免疫辅助治疗初治肺结核的研究

Analysis of immune adjuvant therapy for the initial treatment pulmonary tuberculosis

目的评估免疫辅助治疗初治肺结核的疗效并探讨使用适应证。方法回顾性研究2014年1月至2015年12月上海市肺科医院收治的246例初治肺结核患者。以CD4＋／CD8＋比值及是否进行免疫辅助治疗（强化期连续注射外源性母牛分枝杆菌菌苗免疫制剂），将患者分为“CD4＋／CD8＋≥1＋辅以免疫治疗”组（简称“A1”组，64例）、“CD4＋／CD8＋≥1＋非免疫治疗”组（简称“A2”组，61例）、“CD4＋／CD8＋〈1＋辅以免疫治疗”组（简称“B1”组，65例）、“CD4＋／CD8＋〈1＋非免疫治疗”组（简称“B2”组，56例），并且随访、比较4个组患者的疗效。结果CD4＋／CD8＋〈1的患者，治疗2个月末病灶吸收的有效率B1组[80．0％（52／65）]高于B2组[55．4％（31／56）]，差异有统计学意义（χ2=8．48，P=0．006）；B1组较B2组患者在并发肺外结核[84．2％（32／38），50．0％（16／32）]、涂阳肺结核[83．3％（25／30），47．8％（11／23）]、无并发症[82．9％（34／41），52．8％（19／36）]及广泛病灶[76．9％（40／52），52．5％（21／40）]方面差异均有统计学意义（χ2=9．43，P=0．002；χ2=7．53，P=0．006；χ2=8．12，P=0．004；χ2=6．04，P=0．016）。A1组CD4＋／CD8＋比值治疗后（1．87±0．78）较治疗前（2．19±0．94）降低，差异有统计学意义（t=3．39，P=0．001）；B1组及B2组CD4＋／CD8＋比值治疗后（1．12±0．53；1．27±0．76）较治疗前（0．79±0．34；0．87±0．49）升高，差异均有统计学意义（t=4．88，P=0．001；t=3．98，P=0．001）。结论对于初治肺结核可以将CD4＋／CD8＋=1作为给予免疫治疗的适应证指标，当CD4＋／CD8＋〈1时，对于涂阳肺结核、无并发症肺结核、肺部病灶广泛、并发肺外结核的患者给予免疫辅助治疗，可加快病灶的吸收。

Objective To evaluate the efficacy of adjuvant therapy for pulmonary tuberculosis, and explore its clinical indications. Methods Data from 246 patients with pulmonary tuberculosis collected from January 2014 to December 2015 was analyzed retrospectively. Patients were divided into groups according to the CD4＋/CD8＋ ratios and use of immunoadjuvant therapy （continuous injection of exogenous Myeobacterium vaccine immune agents during the intensive treatment period）： CD4＋/CD8＋ ≥1 with immunoadiuvant therapy （A1 group, 64 cases）, CD4＋/CD8＋≥1 without immunoadjuvant therapy （A2 group, 61 cases）, CD4＋/CD8＋ 〈1 with immunoadjuvant therapy （B1 group, 65 cases）, and CD4＋/CD8＋ 〈1 without immunoadjuvant therapy （B2 group, 56 cases）, and the efficacy of anti-TB treatment in the four groups was followed up. Results After treatment for two months, the efficacy for patients with CD4＋/CD8＋ 〈1 in the B1 group （80.0% （52/65）） was better than that in the B2 group （55.4% （31/56））, and the difference was statistically significant （χ2 =8.48, P=0. 006）. The difference in concurrent extrapulmonary tuberculosis （84.2%（32/38）, 50. 0% （16/32））, Smear-positive pulmonary tuberculo- sis （83.3% （25/30）, 47.8% （11/23））, no complications （82.9% （34/41）, 52.8% （19/36））, and extensive lesions （76.9% （40/52）, 52.5% （21/40）） was statistically significant （χ2 = 9.43, P= 0. 002; χ2 = 7.53, P= 0. 006; χ2 = 8.12, P = 0. 004, χ2 = 6.04, P = 0. 016）. The CD4＋/CD8＋ value of post treatment in group A1 （1.87±0.78） reduced significantly compared with that of prior treatment （2.19±0.94）, the difference was statisti cally significant （t=3.39, P = 0. 001）; the CD4＋/CD8＋ values of post treatment in groups B1 and B2 （1.12 ±0.53, 1.27±0.76 respectively） increased significantly compared with that of prior treatment （0. 79±0.34, 0.87±0.49）, the differences were statistically significant （t=4.88, P=0. 001, t=3.98, P=0. 001）; Concision This study shows that CD4＋/CD8＋ = 1 can be used as an indication of immune therapy. When CD4＋/CD8＋〈1, patients with pulmonary tuberculosis, extensive lesions of pulmonary tuberculosis and combined pulmonary tuberculosis, the immune therapy can accelerate the absorption of lesions.