内消瘰疬片辅助治疗初治肺结核并发颈部淋巴结结核患者的临床疗效

doi:10.3969/j.issn.1000-6621.2019.10.012

摘要/Abstract

摘要：

选取2014年3月至2018年3月南京市中西医结合医院收治的初治肺结核并发颈部淋巴结结核患者77例。所有患者通过影像学检查、实验室检查及结核菌素试验确诊且符合纳入标准的患者。根据治疗方式的不同将其分成对照组(32例)和观察组(45例)。对照组给予常规西药(2H-R-Z-E/4H-R)治疗,观察组在对照组的基础上加用内消瘰疬片。比较两组患者临床疗效、痰菌阴转率、病灶吸收率,以及炎症因子水平及不良反应情况。观察组临床治疗总有效率、痰菌阴转率、病灶明显吸收率分别为97.78%(44/45)、97.78%(44/45)、80.00%(36/45),均明显高于对照组的81.25%(26/32)、75.00%(24/32)、56.25%(18/32),差异均有统计学意义(χ ²值分别为4.343、9.400、5.036,P值分别为0.037、0.002、0.002);治疗后,观察组患者的IL-6和TNF-α水平分别为(36.01±4.26)ng/L和(7.66±3.16)ng/L,均明显低于治疗前的(58.74±6.11)ng/L和(23.01±4.52)ng/L(t=20.471,P<0.001;t=18.671,P<0.001),且明显低于对照组的(43.21±5.22)ng/L和(12.12±3.96)ng/L(t=6.652,P<0.001;t=5.491,P<0.001);观察组的不良反应发生率为42.22%,对照组的不良反应发生率为46.88%(15/32),两组比较差异无统计学意义(χ ²=0.164,P=0.685)。研究认为,内消瘰疬片联合化疗初治肺结核并发颈部淋巴结结核患者可显著降低炎症因子水平,提高临床疗效。

关键词: 结核, 肺, 结核, 淋巴结, 药物疗法, 联合, 中草药, 疗效比较研究

Abstract:

A total of 77 patients with primary pulmonary tuberculosis complicated with cervical lymphatic tuberculosis admitted in Nanjing Integrated Traditional Chinese and Western Medicine Hospital from Mar. 2014 to Mar. 2018 were selected. All patients were diagnosed by imaging examinations, laboratory examinations and tuberculin tests and all met the inclusion criteria. They were divided into control group (n=32) and observation group (n=45) according to different treatment methods. The control group was treated with conventional western medicine (2H-R-Z-E/4H-R), while the observation group was treated with Neixiao Luoli slice on top of the control group treatment. The clinical effectiveness, sputum negative conversion rate, lesion absorption, change of inflammatory factors test results and adverse reactions were compared between the two groups. The total effective rate, sputum negative conversion rate, and obvious absorption rate of lesions in the observation group were 97.78% (44/45), 97.78% (44/45), and 80.00% (36/45) respectively, which were higher than those in the control group (81.25% (26/32), 75.00% (24/32), and 56.25% (18/32)) with statistically significant differences (χ ² values were 4.343, 9.400, 5.036, and P values were 0.037, 0.002, 0.002, respectively). After treatment, IL-6 and TNF-α levels in the observation group were (36.01±4.26) ng/L and (7.66±3.16) ng/L respectively, which were significantly lower than before treatment ((58.74±6.11) ng/L and (23.01±4.52) ng/L, t=20.471, P<0.001; t=18.671, P<0.001), and significantly lower than the control group ((43.21±5.22) ng/L and (12.12±3.96) ng/L, t=6.652, P<0.001; t=5.491, P<0.001). The incidence of adverse reactions was 42.22% in the observation group and 46.88% (15/32) in the control group, with no statistically significant difference between the two groups (χ ²=0.164, P=0.685). Our study shows that Neixiao Luoli slice combined with chemotherapy for the primary treatment of pulmonary tuberculosis complicated with cervical lymph node tuberculosis can effectively improve the immune function of patients, significantly reduce the level of inflammatory factors, and improve the clinical effectiveness.

