初治肺结核联用维生素C的前瞻性研究

A prospective study of combined with vitamin C for primary treatment of pulmonary tuberculosis

目的研究初治肺结核患者联用维生素C治疗的效果。方法以前瞻性研究方法 ,选取151例初治肺结核患者,按照来院治疗的先后顺序及随机数字表,随机表从第1行第1列开始,每个数除以3,整除的作为对照组(49例),余1的作为低剂量组(52例),余2的作为高剂量组(50例)。三组均进行正规的抗结核治疗,低剂量组增加200 mg/d维生素C,高剂量组增加1000 mg/d维生素C,对照组则应用安慰剂。观察患者的治疗效果及不良反应情况,并比较三组患者的痰涂片转阴情况、发热周数。结果 151例患者中146例完成治疗,1例因工作原因转外地继续治疗,4例中途失联;其中132例治愈,14例未转阴或影像学未达标,继续治疗。对照组、低剂量组和高剂量组患者的发热周数分别为(5.10±2.37)、(5.33±1.74)、(2.97±1.66)周;高剂量组患者的发热周数显著少于对照组和低剂量组,差异具有统计学意义(P<0.05);低剂量组与对照组患者的发热周数比较差异无统计学意义(P>0.05)。治疗期间各组均未发现有严重的腹泻、肾结石等不良反应,无新发的消化性溃疡。结论初治肺结核化疗合并大剂量的维生素C,经济,安全,提高治疗效果,可考虑缩短治疗时间,有临床推广意义。

Objective To research the effect of treatment combined with vitamin C on primary treatment of pulmonary tuberculosis. Methods In a prospective study, 151 pulmonary tuberculosis patients with primary treatment were selected. According to the order of admission and the random number table, the random table starts at the first row, the first column, and each number was divided by three. They were divided into the control group for 49 cases（no remainder after divisible）, the low dose group for 52 cases（the remainder was 1 after divisible） and the high dose group for 50 cases（the remainder was 2 after divisible）. All three groups received regular anti-tuberculosis treatment. On this basis, the low dose group received 200 mg/d vitamin C, the high dose group received 1000 mg/d vitamin C, and the control group received placebo. The curative effect, adverse reactions, sputum smear turning negative and fever cycle were observed and compared among the three groups. Results In 151 patients, 146 cases completed the treatment, 1 case was transferred for further treatment due to work reasons, 4 cases were lost in the middle of the treatment, 132 cases were cured, 14 cases did not turn to negative or did not reach the imaging standard, continued treatment. The fever cycles of the control group, the low dose group and the high dose group were（5.10 ±2.37）,（5.33±1.74）,（2.97±1.66） weeks respectively, and the fever cycles of the high dose group was significantly less than those of the control group and the low dose group, the differences were statistically significant（P〈0.05）. There was no significant difference in fever cycles between low dose group and control group（P〉0.05）. During the treatment period, no severe diarrhea, kidney stones and other adverse reactions were found in each group, and no new peptic ulcer was found. Conclusion It is economical and safe to treat pulmonary tuberculosis with high dose of vitamin C. It can improve the treatment effect, shorten treatment time can be considered, and has clinical significance.