胸腺肽联合化疗治疗难治性肺结核疗效观察

Curative effect of combined therapy of thymosin and chemotherapy in treatment of refractory pulmonary tuberculosis

目的评价胸腺肽在难治性肺结核治疗中的作用。方法78例难治性肺结核病人随机分为对照组(单纯化疗组)和治疗组(胸腺肽联合化疗组)。对照组应用2S(E)RHZ/4HR督导化疗6个月。治疗组在上述方案上加用胸腺肽6个月。观察两组痰菌阴转和病变吸收情况。结果疗程结束后,治疗组、对照组的痰菌阴转率分别为81.6%、57.5%;病灶吸收好转率分别为76.3%、55.0%;空洞闭合率分别为75.0%、30.8%,三者均有显著差异。随访结果:治疗组的痰菌转阳率及病情复发加重者均低于对照组,但无显著性差异(P>0.05)。结论胸腺肽可作为难治性肺结核的安全有效辅助疗法。

Objective To evaluate the curative effect of immunotherapy in treating refractory pulmonary tuberculosis. Methods 78 cases patients with refractory pulmonary tuberculosis were divided into two groups randomly： 40 patients in the control group （chemotherapeutical group）were treated with chemotherapeutical scheme of 2S（E） RHZ/4HR and 38 patients in the treatment group received thmosin and the standard chemotherapy at the same time. thymasin was given 100 mg＋ NS or 5 ～ 10% GS 250 ～ 500 ml, ivgtt qd. The period of treatment for both groups was 6 months. Patients＇clinical symptoms, sputum bacterial smear and culture results and X ray examination of both groups were observed. Results After the 6 months, the results showed the following： ① the negative bacterial smear and culture rate of sputum was 81.6% ,57.5% respectively in the treatment group and in the control group（P 〈0. 025 ） ; The focus improvement rate demonstrated by X ray was 76.3% ,55.0% respectively in the treatment group and in the control group（ P 〈0. 05 = ; The cavity close-up rate was 75. 0% ,30. 8% respectively in the treating group and in the control group（ P 〈0. 05 = ;② ESR dropped more in the treatment group compare with control group, but no statistical difference was observed in the group comparison：P 〉 0. 05. ③ In the 1 -2 year of follow-up after the treatment, the positive bacterial smear culture rate of sputum, the tuberculous relapse rate or reoccurring rate of TB in the treatment group were less than those in the control group, but no statistical differences were observed ： P 〉 0. 05. Conclusion Immunotherapy may heighten markedly the effect of antitubercular chemotherapy by strengthening immunofunction of body and decreases the positive bacterial smear and culture rate of sputum and the tuberculous relapse rate. It shows that thymosin is an effective and safe auxiliary therapy for refractory pulmonary tuberculosis.