加味定喘汤联合抗痨治疗重症肺结核患者的临床效果

Jiawei Dingchuan decoction combined with anti-tuberculosis therapy on clinical effect of patients with severe pulmonary tuberculosis

目的探讨加味定喘汤联合抗痨治疗对重症肺结核患者的临床效果及炎症介质水平的影响。方法选取上海市浦东新区肺科医院结核科收治的84例重症肺结核患者,收集时间2015年1月-2017年1月,采用信封法随机分为病例组和对照组各42例,两组患者均给予抗痨治疗,病例组同时给予加味定喘汤治疗2个月,对比两组的结核杆菌转阴率、血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、中医证候积分及临床疗效。结果治疗前,两组患者的血清TNF-α、CRP、IL-6、IL-1β水平差异无统计学意义(P>0.05);治疗后,病例组的血清TNF-α、CRP、IL-6、IL-1β水平显著低于对照组(P<0.05);治疗前,两组患者的气促、发热、咳嗽积分差异无统计学意义(P>0.05);治疗后,病例组的气促、发热、咳嗽积分显著的低于对照组(P<0.05);病例组达到临床控制54.76%、显效30.95%、有效14.29%,对照组临床控制35.71%、显效33.33%、有效28.57%、无效2.38%,两组比较差异有统计学意义(P<0.05);病例组痰菌转阴率64.29%(27/42)、对照组痰菌转阴率52.38%(22/42),两组比较差异无统计学意义(χ~2=1.224,P>0.05)。结论加味定喘汤联合抗痨治疗能改善重症肺结核患者的炎症反应程度及临床症状,对于提高患者的治疗效果具有积极意义。

Objective To investigate the effect of Jiawei Dingchuan Tang combined with anti-tuberculosis treatment on the inflammatory mediators in patients with severe pulmonary tuberculosis. Methods Eighty-four patients with severe tuberculosis who were admitted to TB Department of Pulmonary Hospital of Pudong New Area in Shanghai were collected from January 2015 to January 2017,and were randomly divided into case group and control group by envelope method,42 cases each;both groups were given anti-tuberculosis treatment,and the case group was also given Jiawei Dingchuan Tang treatment for 2 months. The Mycobacterium tuberculosis negative rate,serum levels of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)and interleukin-1β(IL-1β),and the TCM syndrome score and clinical efficacy were compared between two groups. Results There were no significant differences in serum TNF-α,CRP,IL-6 and IL-1β levels between the two groups before treatment(P>0.05). After treatment,the serum levels of TNF-α,CRP,IL-6 and IL-1β in the case group were significantly lower than those in the control group(P<0.05). Before treatment,there was no significant difference in the scores of shortness of breath,fever and cough between the two groups(P>0.05). After treatment,the scores of shortness of breath,fever and cough in the case group were significantly lower than those in the control group(P<0.05). The case group achieved clinical control of 54.76%,markedly effective 30.95%,effective 14.29%,while the control group achieved clinical control 35.71%,markedly effective 33.33%,effective 28.57%,and ineffective2.38%. The difference between the two groups was statistically significant(P<0.05). In the case group,the negative rate of sputum was 64.29%(27/42),and the negative rate of sputum in the control group was 52.38%(22/42). There was no significant difference between the two groups(χ~2=1.224,P>0.05). Conclusion Jiawei Dingchuan Decoction combinedwith anti-tuberculosis treatment could improve the degree of inflammatory reaction and clinical symptoms in patients with severe pulmonary tuberculosis,which might significantly improve the therapeutic effect of patients.