糖皮质激素辅助治疗血行播散性肺结核的临床效果观察

Clinical observation of adjunctive therapy with corticosteroid in hematogenous pulmonary tuberculosis patients

目的探讨急性血行播散性肺结核早期应用糖皮质激素辅助治疗的临床疗效观察。方法2010年3月至2013年5月首都医科大学附属北京胸科医院急诊科收治的72例急性血行播散性肺结核患者，按病历号设立随机种子，建立伪随机函数，随机分为治疗组（36例）和对照组（36例），两组均给予标准抗结核方案治疗[3HR（L2）ZE／6～9HR（L2）E]，治疗组在强化期应用泼尼松治疗4周。本研究采用SPSS13．0统计学软件，临床症状改善时间采用t检验；胸片改善有效率及药物性肝损伤发生率采用χ^2检验，以P〈0．05为差异有统计学意义。结果发热症状好转时间在治疗组和对照组分别为（2．5±0．5）d和（7．5±0．5）d，差异有统计学意义（t=-42．43，P〈0．01）；4周后两组胸片的有效率分别为86．1％（31／36）和58．3％（21／36），差异有统计学意义（χ^2=6．92，P〈0．01）；药物性肝损伤发生率分别为5．6％（2／36）和27．8％（10／36），差异有统计学意义（χ^2=6．40，P〈0．05）。结论急性血行播散性肺结核早期抗结核治疗的同时辅助应用糖皮质激素有助于临床症状改善和胸片病变的吸收好转，并能够降低药物性肝损伤的发生率。

Objective To observe clinical efficacy of adjunctive therapy with corticosteroid in acute hematogenous pulmonary tuberculosis patients. Methods Seventy-two acute hematogenous pulmonary tuberculosis cases were randomly divided into treatment group （n=36） and the control （n=36）. All patients were given the standard regimen（3HR（La ） ZE/6-9HR（L2 ） E） for antituberculous treatment. In addition to treatment group, prednisone （20 mg） were also given in the intensive phase for 2 weeks and then reduce to stop for 2 weeks. Results The time of fever improvement after treatment was（2.5±0.5） and （7.5±0. 5） days in treatment groups and the control, respectively（t=-42.43,P〈0. 001）. The effective rate of chest X-ray at the 4th month after treatment was 86.1% （31/36） and 58.3%（21/36） in treatment groups and the control, respectively（χ^2 = 6.92, P〈0. 01）. Meanwhile, the incidence rate of drug induced liver injury（DILI） was S. 6 % （2/36） and 27.8% （10/36） treatment groups and the control, respectively （χ^2= 6.40, P 〈 0.05）. The above-mention differences were significant statistically. Conclusion Corticosteroid with antituberculous drugs earlier is helpful to improve clinical symptom and miliary tubercle absorption in chest X-ray and decrease incidence of DILI in patients with hematogenous pulmonary tuberculosis. It is worth popularizing in the future.