人参多糖辅助治疗糖尿病合并肺结核患者的近期临床观察

Curative effect of ginseng polysaccharide on adjuvant therapy of diabetes combined with pulmonary tuberculosis

目的探讨人参多糖辅助治疗2型糖尿病合并肺结核的近期临床效果。方法选择2011年1月至2011年12月汕头市结核病防治所的门诊2型糖尿病合并肺结核患者,全部患者结核病的诊断均符合《临床诊疗指南结核病分册》中所制定的标准,所有患者2型糖尿病的诊断符合中华医学会糖尿病学分会2009年颁布的《中国糖尿病防治指南》中所制定的标准。将120例2型糖尿病合并肺结核患者按门诊登记的单双号数随机分为实验组62例和对照组58例。实验组在行常规抗结核和降糖治疗的同时加用人参多糖(隔日一次肌内注射,每次12mg),共计180d;对照组仅行常规抗结核、降糖治疗,共计180d。观察两组的短期治疗效果和T细胞亚群变化,并加以比较。采用SPSS 13.0统计学软件进行分析,计量资料采用t检验,率比较采用χ2检验,P<0.05为差异有统计学意义。结果人参多糖辅助治疗180d后,实验组患者痰菌阴转率为95.2%(59/62),明显高于对照组患者的79.3%(46/58)(χ2=6.88,P<0.01);实验组患者治疗的有效率达96.8%(60/62),明显高于对照组患者的75.9%(44/58)(χ2=11.34,P<0.01)。实验组患者治疗后外周血液检测,CD3+为(50.00±10.42)%,治疗前为(34.89±7.26)%,对照组患者治疗后检测为(37.46±8.96)%;实验组治疗后分别与后二者比较(t值分别为9.36、7.04,P值均<0.01)。实验组患者治疗后外周血液检测,CD4+为(34.88±9.96)%,治疗前为(25.89±8.68)%,对照组患者治疗后为(25.64±9.68)%;实验组治疗后分别与后二者比较,t值分别为5.38、5.11,P值均<0.01。实验组患者治疗后外周血液检测,CD4+/CD8+值为1.58±0.78,治疗前为1.15±0.45,对照组患者治疗后检测值为1.20±0.62;实验组治疗后分别与后二者比较,t值分别为3.76、2.94,P值均<0.01。实验组患者治疗后外周血液检测,CD8+为(18.50±7.22)%,治疗前为(24.76±9.85)%,对照组患者治疗后为(23.86±8.92)%;实验组治疗后分别与后二者比较,t值分别为4.03、3.63,P值均<0.01。与治疗前及对照组治疗后比较差异均有统计学意义。结论采用人参多糖辅助治疗2型糖尿病合并肺结核患者的痰菌阴转、治疗有效率、细胞免疫功能改善均有明显的促进作用。

Objective To investigate the curative effect of ginseng polysaccharide on adjuvant therapy of type 2 diabetes combined with pulmonary tuberculosis（PTB）. Methods One hundred and twenty out-patients with diabetes combined with PTB notified in Shantou Institute of Tuberculosis Control and Prevention from January to December, 2011 were the study targets. The diagnosis of TB was accord with the standard of Clinical Practice Guidelines for Tuberculosis, and the diagnosis of type 2 diabetes was accord with the standard of China Guideline for Diabetes issued in 2009 by Chinese Diabetes Society. One hundred and twenty patients were randomly divided into experimental group（62 cases）and control group（58 cases）based on odd-even notified number. Routine anti-TB and glucose-lowering treatment were applied in control group（180 days） ,while ginseng polysaccharide was given（12 mg intramuscular injection every other day for 180 days）to experimental group besides the routine treatment. The short term effect and the change of T cell subset of the two groups were compared. SPSS 13.0 software was used for data analysis,t-test was used for quantitative data and Х^2 test was applied for rate comparison. P〈0.05 was set as the standard of statistical significance. Results The sputum conversion rate of experimental group was 95.2% （59/62） ,which was significantly higher than that of the control group（79.3%,46/58） （Х^2 =6.88,P〈0.01）. The effective rate of experimental group（96.8%,60/62）was also significantly higher than control group（75.9%,44/58） （Х^2= 11.34, P〈0.01）. From peripheral blood testing, the proportions of CD3＋ T cells in patients in experimental group was（50. 0±10. 42）% after treatment and（34. 89%7. 26）%before treatment,and the proportion in patients in control group was（37.46 % 8.96）% before treatment, t-values were 9.36 and 7.04 respectively compared with the latter two,and both P value were less than 0.01. The proportions of CD4^＋T cell in experimental group were（34. 88±9.96） % after treatment and（25.89＋8.68） % before treatment,while that in control group after treatment was（25.64±9. 68） % after treatment, t-values were 5.38 and 5.11 compared with the latter two with P〈0.01. The ratios of CD4/CD8 were 1.58±0. 78,1.15±0. 45 and 1.20%0. 62 respectively, and the t-values were 3.76 and 2. 94 com- pared with the latter two with P〈0.01. The proportions of CD8^＋T cell were（18. 50±7.22） %, （24. 76±9.85） % and（23.86±8.92） % respectively, and the t-values were 4. 03 and 3.63 compared with the latter twowith P〈0. 01. Conclusion The sputum conversion rate, effective rate and cellular immune function were clearly improved by ginseng polysaccharide on diabetes combined with PTB.