猫爪草水煎剂联合标准抗结核方案治疗颈淋巴结结核疗效观察

Efficacy of radix ranunculus ternate decoction combined with standard anti-tuberculosis treatment regimen in patients with cervical tuberculous lymphadenitis

目的观察猫爪草水煎剂联合标准抗结核方案治疗颈淋巴结结核(CTL)的临床疗效。方法选取2009年1月至2017年6月在深圳市福田区慢性病防治院就诊的CTL患者504例,按随机数表法分为观察组和对照组,每组252例,所有患者均接受12个月标准抗结核治疗及治疗期间至停药1年的随访,观察组加用每天一剂的猫爪草水煎剂,疗程12个月。比较两组患者淋巴结开始缩小时间、治疗转归、淋巴结血供类型和淋巴结最大切面长径(L)/短径(S)比值变化。治疗前后以流式细胞仪监测两组T细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+比值)及NK细胞百分比。结果 475例患者完成研究,其中观察组235例,对照组240例。观察组患者在第2、4、8周出现淋巴结缩小的患者分别占32.3%、52.0%和15.7%,对照组分别为22.5%、35.8%、41.7%,两组差异有统计学意义(P<0.05);观察组痊愈率为93.2%,高于对照组的78.8%,差异有统计学意义(P<0.05);治疗后,观察组患者中淋巴结呈中心型血供者占44.3%,混合型血供者43.8%,对照组中则分别为37.5%和40.8%,两组间血供类型分布差异有统计学意义(P<0.05);治疗后观察组患者的淋巴结短径S平均为(4.92±1.58) mm,L/S中位数为2.33,对照组S平均为(6.33±1.41) mm,L/S中位数为2.00,差异有统计学意义(P<0.05);治疗后观察组患者的CD3+、CD4+、CD8+、CD4+/CD8+比值及NK细胞水平分别为(66.84±11.40)%、(43.25±7.31)%、(24.24±3.80)%、(1.80±0.33)、(25.62±3.30)%,对照组分别为(65.12±10.20)%、(37.34±8.26)%、(26.61±4.23)%、(1.40±0.28)、(21.22±5.18)%,观察组治疗后CD4+、CD4+/CD8+比值和NK细胞水平高于对照组,差异均有统计学意义(P<0.05);治疗结束后随访1年,观察组痊愈219例,未见复发,对照组痊愈189例,有10例复发,占5.29%(10/189),复发率差异有统计学意义(χ2=9.77,P<0.05);治疗过程中两组患者均无不良事件发生。结论应用猫爪草水煎剂联合标准抗结核方案可使颈淋巴结结核症状改善更快,提高痊愈率,机体免疫水平更强,随访1年未见复发,全程随访未见明显不良反应,安全有效。

Objective To study the effect of radix ranunculus ternate decoction combined with standard anti-tuberculosis medicine in the treatment of cervical tuberculous lymphadenitis （CTL）. Methods From January 2009 to June 2017, 504 patients with CTL treated in Department of Tuberculosis Control and treatment of Fntian Hospital of Chronic Disease Prevention and Control were selected as the research objects according to the random number table method, which were divided into observation group （n=252） and control group （n=252）. All the patients received a standard 12-month anti-tuberculosis treatment and were followed from the beginning of the treatment to 1 year after drug withdrawl, and the observation group additionally received a daily dose of radix ranunculus temate decoction for 12 months. The time that lymph node begin shrinking, treatment outcomes, lymphnode, blood supply and the ratio of maximum length and maximum short diameter （L/S） were compared. T cell subsets （CD3^＋, CD4^＋, CD8^＋, CD4^＋/CD8^＋） were measured before and after treatment by flow cytometer. Results A total of 475 patients completed the research, including 235 patients in the observation group and 240 patients in the control group. At the second, fourth and eighth week, the patients with lymph node shrinkage in the observation group accounted for 32.3%, 52.0% and 15.7%, significantly higher than 22.5%, 35.8%, 41.7% in the control group respectively （P〈0.05）.The cure rate in the observation group （93.2%） was significantly higher than that （78.8%） in the control group （P〈0.05）. After treatment, the patients in observation group whose lymph node changed to central blood supply and mixed blood supply accounted for 44.3% and 43.8%, significantly higher than 37.5% and 40.8% in the control group （P〈0.05）. In the observation group, the average short diameter （S） of lymph node was （4.92±1.58） mm and the median L/S ratio was 2.33 when the treatment finished, significantly better than （6.33±1.41） mm and 2.00 in the control group （P〈0.05）. The levels of CD3^＋, CD4^＋, CD8^＋, CD4^＋/CD8^＋ ratio and NK cell in the observation group were （66.84±11.40）%, （43.25±7.31）%, （24.24±3.80）%, （1.80±0.33）, （25.62±3.30）%, and those in the control group were （65.12±10.20）%, （37.34±8.26）%, （26.61±4.23）%, （1.40±0.28）, （21.22±5.18）% when the treatment finished, respectively. The differences in the level of CD4^＋, CD4^＋/CD8^＋ ratio and NK cell between the two groups were significant （P〈0.05）. Both groups were followed up for 1 year after the treatment completion. During the follow-up, 219 cases in the observation group who had been cured had no recurrence, and 10 cases among 189 cases who had been cured in the control group relapsed, with statistically significant difference in the recurrence ratebetween the two groups （χ^2=9.77, P〈0.05）. There was no adverse events occurred throughout the whole treatment course. Conclusion Applying radix ranunculus temate decoction combined with standard anti-tuberculosis treatment regimen could improve the symptoms of tuberculous lymphadenitis, increase the cure rate significantly, and improve the immunologic function of cell, with no recurrence during the one-year follow-up and no adverse events during the treatment course. The regimen is effective and safe.