抗痨凝胶介入治疗初治菌阳肺结核并支气管内膜结核的疗效及安全性

Clinical Effects and Safety of Interventional Anti-tuberculosis Chemotherapy Gel Assisted Method in Treatment of New Smear-positive Tuberculosis Patients Combined with Endobronchial Tuberculosis

目的观察经纤维支气管镜介入抗痨凝胶治疗初治菌阳肺结核并支气管内膜结核的临床近期疗效及安全性。方法 115例经纤支镜确诊的支气管结核患者随机自愿分为全身化疗加凝胶介入注药(介入组)和全身化疗加雾化吸入(吸入组),比较患者治疗前及治疗后2个月和6个月临床症状改善、胸部X线或CT病灶好转、痰菌阴转、不同类型镜下的转归。结果治疗2个月后介入组和吸入组的临床症状显效率分别为92.9%和77.8%,病灶显效率为91.4%和53.3%,痰阴转率为95.7%和75.6%及镜下改变显效率Ⅰ型(炎症浸润型)为96.4%和64.7%,Ⅱ型(溃疡坏死型)为96.2%和56.3%,两组比较有显著性差异(P<0.05或P<0.01);6个月后两组比较仅肺部病灶吸收有显著性变化。结论抗痨凝胶经纤维支气管镜介入治疗支气管内膜结核的近期疗效显著优于雾化吸入组,能迅速缓解患者临床症状、促进病灶吸收、提高临床疗效,且无明显的并发症及毒副作用,是目前治疗支气管内膜结核的较好方法。

OBJECTIVE To evaluate clinical effects and safety of interventional anti-tuberculosis chemotherapy gel assisted method in treatment of new smear-positive tuberculosis patients combined with endobronchial tuberculosis.METHODS A total of 115 patients who had been diagnosed with bronchoscope as endobronchial tuberculosis were randomly divided into two groups： interventional therapy group（n=70） and aerosolizing inhalation group（n=45）.All patients were given anti-tuberculosis chemotherapy.After 2 and 6 months’ treatment,the clinical symptom improvement rate,the pulmonary tuberculosis lesion absorption rate,the sputum bacteria negative rate and bronchoscopic features’ transition were compared.RESULTS After 2 months’ treatment,the clinical symptom improvement rate,the pulmonary tuberculosis lesion absorption rate,the sputum bacteria negative rate,the bronchoscope features’ transition Ⅰ type rate and Ⅱtype rate of interventional therapy group and aerosolizing inhalation group were 92.9% and 77.8%,91.4% and 53.3%,95.7% and 75.6%,96.4% and 64.7%,96.2% and 56.3%,respectively.There was significant difference between two groups（P0.05 or P0.01）.After 6 months,only the pulmonary tuberculosis lesion absorption rate improved noticeably.CONCLUSION Use of interventional anti-tuberculosis chemotherapy gel assisted method to treat new smear-positive tuberculosis patients combined with endobronchial tuberculosis can quickly relieve clinical symptom,accelerate the absorption of focus,raise clinical effects.