中医辨证对治疗耐多药肺结核的效果分析

Effect Analysis of TCM Differentiation Treat of Recurrent Multidrugresistant Tuberculosis MDR-TB

目的分析中医辨证联合化疗方案治疗耐多药肺结核病（MDR-TB）疗效及安全性。方法随机选取2011年1月～2014年1月我院收治的200例耐多药肺结核患者为研究对象，其中男112例，女88例，年龄22～71（42．7±3．31岁。病程1～18（7．1±1．5）年。随机分为观察组与对照组各100例，采用两组全程给予莫西沙星治疗，对照组应用药物为8（D＋z＋pto＋Am）／12（D＋z＋Pto），观察组在对照组的基础上加用微卡，两组疗程均为20个月，比较两组治疗后2、4、6及12个月的痰菌阴转率；胸片检查病灶吸收情况及CD3^＋、CD4^＋、CD8^＋淋巴CD4^＋／CD8^＋细胞亚群变化和患者不良反应情况。结果（1）观察组患者治疗后2、4、6及12月的痰菌阴转率[分别为37（37％）、62（62％）、75（75％）、77（77％）]与对照组[分别为（19（19％）、42（42％）、51（51％）、52（52％）]比较，差异均有统计学意义（P〈0．05；P〈0．01）；（2）观察组病灶显著吸收、吸收、无变化的有效率与对照组比较，差异均有统计学意义（P〈0．05）；（3）观察组CD3‘、CD4‘、CD8‘、CD4’／CD8’淋巴细胞亚群变化与对照组比较，差异均有统计学意义（P〈0．05）；（4）两组不良反应发生率比较，差异均无统计学意义（P〉0．05）。结论中医辨证联合化疗方治疗MDR-TB，可以提高临床痰菌转阴率，有助于病灶吸收，改善提高患者免疫力，同时不增加临床不良反应，安全有效。

Objective To analyze the efficacy and safety of TCM syndrome differentiation combined with chemotherapy in the treatment of multi drug resistant pulmonary tuberculosis （MDR-TB）. Methods Randomly selected from January 2011 to January 2014, 200 patients with multi drug resistant pulmonary tuberculosis were studied, including 112 males and 88 females, aged from 22 to 71 （42.7 ± 3.3） years. The course of disease was from 1 to 18 （7.1 ± 1.5） years. Randomly divided into observation group and control group with 100 cases in each. The two groups given a full course of moxifloxacin in the treatment of, the group using drugs control 8 D＋Z＋Pto＋Am / D＋Z＋Pto. Observation group on the basis of the control group treated with micro card. The course of treatment in the two groups were 20 months and compared between the two groups after treatment 2, 4, 6 and 12 months of sputum Yin conversion rate; chest lesions absorption and CD3^＋, CD4^＋, CD8^＋ lymphocyte CD4^＋ / CD8^＋ cell subsets change and adverse reaction in the patients of the situation. Results （1）In the observation group, 2, 4, 6 and December were compared with the control group （19 （37%）, 62 （75%）, 77 （77%）, 51 （19%）, 42 （51%）, 52 （52%）, respectively, and the difference was statistically significant （P〈 0.05, P〈0.01）;（2）In the observation group, the difference was statistically significant （P〈0.05）;（3） CD3^＋, CD8^＋, CD4^＋ and CD4^＋/CD8^＋ lymphocyte subsets in the observation group were significantly different from the control group （P〈0.05）;（g）There was no significant difference in the incidence of adverse reactions between the two groups （P〉0.05）. Conclusions TCM combined with chemotherapy Decoction ＂in the treatment of MDR-TB can improve clinical sputum negative conversion rate, helps in the absorption of lesions, improve the immunity of the patients, and no adverse reaction, safe and effective.