养阴祛瘀方辅助治疗对肺结核患者血清血管内皮生长因子、血清干扰素-γ水平及免疫功能的影响

Effects of Yangyin Quyu Formula on Serum VEGF and IFN-γ Levels and Immune Function in Patients with Pulmonary Tuberculosis

目的 探讨养阴祛瘀方辅助治疗对肺结核患者血清血管内皮生长因子(Vascular Endothlial Growth Factor, VEGF)、血清干扰素-γ(Interferon-γ,IFN-γ)水平及免疫功能的影响。方法 选取2019年6月1日—2020年5月31日陕西省结核病防治院收治的肺结核患者100例,采用随机数字表法将肺结核患者分为对照组和观察组,每组各50例。对照组患者采用2EHRZ/4HR标准化疗方案治疗,观察组在对照组的基础上采用养阴祛瘀方治疗。治疗6个月后,观察比较两组患者临床疗效、痰转阴、病灶转归及不良反应发生情况,治疗前及治疗6个月后中医证候积分、血清VEGF、IFN-γ水平及免疫功能指标的变化。结果 治疗后观察组总有效率92.00%(46/50)高于对照组76.00%(38/50),差异有统计学意义(P<0.05)。治疗6个月后,两组患者痰菌转阴率、病灶吸收率均较治疗3个月升高,差异有统计学意义(P<0.05);且观察组治疗3、6个月后痰菌转阴率、病灶吸收率均较对照组明显升高,差异有统计学意义(P<0.05)。治疗后两组患者中医证候积分均较治疗前降低,差异有统计学意义(P<0.05);且观察组中医证候积分较对照组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者血清VEGF水平均较治疗前降低,IFN-γ水平均较治疗前升高,差异有统计学意义(P<0.05);且观察组血清VEGF水平较对照组降低,IFN-γ水平较对照组升高,差异有统计学意义(P<0.05)。治疗后两组患者CD4^(+)、CD4^(+)/CD8^(+)指标均较治疗前升高,CD8^(+)指标均较治疗前降低,差异有统计学意义(P<0.05);且观察组CD4^(+)、CD4^(+)/CD8^(+)指标均较对照组升高,CD8^(+)指标较对照组降低,差异有统计学意义(P<0.05)。治疗期间,观察组消化道反应、骨髓抑制及肝损害发生率(40.00%、2.00%、4.00%)明显低于对照组(82.00%、18.00%、28.00%),差异有统计学意义(P<0.05)。结论 养阴祛瘀方辅助治疗肺结核具有良好的疗效,能明显改善患者临床症状及病情转归,增强免疫功能,减轻炎症反应及化疗毒副作用,值得临床推广使用。

Objective To investigate the effects of Yangyin Quyu Formula on serum vascular endothelial growth factor(VEGF)and interferon-γ(IFN-γ)levels and immune function in patients with pulmonary tuberculosis.Methods A total of 100 patients of pulmonary tuberculosis admitted to Shaanxi Provincial Hospital for Tuberculosis from June 1,2019,to May 31,2020,were selected and divided into a control group(n=50)and an observation group(n=50)by the random number table.All patients were treated following the 2EHRZ/4HR standard chemotherapy regimen, while those in the observation group received additional Yangyin Quyu Formula.After six months of treatment, the clinical efficacy, sputum negative conversion rate, lesion outcomes, and incidence of adverse reactions were compared between the two groups.The changes in traditional Chinese medicine(TCM)syndrome scores, serum VEGF and IFN-γ levels, and immunefunction indexes were observed and compared between the two groups before and six months after treatment.Results After treatment, the total effective rate of the observation group was 92.00%(46/50),higher than 76.00%(38/50)of the control group(P<0.05).After six months of treatment, the sputum negative conversion rate and lesion absorption rate of the two groups were higher than those after three months of treatment(P<0.05).After three and six months of treatment, the sputum negative conversion rate and the lesion absorption rate in the observation group were higher than those in the control group(P<0.05).After treatment, the scores of TCM syndromes in the two groups were lower than those before treatment(P<0.05),and the observation group was lower than the control group(P<0.05).In both groups after treatment, the serum VEGF level was lower and the IFN-γ level was higher than those before treatment(P<0.05).Besides, compared with the control group, the observation group showed decreased serum VEGF level and increased IFN-γ level(P<0.05).After treatment, the indexes CD4^(+)and CD4^(+)/CD8^(+)in both groups were higher than those before treatment, and the index CD8^(+)was lower than that before treatment(P<0.05).In addition, CD4^(+)and CD4^(+)/CD8^(+)in the observation group were higher than those in the control group, and CD8^(+)was lower than that in the control group(P<0.05).In the treatment period, the incidence of digestive tract reaction, bone marrow suppression, and liver damage in the observation group(40.00%,2.00%,and 4.00% respectively)was significantly lower than that in the control group(82.00%,18.00%,and 28.00% respectively)(P<0.05).Conclusion Yangyin Quyu Formulain the adjuvant treatment of pulmonary tuberculosis has good efficacy.It can significantly reduce patients′ clinical symptoms and promote disease outcomes, enhance immune function, and reduce inflammation and the toxic and side effects of chemotherapy, which is worthy of clinical application.