中西医结合治疗肺结核的临床疗效研究

doi:10.19982/j.issn.1000-6621.20220131

摘要/Abstract

摘要：

目的:评价常规化疗方案联合中成药“抗痨合剂”及中医适宜技术治疗肺结核的临床疗效。方法:采用前瞻性研究的方法,连续纳入2017年1月至2019年12月浙江中医药大学附属丽水中医院结核科诊治的300例初治肺结核患者,采用随机数字表法将患者均等分成3组,即常规西药抗结核治疗组(A组)、常规西药抗结核治疗联合中成药抗痨合剂组(B组)、常规西药抗结核治疗联合中成药抗痨合剂及中医适宜技术组(C组)。剔除24例因诊断变更、中断治疗、发生药物不良反应患者后最终纳入276例患者,其中A组97例、B组93例、C组86例。观察并比较三组患者疗程末的中医症状改善情况、肺部病灶吸收情况、T淋巴细胞亚群变化及治疗转归情况。结果:治疗6个月后,B组和C组中医证状改善有效率[92.5%(86/93)和94.2%(81/86)]、肺部病灶吸收有效率[92.5%(86/93)和94.2%(81/86)]、CD3⁺T淋巴细胞百分比[(65.76±5.42)%和(67.06±5.95)%]、CD4⁺T淋巴细胞百分比[(44.97±5.35)%和(46.51±5.26)%]、治疗成功率[94.6%(88/93)和97.7%(84/86)]均明显优于A组[分别为82.5%(80/97)、76.3%(74/97)、(63.80±4.57)%、(42.72±4.82)%、80.4%(78/97)],差异均有统计学意义(χ²=2.000,P=0.046;χ²=2.999,P=0.003;χ²=2.427,P=0.015;χ²=2.886,P=0.004;t=2.699,P=0.008;t=4.186,P=0.005;t=3.048,P=0.003;t=6.428,P<0.001;χ²=2.069,P=0.039;χ²=2.192,P=0.028)。而B组和C组治疗后外周血CD8⁺T淋巴细胞百分比[(27.12±2.32)%和(26.35±3.17)%]均明显低于A组[(29.12±2.21)%],差异有统计学意义(t=5.051,P<0.001;t=9.231,P<0.001)。结论:中西药联合抗结核治疗可明显减轻肺结核患者的临床症状,促进肺部病灶吸收,提高肺结核患者免疫力,有效提高临床疗效,但中医适宜技术的应用效果未得到证实。

关键词: 结核,肺, 中草药, 治疗应用, 治疗结果

Abstract:

Objective:To evaluate the clinical efficacy of conventional chemotherapy combined with traditional Chinese medicine (TCM) anti-tuberculosis mixture and appropriate traditional Chinese medicine technology in the treatment of pulmonary tuberculosis (PTB). Methods:Using the approach of a prospective study, 300 primary diagnosed and treated TB patients in the Tuberculosis Department of Lishui Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine were continuously collected from January 2017 to December 2019. According to the random number table, patients were equally divided into 3 groups, the conventional western medicine anti-TB treatment group (group A), conventional western medicine anti-TB treatment combined with TCM anti-TB mixture group (group B), and conventional western medicine anti-TB treatment combined with TCM anti-TB mixture and TCM appropriate technology group (Group C). After excluding 24 patients due to diagnosis changes, treatment interruption and adverse reactions, 276 patients were finally included in group A (n=97), group B (n=93) and group C (n=86). The improvement of TCM symptoms, absorption of pulmonary lesions, changes of T lymphocyte subsets and treatment outcomes were observed and compared among the three groups. Results:After 6 months of treatment, in group B and group C, the effective rate of TCM syndromes improvement (92.5% (86/93) and 94.2% (81/86)), the effective rate of pulmonary lesions absorption (92.5% (86/93) and 94.2% (81/86)), the percentage of CD3⁺T cells ((65.76±5.42) % and (67.06±5.95) %), the percentage of CD4⁺T cells ((44.97±5.35) % and (46.51±5.26) %), and the effective rate of treatment (94.6% (88/93) and 97.7% (84/86)) were significantly better than those in group A (82.5% (80/97), 76.3% (74/97), (63.80±4.57) %, (42.72±4.82) %, 80.4% (78/97)), the differences were statistically significant (χ²=2.000, P=0.046; χ²=2.999, P=0.003; χ²=2.427, P=0.015; χ²=2.886, P=0.004; t=2.699, P=0.008; t=4.186, P=0.005; t=3.048,P=0.003; t=6.428, P<0.001; χ²=2.069, P=0.039; χ²=2.192, P=0.028, respectively). The percentages of CD8⁺T cells in group B and C ((27.12±2.32) % and (26.35±3.17) %) were significantly lower than that in group A ((29.12±2.21) %), and the difference was statistically significant (t=5.051, P<0.001; t=9.231, P<0.001, respectively). Conclusion:The traditional Chinese and western medicine combined with anti-TB regimen can significantly reduce the clinical symptoms of PTB patients, promote the absorption of pulmonary lesions, improve the immunity of PTB patients, and effectively improve the clinical efficacy, however, the application effect of TCM appropriate technology has not been confirmed.

