左氧氟沙星及胸腺肽联合2HRZE/4HR方案治疗初治肺结核的临床疗效及对痰上清液细胞因子水平的影响

Clinical Effect of Levofloxacin Combined with Thymosin on Treatment-naive Pulmonary Tuberculosis and the Impact on Sputum Supernatant Cytokines Levels Based on 2HRZE/4HR Regimen

目的观察左氧氟沙星及胸腺肽联合2HRZE/4HR方案治疗初治肺结核(TB)的临床疗效,探讨其对痰上清液细胞因子水平的影响。方法选取2013年1月—2015年1月恩施土家族苗族自治州民族医院收治的初治TB患者118例,随机分为观察组与对照组,每组59例。对照组患者予以2HRZE/4HR方案治疗,观察组患者在对照组基础上予以左氧氟沙星联合胸腺肽治疗;两组患者疗程均为6个月。比较两组患者肺部病灶吸收效果,治疗2、4、6个月痰菌转阴率,治疗前后痰上清液细胞因子〔白介素4(IL-4)、干扰素γ(IFN-γ)、肿瘤坏死因子α(TNF-α)〕水平,临床疗效及不良反应/毒副作用发生情况。结果观察组患者肺部病灶吸收效果优于对照组(P<0.05)。治疗2、4、6个月观察组患者痰菌转阴率高于对照组(P<0.05)。治疗前两组患者痰上清液IL-4、IFN-γ、TNF-α水平比较,差异无统计学意义(P>0.05);治疗后观察组患者痰上清液IL-4、TNF-α水平低于对照组,痰上清液IFN-γ水平高于对照组(P<0.05)。观察组患者临床疗效优于对照组(P<0.05)。两组患者不良反应/毒副作用发生率比较,差异无统计学意义(P>0.05)。结论左氧氟沙星及胸腺肽联合2HRZE/4HR方案治疗初治TB的临床疗效确切,可促进病灶吸收及痰菌转阴,调节患者免疫功能,且安全性较高。

Objective To observe the clinical effect of levofloxacin combined with thymosin on treatment - naivepulmonary tuberculosis based on 2HRZE/4HR regimen, to investigate the impact on sputum supernatant cytokines levels.Methods A total of 118 treatment - naive patients with pulmonary tuberculosis were selected in the National Hospital of EnshiTujia and Miao Autonomous Prefecture from January 2013 to January 2015 , and they were randomly divided into control group andobservation group, each of 59 cases. Patients of control group received 2HRZE/4HR regimen, while patients of observation groupreceived levofloxacin combined with thymosin based on 2HRZE/4HR regimen; both groups continuously treated for 6months. Absorbing effect of pulmonary lesions, sputum bacterium negative conversion rate after 2 months, 4 months and 6 monthsof treatment, sputum supernatant cytokines （ including I L 4 ,IFN-7 and TN F-a） levels before and after treatment, clinicaleffect and incidence of adverse reactions/toxic and side effects were compared between the two groups. Results The absorbingeffect of pulmonary lesions of observation group was statistically significantly better than that of control group （ P 〈 0. 05 ） . After2 months, 4 months and 6 months of treatment, sputum bacterium negative conversion rate of observation group was statisticallysignificantly higher than that of control group after treatment, respectively （ P 〈0. 05）. No statistically significant differences ofsputum supernatant level of IL-4 ,IFN-7 or TNF-a was found between the two groups before treatment （ P 〉 0. 05 ） ; aftertreatment, sputum supernatant levels of IL-4 and TNF-a of observation group were statistically significantly lower than those of control group, while sputum supernatant IFN-7 level of observation group was statistically significantly higher than that of controlgroup （ P 〈0. 05）. The clinical effect of observation group was statistically significantly better than that of control group （ P 〈0. 05 ） . No statistically significant differences of incidence of adverse reactions or toxic and side effects was found between the twogroups （ P 〉 0. 05 ） . Conclusion Levofloxacin combined with thymosin has certain clinical effect in treating treatment - naivepatients with pulmonary tuberculosis based on 2 HRZE/4HR regimen, can effectively promote the lesions absorption and negativeconversion of sputum bacterium, adjust the immunologic function, and is relatively safe.