利奈唑胺对重症结核病患者炎性因子、T淋巴细胞水平的影响

Effect of linezolid on inflammatory factors and T lymphocyte levels in patients with severe tuberculosis

目的观察利奈唑胺对重症结核病患者炎性因子、T淋巴细胞水平的影响.方法选择浙江金华广福医院2016年4月至2017年11月治疗的重症结核病患者60例为研究对象,根据治疗方案不同分为对照组(n=30)和观察组(n=30).对照组采用个性化抗结核方案治疗,观察组在对照组基础上联合利奈唑胺治疗,两组均连续治疗9个月.观察两组治疗前后白细胞介素1(IL-1)、肿瘤坏死因子α(TNF-α)、IL-6、IL-10及CD3+、CD4+、CD8+、CD4+/CD8+变化,比较两组肝功能受损、血小板减少、骨髓抑制、恶心呕吐、腹泻发生情况.结果治疗前,两组IL-1、TNF-α、IL-6、IL-10及CD4+、CD8+、CD8+、CD4+/CD8+差异均无统计学意义(均P>0.05).治疗后9个月,对照组IL-1、TNF-α、IL-6、IL-10分别为(10.94±1.31) ng/L、(3.03±0.49) ng/L、(183.43±13.24)ng/L、(134.93±34.51) ng/L,观察组分别为(6.89±1.29) ng/L、(2.49±0.45) ng/L、(129.48±10.74) ng/L、(189.35±43.27) ng/L,两组差异均有统计学意义(t=12.195、11.214、8.414、11.291,均P<0.05);对照组CD3+、CD4+、CD8+、CD4+/CD8+分别为(47.61±7.16)%、(15.49±6.64)%、(20.58±5.61)%、(0.79±0.19),观察组分别为(65.46±8.31)%、(30.23±7.85)%、(34.59±7.41)%、(0.87±0.24),两组差异均有统计学意义(t=10.497、7.865、12.128、10.291,均P<0.05).两组肝功能受损、血小板减少、骨髓抑制、恶心呕吐、腹泻发生率差异均无统计学意义(均P>0.05).结论利奈唑胺用于治疗重症结核病,有助于降低炎性因子水平,改善患者细胞免疫水平,不良反应发生率较低.

Objective To observe the effects of linezolid on the levels of inflammatory factors and T lymphocytes in patients with severe tuberculosis. Methods Sixty patients with severe tuberculosis treated in Jinhua Guangfu Hospital from April 2016 to November 2017 were selected and divided into control group ( n= 30 ) and observation group (n = 30) according to different treatment options. The control group was treated with personalized anti-tuberculosis regimen. The observation group was treated with linezolid on the basis of the control group, and both two groups were treated for 9 months. The changes of interleukin - 1 (IL - 1 ), tumor necrosis factor alpha ( TNF-α), IL - 6, IL-10 and CD3+, CD4+,CD8+ and CD4+/CD8+ were observed before and after treatment. The incidence of liver injury, thrombocytopenia, myelosuppression, nausea and vomiting, diarrhea were observed. Results Before treatment, there were no statistically significant differences in IL -1 ,TNF -α, IL - 6, IL - 10, CD3+, CD4+, CD8+, CD4+/CD8+ between the two groups(all P > 0. 05). At 9 months after treatment, the levels of IL - 1, TNF -α, IL - 6 and IL - 10 in the control group were (10. 94 ± 1.31) ng/L,(3. 03 ± 0. 49) ng/L,( 183. 43 ± 13. 24) ng/L,( 134. 93 ± 34. 51) ng/L, respectively, which in the observation group were (6. 89 ± 1.29) ng/L,(2. 49 ± 0. 45 ) ng/L,( 129. 48 ± 10. 74) ng/L,(189. 35 ± 43. 27 ) ng/L,respectively, the differences between the two groups were statistically significant(t= 12. 195 , 11.214,8.414,11. 291, all P < 0. 05 ). The CD3+, CD4+, CD8+, CD4+/CD8+ in the control group were (47. 61 ± 7. 16)%,( 15. 49 ±6. 64)%,(20. 58 ±5. 61 )%,(0. 79 ±0. 19),respectively,which in the observation group were (65.46 ± 8.31)%,( 30. 23 ± 7. 85 )%,( 34. 59 ± 7. 41)%,( 0. 87 ± 0. 24), respectively, the differences between the two groups were statistically significant(i = 10.497 ,7. 865,12. 128,10. 291 ,all P <0. 05). There were no statistically significant differences in the incidence of liver function impairment, thrombocytopenia, myelosuppression, nausea and vomiting, and diarrhea between the two groups( all P>0. 05). Conclusion Linezolid in the treatment of severe tuberculosis can reduce the level of inflammatory factors, improve the cellular immune level of patients, and has a lower incidence of adverse effects.