Key words: Tuberculosis,pulmonary, Drugs, Chinese herbal, Therapeutic uses, Treatment outcome

中图分类号:

何媚燕, 张尊敬, 刘忠达. 中西医结合治疗肺结核的临床疗效研究[J]. 中国防痨杂志, 2022, 44(10): 1037-1042. doi: 10.19982/j.issn.1000-6621.20220131

He Meiyan, Zhang Zunjing, Liu Zhongda. Study on clinical efficacy of integrated traditional Chinese and western medicine in the treatment of pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2022, 44(10): 1037-1042. doi: 10.19982/j.issn.1000-6621.20220131

图/表 4

表1

表2

表3

三组患者治疗前后T淋巴细胞亚群检测情况

组别	CD3⁺(%, $x ¯$ ±s)		CD4⁺(%, $x ¯$ ±s)		CD8⁺(%, $x ¯$ ±s)
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
A组(97例)	61.43±5.99	63.80±4.57	38.32±5.23	42.72±4.82	31.21±2.38	29.12±2.21
B组(93例)	62.16±5.86	65.76±5.42	37.02±5.13	44.97±5.35	30.07±3.15	27.12±2.32
C组(86例)	62.27±5.27	67.06±5.95	38.51±5.34	46.51±5.26	31.62±2.23	26.35±3.17
F值	2.668	19.636	3.612	20.588	2.651	18.276
P值	0.071	<0.001	0.891	<0.001	0.689	<0.001
t_AB值	-	2.699		3.048		5.051
P_AB值		0.008		0.003		<0.001
t_AC值		4.186		6.428		9.213
P_AC值		0.005		<0.001		<0.001
t_BC值		1.530		1.940		1.864
P_BC值		0.128		0.054		0.064

表3

表4

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组别	治愈 [例(构成比,%)]	显效 [例(构成比,%)]	有效 [例(构成比,%)]	无效 [例(构成比,%)]	合计 [例(改善率,%)]
A组(97例)	62(63.9)	10(10.3)	8(8.3)	17(17.5)	80(82.5)
B组(93例)	70(75.3)	10(10.8)	6(6.4)	7(7.5)	86(92.5)
C组(86例)	71(82.6)	6(7.0)	4(4.6)	5(5.8)	81(94.2)

组别	显著吸收 [例(构成比,%)]	吸收 [例(构成比,%)]	无改变 [例(构成比,%)]	失败 [例(构成比,%)]	合计 [例(有效率,%)]
A组(97例)	31(32.0)	43(44.3)	19(19.6)	4(4.1)	74(76.3)
B组(93例)	39(41.9)	47(50.5)	6(6.5)	1(1.1)	86(92.5)
C组(86例)	39(45.3)	42(48.8)	4(4.7)	1(1.2)	81(94.2)

组别	治愈 [例(构成比,%)]	完成疗程 [例(构成比,%)]	治疗未成功 [例(构成比,%)]	治疗成功 [例(成功率,%)]
A组(97例)	43(44.3)	35(36.1)	19(19.6)	78(80.4)
B组(93例)	50(53.7)	38(40.9)	5(5.4)	88(94.6)
C组(86例)	46(53.5)	38(44.2)	2(2.3)	84(97.7)