母牛分枝杆菌菌苗辅助治疗复治涂阳肺结核效果观察

Curative effect of the re-treated bacteriological positive pulmonary tuberculosis treated with Mycobacterium vaccae vaccine

目的评价母牛分枝杆菌菌苗作为免疫调节剂治疗复治涂阳肺结核的临床疗效与安全性。方法采用随机分组,82例复治涂阳肺结核患者分为治疗组(42例)和对照组(40例),两组均采用2HRZES/1HRZE/5HRE方案;治疗组加用母牛分枝杆菌菌苗(微卡)每2周1次,共8个月。观察治疗后肺部病灶吸收、痰菌阴转、临床症状缓解情况。结果疗程结束时治疗组与对照组胸部X线病灶显著吸收率分别为83.3%和50.0%(P<0.05);空洞闭合率分别为78.5%和52.5%(P<0.05);治疗2、4、6、8个月末痰菌阴转率治疗组为61.9%、80.9%、90.4%、92.8%;对照组为37.5%、55.0%、67.5%、72.5%(P<0.05);疗程结束时治疗组与对照组临床症状缓解无显著差异(P>0.05)。微卡不良反应:发热1例。结论母牛分枝杆菌菌苗辅助治疗复治涂阳肺结核,能增强免疫细胞活性,促进肺部病灶吸收,提高痰菌阴转率,是较好的结核病免疫治疗制剂。

Objective To evaluate the clinical curative effect and safety of Mycobacterium vaccae vaccine in treating re-treated bacteriological positive pulmonary tuberculosis （TB）. Methods 82 re-treated bacteriological positive pulmonary tuberculosis patients were randomly allocated into treatment group （42cases） and control group （40cases）, 2HRZES/1HRZE/SHRE was applied in both group, vaccae was added in the treatment group. Foci absorption, sputum negative conversion and clinical symptoms conversion were observed. Results At the end of the treatment, chest radiography showed that the resolution of pulmonary lesions in the treatment group and control group were 83. 3% and 50. 0% respectively;cavity closure rate was 78.5% in the treatment group and 52. 2% in the control group ;the sputum negative conversion rate at the 2^nd ,4^th ,6^th ,8^th month after treatment were 61.9% ,80. 9% ,90.4% ,92. 8% in the treatment group and 37.5 % ,55.0% ,67.5 % ,72. 5 % in the control group respectively;At the end of the treatment there was no significant difference in clinical symptoms both in the treatment group and control group （ P 〉 0. 05 ）. Conclusion Mycobacterium vaccae vaccine may improve the vitality of immune cell, accelerate the foci absorption and increase the sputum negative conversion rate. It is an effective immune treatment for pulmonary tuberculosis.