雾化吸入重组人干扰素-γ治疗复治耐多药肺结核的临床研究

Clinical research on aerosolizing inhalation reeombinated human Interferon-gamma therapy pulmonary tuberculosis patients with retreatment acquired multi-drug resistance

目的探讨重组人干扰素-γ雾化吸入治疗复治耐多药肺结核的疗效。方法选择复治痰涂片抗酸染色阳性或痰菌培养阳性、耐多药肺结核患者64例，随机分为：治疗组32例，雾化吸入干扰素-γ100万u，隔日1次，疗程为8周；对照组32例，雾化吸入异烟肼0．1g＋丁胺卡那霉素0．2g，每日1次，疗程为8周。两组患者给予抗结核方案为HRZE（S），6HRE，或根据药敏结果调整用药。4周、8周末检查痰涂片、痰菌培养、血沉和胸部ET各1次。结果治疗组和对照组，4周末：痰涂片转阴分别为11例、8例（x^2=0．03，P=0．80）；痰菌培养转阴分别为9例、5例（x^2=0．64，P=0．50）；血沉恢复正常分别为26例、19例（x^2=0．14，P=0．70）；病灶吸收好转分别为13例、9例（x^2=0．11，P=0．70）。8周末：痰涂片转阴分别为20例、13例（x^2=0．49，P=0．50）；痰菌培养转阴分别为23例、10例（x^2=5．01，P=0．02）；血沉恢复正常分别为30例、23例（x^2=0．02，P=0．90）；病灶吸收好转分别为25例、12例（x^2=4．40，P=0．05）。结论重组人干扰素-γ作为一种免疫调节剂，雾化吸人治疗耐多药肺结核疗效明显，可以在临床中推广应用。

Objective To explore the therapeutic effect of aerosolizing inhalation recombinated human interferon-gamma （IFN-γ） therapy pulmonary tuberculosis patients with retreatment acquired multi-drug resistance. Methods Sixty-four pulmonary tuberculosis patients with sputum smear positive or cultivate positive and multi-drug resistance were divided into two groups at random. Treatment group （32 eases ） and control group （32 eases）. The former were aerosolized IFN-γ 1 × 10^6 U, once two days, course of treatment was eight weeks. The latter were aeresolized isoniazid 0.1 g and amikacin 0.2 g, once a day, for eight weeks. All the patients were given antitubereulosis therapy. The regimes was HRZE （S）/6HRE or adjusted medicines aeccording to the result of drug sensitivity test. Sputum smears acid fast stain,sputum cultivates, blood sedimentation rate （ESR） and chest routine scanning （CT）,once every four weeks. Results In treatment and control group： the sputum smear negative conversion eases were 11 and 8 （ X ^2 = 0.03, P = 0.80）, the eases of sputum cultivate negative were 9 and 5 （ X ^2 = 0.64 ,P= 0.50）, the cases of ESR returning to normal were 26 and 19 （ X ^2 =,0.14,P = 0.70） ,lesion improving checked by CT were 13 and 9 （ X ^2 = 0.11 ,P = 0.70） on the fonrth weekend. While it was 20 and 13 （ X ^2 = 0.49,P = 0.50）, 23 and 10 （ X ^2 = 5.01, P = 0.02 ）, 30 and 23 （ X^2 = 0.02, P = 0.90 ）, 25 and 12 （X^2= 4.40, P = 0.05 ） on the eighth weekend, respectivdy. Conclusions As a immunomedulator, the therapeutic effect of being aerosolize inhalation IFN-γ to treat pulmonary tuberculosis patients with acquired muhi-drug resistance is obvious. This therapy regime may be applied in clinic.