母牛分支杆菌菌苗在难治性肺结核治疗中的作用

Immunotherapeutic effect of Mycobacterium vaccae on multi-drug resistant pulmonary tuberculosis

目的 观察和评价母牛分支杆菌 (微卡 )菌苗在难治性肺结核免疫治疗中的疗效及安全性。方法 采用随机配对分组法将 90例菌阳难治性肺结核患者分入微卡菌苗治疗组 (M组 ,2 8例 )和对照组 (C组 ,2 8例 ) ,另设自身对照组 (S组 ,34例 )。M组化疗 6个月加用微卡菌苗治疗 6个月 ,C组化疗 6个月 ,不用微卡菌苗。S组前 3个月只化疗 ,后 6个月化疗方案不改变 ,加用微卡菌苗治疗。结果 治疗 6个月后 ,M组涂阳阴转率 43% ,培阳阴转率 46 % ;C组涂阳阴转率 2 1% ,培阳阴转率18%。痰菌阴转率M组显著高于C组 (P <0 0 1)。S组化疗 3个月后涂阳阴转率 3% ,培阳阴转率3% ,加用微卡菌苗治疗 6个月后涂阳阴转率达 44 % ,培阳阴转率达 41%。M组病灶吸收 ,空洞关闭、缩小速度均显著高于C组 (P <0 0 5 )。M组细胞免疫改善显著优于C组。 1年后复查 ,M、C和S组的痰菌复发率分别是 8%、2 0 %和 7%。结论 微卡菌苗能改善难治性肺结核患者的细胞免疫功能 ,增强化疗疗效 ,有助于痰菌阴转 ,病灶吸收好转 ,可作为难治性肺结核的免疫治疗和化疗的辅助治疗。

Objective To evaluate the immuotherapeutic effect of M vaccae on multi drug resistant (MDR) pulmonary tuberculosis Methods 90 cases of MDR pulmonary tuberculosis with bacteriological positive were divided into immunotherapy (M, 28 cases) group , control (C,28 cases) group at random pair and self control (S,34 cases) group The group M were treated by chemotherapy and M vaccae for 6 months, the group C only treated by chemotherapy for 6 months,while group S only by chemotherapy in the first 3 months and in combination with M vaccae in the next 6 months Results After 6 months, the sputum negative conversion rates of group M were 43% in smear positive cases and 46% in culture positive cases,both of which were significant higher than those of group C (21%, 18%, P <0 01) The sputum negative conversion rates of group S were 3%, 3% in smear and culture positive cases after 3 month chemotherapy, which increased to 44%, 41% respectively when M vaccae was added for 6 months Compared with group C, group M was better in improving of X ray manifestation and cell mediated immunity and closing of cavity ( P <0 05) The bacteriological relapse rates in group M, C, S were 8%, 20% and 7% respectively Conclusion As a adjunct to chemotherapy, M vaccae is helpful for patients with MDR pulmonary tuberculosis by improving the cell medicated immunity, sputum negative conversion and X ray manifestation