抗痨方辅助化疗药物治疗耐多药肺结核50例临床观察

Clinical Observtion of Kanglao Decoction Assisted with Chemotherapy for Treatment of Multi-drug Resistant Tuberculosis in 50 Patients

目的:观察抗痨方辨证辅助化疗药物治疗耐多药肺结核(MDR-TB)的疗效及对细胞免疫调节作用。方法:将100例MDR-TB患者采用随机按数字表法分成对照组与观察组各50例。对照组根据不同情况给予标准西药化疗方案进行治疗,观察组在对照组治疗的基础上加用抗痨方辨证治疗。两组疗程均为6个月。观察治疗后痰菌阴转,CT胸片吸收情况,记录中医证候积分,检测治疗前后T淋巴细胞亚群(CD3+,CD4+,CD8+)水平;进行血常规、肝、肾功能监测,记录治疗期间发生的不良发应。结果:经Ridit分析,观察组综合疗效优于对照组(P<0.05);治疗后6个月观察组痰菌阴转率为88%,对照组为62%,观察组优于对照组(P<0.05);治疗后6个月观察组胸部CT疗效好转率为90%,优于对照组的64%(P<0.05);治疗后2,4,6个月观察组中医症状积分均低于对照组(P<0.01);治疗后观察组CD3+,CD4+高于对照组,CD8+水平低于对照组(P<0.01);治疗后观察组肝损害及白细胞减少的发生率均低于对照组(P<0.05);观察组消化、皮肤、神经等系统副反应发生频次低于对照组(P<0.01)。结论:抗痨方辨证辅助化疗药物治疗MDR-TB能促进痰菌转阴、改善胸部CT吸收、减轻临床症状、减少副反应少和提高机体细胞免疫功能,临床综合疗效优于单纯西医治疗。

Objective： To observe the curative efficacy of syndrome dependent Kanglao decoction combined chemotherapy in treating multi-drug resistant tuberculosis （MDR-TB） , and to investigate its influence on cellular immune regulation. Method： One hundred patients with MDR-TB were randomly divided into the control group （50 cases） and the observation group （50 cases） by a random number table. According to the different situation, patients in the control group received conventional chemotherapy. Based on the treatment of the control group, patients in the observation group added modified Kanglao decoction. All patients in two groups received 6 months of treatment. Sputum negative conversion and situation of computed tomography （CT） X-ray absorption were observed, and scores of traditional Chinese medical （TCM） syndrome were recorded. Before and after treatment, levels of T lymphocyte subsets （ CD3 ^＋ , CD4 ^＋ , CD8 ^＋ ） were detected, blood routine of kidney and liver function were monitored. Adverse reaction was recorded during the treatment. Result： The comprehensive curative effect of the observation group was superior to that of the control group （ P 〈 0.05 ）. Sputum negative conversion rate was 88% in the observation group, which was better than that of 62% in the control group during 6 months of treatment （P 〈 0.05）. The curative effect of chest CT in the observation group was 90% , which was superior to that of 64% in the control group during 6 months of treatment （P 〈 0.05）. Symptom score of TCM in the observation group was lower than that in the control group after 2, 4, 6 months of treatment （P 〈 0.01 ）. Levels of CD3^ ＋ , CD4 ^＋ in the observation group were higher, while CD8 ^＋ standard was lower than those in the control group （P 〈0.01）. The incidence of liver damage and leukopenia in the observation group was less than those in the control group （P 〈 0.05）. Occurrence frequency of side effects on digestion system, skin system, nerve system, etc, in the observation group were inferior to those in the control group （P 〈 0. 01 ）. Conclusion： Kanglao decoction assisted with chemotherapy drugs could reduce sputum negative conversion, improve chest CT absorption, relieve clinical symptoms and side reaction, enhance organism cellular immunity function in treating MDR-TB. Its clinical comprehensive efficacy is superior to using Western medicine treatment alone.