注射用母牛分枝杆菌对初治涂阳肺结核伴尘肺患者免疫功能的影响

Effect of Mycobacterium bovis injection on immune function in patients with newly diagnosed smear positive pulmonary tuberculosis and pneumoconiosis

目的探讨注射用母牛分枝杆菌对初治涂阳肺结核伴尘肺患者免疫功能的影响。方法将100例初治涂阳肺结核伴尘肺患者均分为对照组和试验组,2组均采用2HRZE/4HR方案进行化疗,化疗2周后试验组加用注射用母牛分枝杆菌、对照组加用生理盐水溶液,均持续治疗6个月,随访1年;比较2组患者治疗6个月时的结核病灶治疗有效率、空洞闭合率、结核杆菌涂片转阴率,比较2组患者治疗前及治疗6个月时的血清白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)水平及全血CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平,比较2组患者治疗期间的不良反应发生率及随访1年后的复阳率。结果治疗6个月时,试验组结核病灶治疗有效率、空洞闭合率、涂片转阴率均高于对照组,差异有统计学意义(P<0.05);2组患者治疗6个月时的血清IL-10、TNF-α水平较治疗前降低,IFN-γ水平较治疗前升高,试验组变化更显著(P<0.05);试验组患者治疗6个月时的全血CD4^(+)、CD4^(+)/CD8^(+)较治疗前升高,全血CD8^(+)较治疗前降低,试验组变化更显著(P<0.05);随访1年,试验组复阳率低于对照组,差异有统计学意义(P<0.05);2组患者治疗期间的不良反应发生率比较,差异无统计学意义(P>0.05)。结论使用注射用母牛分枝杆菌治疗初治涂阳肺结核伴尘肺患者,可有效减轻患者炎症反应,提高患者免疫功能,有助于改善患者病灶及空洞情况,提高涂片转阴率及降低复阳率。

Objective To investigate the effect of mycobacterium bovis injection on immune function in newly diagnosed smear positive pulmonary tuberculosis patients with pneumoconiosis.Methods A total of 100 newly diagnosed smear positive pulmonary tuberculosis patients with pneumoconiosis was divided into control group and experimental group.Both groups received chemotherapy using the 2HRZE/4HR regimen.After 2 weeks of chemotherapy,the observation group received additional injection of mycobacterium bovis,while the control group received saline solution.Both groups continued treatment for 6 months and were followed up for 1 year;the treatment efficiency,cavity closure rate and negative converting rate of tuberculosis smear were compared between the two groups after 6 months of treatment.The levels of serum interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),and the levels of whole blood CD4^(+),CD8^(+),CD4^(+)/CD8^(+)were compared between the two groups before treatment and after 6 months of treatment.The incidence of adverse reactions during treatment and the rebound positivity rate after 1 year of follow-up were compared between the two groups.Results After 6 months of treatment,the effective rate,cavity closure rate and smear negative converting rate of tuberculosis lesion in the experimental group were higher than those of control group,differences were statistically significant(P<0.05);the serum IL-10 and TNF-αlevels of two groups after 6 months of treatment decreased compared to before treatment,while IFN-γlevels increased compared to before treatment.Changes in the experimental group were more significant(P<0.05).After 6 months of treatment,the levels of CD4^(+)and CD4^(+)/CD8^(+)in the whole blood of two groups increased compared to before treatment,while the levels of CD8^(+)in the whole blood decreased compared to before treatment.The changes in the experimental group were more significant(P<0.05).After one-year follow-up,the rebound positivity rate of the experimental group was lower than that of the control group,with a statistically significant difference(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups during treatment(P>0.05).Conclusion The use of mycobacterium bovis injection in the treatment of newly diagnosed smear positive pulmonary tuberculosis with pneumoconiosis can effectively reduce the patient's inflammatory response,improve patient's immune function,improve the patient's lesion and cavity condition,increase the smear negative conversion rate,and reduce the rate of rebound positivity.