Key words: Tuberculosis, pulmonary, Tuberculosis, lymph node, Drug therapy, combination, Drugs, Chinese herbal, Comparative effectiveness research

傅良杰,钮晓红. 内消瘰疬片辅助治疗初治肺结核并发颈部淋巴结结核患者的临床疗效[J]. 中国防痨杂志, 2019, 41(10): 1127-1131. doi: 10.3969/j.issn.1000-6621.2019.10.012

Liang-jie FU,Xiao-hong NIU. Clinical effectiveness of Neixiao Luoli Slice adjuvant therapy for patients with primary treated pulmonary tuberculosis complicated with cervical lymphatic tuberculosis[J]. Chinese Journal of Antituberculosis, 2019, 41(10): 1127-1131. doi: 10.3969/j.issn.1000-6621.2019.10.012

图/表 6

表1

一般临床资料在两组患者间的比较

一般资料	对照组(32例)	观察组(45例)	检验值	P值
性别[例数(构成比,%)]			0.031^a	0.861
男	20(62.50)	29(64.40)
女	12(37.50)	16(35.60)
年龄(岁, $x ˉ$ ±s)	65.72±8.54	67.01±8.86	0.639^b	0.525
BMI( $x ˉ$ ±s)	22.97±0.96	22.79±1.03	0.777^b	0.440
病程(年, $x ˉ$ ±s)	10.69±2.71	10.57±2.68	0.193^b	0.848
颈部淋巴结结核分型[例数(构成比,%)]			0.687^a	0.922
结节型	17(63.13)	21(46.67)
浸润型	11(34.38)	16(35.56)
脓肿型	3(9.37)	5(8.89)
溃疡瘘管型	1(3.12)	3(8.89)
病灶累及肺叶[例数(构成比,%)]			0.341^a	0.559
1~3个	20(62.50)	31(68.89)
4~5个	12(37.50)	14(31.11)
出现空洞[例数(构成比,%)]			0.056^a	0.813
1~2个	27(84.38)	40(88.89)
≥3个	5(15.62)	5(11.11)

表1

表2

表3

表4

表5

两组患者治疗前后IL-6、TNF-α水平的比较

组别	IL-6(ng/L, $x ˉ$ ±s)		t值	P值	TNF-α(ng/L, $x ˉ$ ±s)		t值	P值
组别	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
对照组(32例)	56.78±5.98	43.21±5.22	9.670	0.000	22.64±4.25	12.12±3.96	10.245	0.000
观察组(45例)	58.74±6.11	36.01±4.26	20.471	0.000	23.01±4.52	7.66±3.16	18.671	0.000
t值	-1.399	6.652			-0.363	5.491
P值	0.166	0.000			0.718	0.000

表5

表6

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组别	明显吸收[例数(构成比,%)]	吸收[例数(构成比,%)]	无变化[例数(构成比,%)]	恶化[例数(构成比,%)]
对照组(32例)	18(56.25)	9(28.12)	3(9.38)	2(6.25)
观察组(45例)	36(80.00)	7(15.56)	2(4.44)	0(0.00)
χ²值	5.036	1.795	0.749	2.888
P值	0.002	0.180	0.387	0.089

组别	存在空洞例数	闭合[例数 (构成比,%)]	缩小[例数 (构成比,%)]	无明显变化 [例数(构成比,%)]
对照组(32例)	22	8(36.36)	9(40.91)	5(22.73)
观察组(45例)	31	20(64.52)	10(32.26)	1(3.22)
Z值	5.969
P值	0.000

组别	恶心[例数 (发生率,%)]	皮疹[例数 (发生率,%)]	肝功能损伤 [例数(发生率,%)]	肾功能损伤 [例数(发生率,%)]	合计[例数 (发生率,%)]
对照组(32例)	4(12.50)	6(18.75)	4(12.50)	1(3.13)	15(46.88)
观察组(45例)	4(8.89)	9(20.00)	3(6.67)	3(6.67)	19(42.22)