【摘要】：目的探討芪甲利肺膠囊輔助治療復(fù)治肺結(jié)核合并2型糖尿病患者的療效及T淋巴細(xì)胞亞群的變化。方法將280例經(jīng)細(xì)菌學(xué)確診的復(fù)治肺結(jié)核合并2型糖尿病患者按入院先后順序隨機(jī)分為觀察組和對(duì)照組,每組140例。2組患者均應(yīng)用3HRZES/9HRE(H:異煙肼,R:利福平,Z:吡嗪酰胺,E:乙胺丁醇,S:鏈霉素)方案抗結(jié)核治療,觀察組患者在此基礎(chǔ)上加用芪甲利肺膠囊輔助治療,每次3粒,口服,每日3次,療程8個(gè)月。比較2組患者痰菌轉(zhuǎn)陰情況、病灶及空洞變化情況、中醫(yī)證候療效及細(xì)胞免疫功能的差異。結(jié)果觀察組患者強(qiáng)化期治療結(jié)束時(shí)和療程結(jié)束時(shí)痰菌陰轉(zhuǎn)率分別為73.72%(101/137)、91.24%(125/137),對(duì)照組患者分別為57.97%(80/138)、80.43%(111/138),觀察組患者強(qiáng)化期治療結(jié)束時(shí)和療程結(jié)束時(shí)痰菌陰轉(zhuǎn)率均高于對(duì)照組(P0.05)。觀察組患者強(qiáng)化期結(jié)束時(shí)和療程結(jié)束時(shí)病灶吸收的顯效率分別為68.62%(94/137)、87.59%(120/137),對(duì)照組患者分別為45.65%(63/138)、69.57%(96/138),觀察組患者強(qiáng)化期結(jié)束時(shí)和療程結(jié)束時(shí)病灶吸收的顯效率均高于對(duì)照組(P0.05)。觀察組患者強(qiáng)化期結(jié)束時(shí)和療程結(jié)束時(shí)空洞閉合率分別為21.9%(30/137)、54.01%(74/137),對(duì)照組患者分別為10.87%(15/138)、28.26%(39/138),觀察組患者強(qiáng)化期結(jié)束時(shí)和療程結(jié)束時(shí)空洞閉合率均高于對(duì)照組(P0.05)。療程結(jié)束時(shí)觀察組和對(duì)照組患者中醫(yī)證候療效總有效率分別為89.78%(123/137)、79.71%(110/138),觀察組患者中醫(yī)證候療效總有效率高于對(duì)照組(P0.05)。與對(duì)照組比較,觀察組患者強(qiáng)化期結(jié)束時(shí)和療程結(jié)束時(shí)CD3~+、CD4~+水平及CD4~+/CD8~+升高(P0.05);2組患者強(qiáng)化期結(jié)束時(shí)和療程結(jié)束時(shí)CD8~+水平比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論芪甲利肺膠囊輔助治療復(fù)治肺結(jié)核合并2型糖尿病能提高痰菌轉(zhuǎn)陰率、病灶顯效率和空洞閉合率,并能提高中醫(yī)證候療效和細(xì)胞免疫功能。
[Abstract]:Objective to investigate the curative effect and the changes of T lymphocyte subsets in patients with pulmonary tuberculosis complicated with type 2 diabetes mellitus treated with Qijia Lifei capsule. Methods 280 patients with recurrent pulmonary tuberculosis complicated with type 2 diabetes were randomly divided into observation group and control group according to the order of admission. One hundred and forty patients in each group were treated with 3HRZES/9HRE (H: isoniazid, R: rifampicin, Z: pyrazinamide, E: ethambutanol, S: streptomycin) regimen. Three times a day for 8 months. The change of sputum bacteria, the changes of focus and cavity, the curative effect of TCM syndrome and the function of cellular immunity were compared between the two groups. Results the sputum negative conversion rates were 73.72% (101 / 137), 91.24% (125 / 137) at the end of intensive treatment and 80.43% (111 / 138) at the end of treatment in the observation group and 57.97% (80 / 138) and 80.43% (111 / 138) in the control group, respectively. The sputum negative conversion rate in the observation group was higher than that in the control group at the end of intensive treatment and at the end of the course of treatment (P0.05). At the end of the intensive phase and the end of the course of treatment, the effective rates of the focus absorption in the observation group were 68.62% (94 / 137), 87.59% (120 / 137), 45.65% (63 / 138) and 69.57% (96 / 138) in the control group, respectively. The effective rate of the focus absorption at the end of the intensive phase and the end of the course of treatment in the observation group was higher than that in the control group (P0.05). The cavity closure rates were 21.9% (30 / 137), 54.01% (74 / 137) and 10.87% (15 / 138), 28.26% (39 / 138) at the end of the intensive period and the end of the course of treatment in the observation group and the control group, respectively. The rate of cavity closure at the end of the intensive period and the end of the course of treatment in the observation group was higher than that in the control group (P0.05). At the end of treatment, the total effective rate of TCM syndromes in observation group and control group was 89.78% (123 / 137) and 79.71% (110 / 138), respectively. The total effective rate of TCM syndrome in observation group was higher than that in control group (P0.05). Compared with the control group, the levels of CD3~, CD4~ and CD4~ / CD8~ increased at the end of the intensive period and at the end of the course of treatment in the observation group (P0.05); there was no significant difference in CD8~ level between the two groups at the end of the intensive period and the end of the course of treatment (P0.05). Conclusion Qijialifei capsule can improve the sputum negative rate, focus apparent rate and cavity closure rate, and improve the curative effect of TCM syndrome and cellular immune function in the treatment of pulmonary tuberculosis with type 2 diabetes.
【作者單位】： 新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院結(jié)核內(nèi)科二病區(qū);新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院結(jié)核內(nèi)科四病區(qū);
【分類號(hào)】：R521;R587.1

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