⅰ组）,正常组（Ⅱ组）,四组分别在治疗前、治疗2个月、6个月末观察其外周血T淋巴细胞亚群、痰抗酸杆菌涂片及培养结果。结果 （1）治疗组2月末CD⁴⁺T淋巴细胞和CD⁴⁺/CD⁸⁺T细胞比值显著升高、CD⁸⁺T淋巴细胞显著下降（P<0.05）;对照组治疗前、2月末及6月末上述指标均变化不大（P>0.05）。治疗组2月末痰菌阴转率较对照组高（<0.05）。（2）治疗Ⅰ组2月末CD⁴⁺T淋巴细胞和CD⁴⁺/CD⁸⁺T细胞比值显著升高、CD⁸⁺T淋巴细胞显著下降（<0.05）;对照Ⅰ组治疗前、2月、6月末上述指标变化不大（P>0.05）。治疗Ⅰ组2月末痰菌阴转率较对照组高（P<0.05）。（3）治疗Ⅱ组治疗前、2月、6月末CD⁴⁺T淋巴细胞变化不大（P>0.05）;2月末CD⁸⁺T淋巴细胞显著下降（P<0.05）;CD⁴⁺/CD⁸⁺T比值明显升高（P<0.05）;对照Ⅱ组治疗前、2月末、6月末上述指标变化不大（P>0.05）。两组2月和6月末痰菌阴转率相似（P>0.05）。结论治疗前CD⁴⁺T淋巴细胞低下的老年患者,采用母牛分枝杆菌菌苗联合治疗能显著改善患者的细胞免疫功能,提高治疗2月末痰菌阴转率。在治疗前CD⁴⁺T淋巴细胞正常的老年患者,采用母牛分枝杆菌菌苗,未能提高临床疗效。更多还原

【Abstract】 Objective To evaluate the effect and safety of Mycobacterium vaccae(M.vaccae vaccine) on initially treated senile pulmonary tuberculosis in whose cellular immune function was different with evidence-based medicine.Methods In this study,the analysis of prospective cohort study to be:80 cases of initially treated elderly pulmonary tuberculosis with smear and culture positive were divided into treatment group with M.vaccae vaccine adjuvant therapy and control group at random pair.Each group patients were divided into abnormal group(groupⅠ) and the normal group(GroupⅡ) according to the percentage of serous CD4+T lymphocyte before treating.A few examinations were performed before and after treatment(at the end of 2,6months ),such as T lymphocyte subsets,sputum samples checking.Results CD4+ lymphocyte percentages,CD4+/CD8+ ratio were significantly higher at the end of 2,6 months after treatment than those before treatment(P<0.05 ) and CD8+T cell lower in treatmentⅠgroup(P<0.05 ).There were more significantly improvement in T lymphocyte subsets in treatmentⅠgroup than those in controlⅠgroup (P<0.05 ).Sputum negative conversion rate in the eng of 2 months in treatmentⅠgroup was significantly higher than that in controlⅠgroup(P<0.05).CD4+ lymphocyte percentages,CD4+/CD8+ ratio in the end of 2 months after treatment were significantly higher compared with that before treatment and CD8+T cell lower in treatmentⅡgroup(P<0.05 ).There were no significant differences between before treatment and controlⅡgroup about cellular immunity function(P>0.05).There were no statistical significances in the sputum negative conversion rate between treatmentⅡgroup and controlⅡgroup.Conclusion Combined with Mycobacterium vaccae vaccin can significantly improve the elderly patients who had abnormal CD4+T cell percentage before treatment in cellular immunologic function and speed up the sputum negative conversion rates. Combined with Mycobacterium vaccae vaccin can not improve curative effect for the elderly patients who had normal CD4+T cell percentage before treatment.更多还原