强化营养支持辅助胸腺五肽治疗复治涂阳重症肺结核患者的近期疗效和对炎性细胞因子及免疫功能的影响

The combined therapeutic effect and the status of inflammatory factors and immunity of nutritional therapy and thymopentin in 88 patients with sputum smear-positive tuberculosis

目的探讨强化营养支持辅助胸腺五肽治疗复治涂阳重症肺结核的临床疗效以及免疫相关指标变化。方法回顾性研究从2014年12月到2017年12月于同济大学附属上海第十人民医院收治的88例复治涂阳重症肺结核患者按不同治疗方法分为三组,包括常规治疗组(n=34)、胸腺五肽治疗组(n=27)和营养支持辅助胸腺五肽治疗组(联合组)(n=27),治疗时间均为2个月。观察三组患者临床疗效、血清炎症因子水平以及免疫功能等指标。结果转阴率情况,联合组[治愈率(88.89%)、完成治疗率(92.59%)]和胸腺五肽治疗组[治愈率(66.67%)、完成治疗率(77.78%)]均显著高于常规治疗组[治愈率(35.29%)、完成治疗率(47.06%)](P<0.05),联合组结核空洞治愈情况显著高于常规治疗组与胸腺五肽治疗组(P<0.05)。同时联合组血清炎症因子TNF-α、IL-6、IL-8水平均显著低于另外两组(P<0.05)。此外,三组患者治疗前后免疫功能包括体重指数、红细胞总数、淋巴细胞总数、血清白蛋白水平、以及免疫五项等指标结果显示,联合组均显著高于其他两组(P<0.05)。结论营养支持与胸腺五肽联合辅助治疗复治涂阳重症肺结核较常规治疗和单纯胸腺五肽治疗的疗效均佳,值得推广。

Objective To explore the therapeutic effect and immune associated indexes of patients with possitive sputum smear of tuberculosis by nutritional therapy and thymopentin treatment.Methods This retrospective study of 88 patients with sputum smear-positive tuberculosis in this hospital during December 2014 to December 2017 were divided into three groups by therapeutic methods,normal group(n=34),thymopentin group(n=27)and combined nutritional therapy with thymopentin treatment group(n=27)respectively.Patients in each groups were treated for two months and the therapeutic effect and indexes of inflammatory factors and immunity were compared.Results Sputum negative conversion rate including cure rate and completion rate of treatment in combined group(88.89%and 92.59%)and thymopentin group(66.67%and 77.78%)were higher than those of normal group(35.29%and 47.06%).The status of closed cavity in combination group is much higher than other two groups(P<0.05).Meanwhile,the serum inflammatory factors such as TNF-α,IL-6 and IL-8 in combination group is lower than other two groups(P<0.05).Finally the health condition of patients is best in combined group compared to other two groups(P<0.05).Conclusion The combined nutritional therapy and thymopentin treatment is superior in exclusive treatment for patients with sputum smear-positive tuberculosis and deserves spreading.