纯中药治疗对难治性广泛耐药肺结核患者细胞免疫状态的改善作用研究

Effect of Chinese Medicine Treatment on Improving Cellular Immune Status of Patients with Refractory Extensive-drug-resistant Tuberculosis

【目的】研究益肺通络方纯中药治疗对难治性的人类免疫缺陷病毒(HIV)阴性的广泛耐药肺结核(XDR-PTB)患者细胞免疫功能改善的影响。【方法】选择29例HIV阴性的无法组成有效抗结核化疗方案的XDR-PTB患者,给予益肺通络方颗粒剂纯中药治疗12个月。观察不同临床特征[性别、年龄和体质量指数(BMI)]患者的基础CD4+及CD8+淋巴细胞数以及治疗前后CD4+及CD8+淋巴细胞数变化情况,比较不同治疗结局患者的细胞免疫功能好转率。【结果】(1)不同性别、年龄的难治性XDR-PTB患者的基础CD4+及CD8+淋巴细胞数比较,差异均无统计学意义(P>0.05);而BMI<18.5 kg/m2的难治性XDR-PTB患者的基础CD4+及CD8+淋巴细胞数均低于BMI≥18.5 kg/m2患者,其中以CD8+淋巴细胞数降低更明显,差异有统计学意义(P<0.05)。(2)经纯中药治疗12个月后,患者的CD4+、CD8+淋巴细胞数均较治疗前明显提高,差异均有统计学意义(P<0.05或P<0.01)。(3)治疗结局:29例患者中,CD4+淋巴细胞数增加者21例(占72.4%),CD8+淋巴细胞数增加者20例(占69.0%),免疫功能好转者(CD8+和CD4+淋巴细胞数均增加)17例(占58.6%);痰菌阴转者8例(占27.6%),肺部病灶好转者16例(占55.2%),临床症状好转者25例(占86.2%),综合治疗结局好转者6例(占20.7%)。(4)综合治疗结局好转患者的免疫功能好转率为100.0%(6/6),明显高于综合治疗结局未好转患者的47.8%(11/23),差异有统计学意义(P<0.05),表明细胞免疫功能的改善与XDR-PTB患者的治疗结局呈正相关。【结论】益肺通络方纯中药治疗能有效改善难治性XDR-PTB患者的细胞免疫状态并有助于改善临床治疗结局,为临床治疗难治性XDR-PTB提供了新方法和新思路。

Objective To investigate the clinical effect of Chinese medicine Yifei Tongluo Granules on improving the cellular immunity of the patients with human immunodeficiency virus(HIV)-negative and refractory extensive-drug-resistant pulmonary tuberculosis(XDR-PTB). Methods Twenty-nine HIV-negative patients with refractory XDR-PTB who could not accept an effective anti-tuberculosis chemotherapy were treated only with Chinese medicine Yifei Tongluo Granules for 12 months. The basal CD4+and CD8+lymphocyte counts,and the pre-and post-treatment CD4+and CD8+lymphocyte counts in the refractory XDR-PTB patients with various clinical features of gender,age and body mass index(BMI)were detected. And the improvement rate of cellular immune function in patients with different treatment outcomes was compared after treatment. Results(1)The difference of the number of basal CD4+and CD8+lymphocytes in refractory XDR-PTB patients with various gender and age was not statistically significant(P>0.05),but the basal CD4+and CD8+lymphocyte counts in the refractory XDR-PTB patients with BMI<18.5 kg/m2 were lower than the patients with BMI ≥ 18.5 kg/m2,and the decrease of CD8+ lymphocyte count was particularly obvious,the difference being statistically different(P<0.05).(2)After 12 months of Chinese medicine treatment,the number of CD4+and CD8+lymphocytes was much increased in comparison with that before treatment,the difference being statistically significant(P<0.05 or P<0.01).(3)Of the 29 cases,21 cases(accounting for 72.4%)had the increased CD4+lymphocyte count,20 cases(accounting for 69.0%)had the increased CD8+lymphocyte count,17 cases(accounting for 58.6%)achieved the improvement of the cellular immune function, 8 cases(accounting for 27.6%) achieved the sputum negative conversion, 16 cases(accounting for 55.2%)achieved the relief of the lung foci,25 cases(86.2%)achieved the relief of the clinical symptoms, and 6 cases(accounting for 20.7%) achieved the improvement of the comprehensive treatment outcomes.(4)The improvement rate of cellular immune function in patients with the improved comprehensive treatment outcomes arrived 100.0%(6/6), which was much higher than the patients the non-improved comprehensive treatment outcomes(47.8%, 11/23), and the differences were statistically significant(P <0.05),indicating that the improvement of cellular immune function was positively correlated with the treatment outcomes in refractory XDR-PTB patients. Conclusion The treatment of Chinese medicine can effectively improve the cellular immune status of patients with refractory XDR-PTB and is helpful for improving the outcomes of the clinical treatment. The results will provide new methods and new ideas for the clinical treatment of refractory XDR-PTB.