不同抗结核治疗方案用于老年肺癌伴肺结核的临床意义

Clinical significance of different anti-tuberculosis therapies in elderly patients with lung cancer complicated with pulmonary tuberculosis

目的探讨不同抗结核治疗用于老年肺癌伴肺结核的临床意义。方法将我院82例老年肺癌伴肺结核患者按随机数表法均分为观察组(新抗结核治疗方案:力克肺疾、利福喷丁、莫西沙星)与对照组(标准抗结核方案:异烟肼、利福平、吡嗪酰胺、乙胺丁醇),两组抗结核治疗时间均为2个月,肺癌治疗采取局部楔形切除术或局部楔形切除术+化疗。对比两组痰菌转阴率、肺部病灶吸收情况及生化检验结果[血沉(ESR)异常、C-反应蛋白(CRP)异常],记录肺癌生活质量评估量表(FACT-L)评分及副作用发生率。结果两组痰菌转阴率比较无显著差异(P> 0. 05)。观察组胸部影像吸收率90. 24%明显高于对照组72. 17%,胸部影像进展率4. 88%明显低于对照组19. 51%(P <0. 05)。两组治疗后生理状况(10. 06±3. 25)分、社会/家庭状况(11. 57±3. 08)分、情感状况(10. 95±3. 35)分、功能状况评分(12. 47±2. 87)分均较治疗前降低,且观察组低于对照组(P <0. 05)。两组治疗前后肺癌相关症状评分比较无显著差异(P> 0. 05)。观察组副作用发生率34. 15%低于对照组56. 10%(P <0. 05)。结论新抗结核方案治疗老年肺癌伴肺结核在痰菌转阴率、生化检验结果方面无显著差异,但前者肺部影像检查及生命质量有明显改善,且副作用更少,临床应用价值更高。

Objective To investigate clinical significance of different anti-tuberculosis therapies in elderly patients with lung cancer complicated with pulmonary tuberculosis. Methods A total of 82 elderly patients with lung cancer complicated with pulmonary tuberculosis were randomly divided into two groups： the observation group （the new scheme of anti tuberculosis treatment： moxifloxacin Lectra lung disease, rifapentine ） and the control group （standard anti tuberculosis therapy： isoniazid, rifampicin, pyrazinamide, ethambutol）. They were continuous treated for 2 months. The anti tumor scheme mainly adopted surgery or surgery ＋ chemotherapy. The negative rate of sputum bacteria, the absorption of lung lesions and the biochemical test results [ ESR （ESR） abnormalities and abnormal C- reactive protein （CRP） 1 were compared between the two groups. The lung cancer quality of life scale （FACT-L） score and the incidence of side effects were recorded. Results There was no significant difference in the rate of sputum negative conversion between the two groups （P 〉 0. 05）. The chest image absorption rate of the observation group was 90. 24%, which was higher than 72. 17% of the control group, and the chest image progression rate was 4.88% , which was significantly lower than 19. 51% of the control group （P 〈0. 05）. The physiological status of the two groups after treatment （ 10. 06 ± 3.25 ）, social/family status （ 11.57± 3.08 ）, emotional status （ 10. 95 ± 3.35 ）, and functional status score （12.47 ±2. 87） were lower than before treatment, and the observation group was lower than the control group （ P 〈 0. 05 ）. There was no significant difference in lung cancer related symptom scores between the two groups before and after treatment （ P 〉 0. 05 ）. The incidence of side effects in the observation group was 34. 15 % , which was lower than 56. 1% in the control group （P 〈 0. 05 ）. Conclusion The new anti tuberculosis regimen has no significant difference in the rate of sputum negative conversion and biochemical tests in the treatment of elderly patients with lung cancer and tuberculosis, but the former lung imaging examination and the quality of life has improved significantly, with less side effects. The clinical application is more valuable.