利奈唑胺联合HRZE抗结核方案治疗肺结核的疗效及对T淋巴细胞亚群水平的影响

Linezolid combined with HRZE antituberculosis regimen in treatment of pulmonary tuberculosis and its effect T lymphocyte subsets

目的探讨利奈唑胺联合HRZE(异烟肼、利福平、吡嗪酰胺、乙胺丁醇)抗结核方案治疗肺结核患者的价值。方法选取滨州市中心医院2021年5月至2022年11月收治的肺结核患者80例进行随机对照试验,随机数字表法将其分为研究组和对照组,各40例。研究组男22例、女18例,年龄30~65(45.68±4.15)岁。对照组男24例、女16例,年龄32~63(45.50±4.20)岁。研究组采用利奈唑胺联合HRZE抗结核方案治疗,对照组采用HRZE抗结核方案治疗。对比两组治疗前后T淋巴细胞亚群水平、临床指标(病灶吸收缩小时间、空洞闭合时间、痰培养转阴时间)、实验室指标[干扰素-γ(INF-γ)、白细胞介素-6(IL-6)、转化生长因子-β(TGF-β)]、临床疗效及不良反应。采用χ^(2)检验和t检验。结果治疗前,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)对比,差异均无统计学意义(均P>0.05);治疗后,研究组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)为(55.16±5.46)%、(39.64±4.55)%、(1.87±0.40),均高于对照组的(50.41±5.11)%、(33.26±4.12)%、(1.55±0.39)(均P<0.05)。研究组病灶吸收缩小时间、空洞闭合时间、痰培养转阴时间为(42.55±5.68)d、(89.65±6.38)d、(45.22±5.41)d,均短于对照组的(56.36±7.10)d、(116.20±8.12)d、(52.02±5.69)d(均P<0.05)。治疗前,两组INF-γ、IL-6、TGF-β水平对比,差异均无统计学意义(均P>0.05);治疗后,研究组INF-γ水平高于对照组[(40.13±5.22)ng/L比(31.05±4.68)ng/L],IL-6、TGF-β水平均低于对照组[(25.16±2.24)ng/L比(33.20±2.66)ng/L、(33.16±4.14)μg/L比(45.25±5.31)μg/L](均P<0.05)。研究组总有效率高于对照组[95.00%(38/40)比77.50%(31/40),P<0.05]。两组不良反应发生率对比,差异无统计学意义(P>0.05)。结论利奈唑胺联合HRZE抗结核方案治疗肺结核具有较好的效果及安全性,能够改善患者T淋巴细胞亚群水平,降低炎性水平,优化临床指标,临床价值较高。

Objective To investigate the value of linezolid combined with HRZE(isoniazide,rifampicin,pyrazinamide,and ethambutol)antituberculosis regimen in the treatment of pulmonary tuberculosis.Methods Eighty patients with pulmonary tuberculosis admitted to Binzhou Central Hospital from May 2021 to November 2022 were selected for the randomized controlled trial.They were divided into a study group and a control group by the random number table method,with 40 cases in each group.There were 22 males and 18 females in the study group;they were 30-65(45.68±4.15)years old.There were 24 males and 16 females in the control group;they were 32-63(45.50±4.20)years old.The study group were treated with linezolid and HRZE antituberculosis regimen,and the control group with HRZE antituberculosis regimen.The T lymphocyte subsets,clinical indicators(absorption reduction time,cavity closure time,and sputum culture negative time),and laboratory indicators[interferon-γ,interleukin-6(IL-6),and transforming growth factor-β(TGF-β)]before and after the treatment,clinical efficacies,and adverse reactions were compared between the two groups.χ^(2) and t tests were applied.Results Before the treatment,there were no statistical differences in CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)between the two groups(all P>0.05);after the treatment,the CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the study group were higher than those in the control group[(55.16±5.46)%vs.(50.41±5.11)%,(39.64±4.55)%vs.(33.26±4.12)%,and(1.87±0.40)vs.(1.55±0.39);all P<0.05].The absorption reduction time,cavity closure time,and sputum culture negative time in the study group were shorter than those in the control group[(42.55±5.68)d vs.(56.36±7.10)d,(89.65±6.38)d vs.(116.20±8.12)d,and(45.22±5.41)d vs.(52.02±5.69)d;all P<0.05].Before the treatment,there were no statistical differences in the levels of interferon-γ,IL-6,and TGF-βbetween the two groups(all P>0.05);after the treatment,the INF-γlevel was higher and the levels of IL-6 and TGF-βwere lower in the study group than in the control group[(40.13±5.22)ng/L vs.(31.05±4.68)ng/L,(25.16±2.24)ng/L vs.(33.20±2.66)ng/L,and(33.16±4.14)μg/L vs.(45.25±5.31)μg/L;all P<0.05].The total effective rate of the study group was higher than that of the control group[95.00%(38/40)vs.77.50%(31/40);P<0.05].There was no statistical difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Linezolid combined with HRZE antituberculosis regimen in the treatment of pulmonary tuberculosis is effective and safe and can improve the patients'levels of T lymphocyte subsets,reduce inflammation,and optimize clinical indicators,so it has high clinical value.