还原型谷胱甘肽联合个体化抗结核化疗方案治疗耐多药肺结核的疗效观察

Observation of the efficacy of reduced glutathione combined with individualized antituberculosischemotherapy regimen in the treatment of MDR-PTB

目的探讨还原型谷胱甘肽联合个体化抗结核化疗方案治疗耐多药肺结核(MDR-PTB)的疗效。方法选取80例MDR-PTB患者,随机均分为化疗组(抗结核化疗)和联合组(抗结核化疗+还原型谷胱甘肽)。比较两组疗效、肝功能指标、CD4^(+)/CD8^(+)、CD4^(+)CD25^(+)、CD4^(+)PD-1^(+)、CD8^(+)CD28^(-)、CD8^(+)PD-1^(+)比值、血清C反应蛋白(CRP)、白细胞介素-6(IL-6)和γ干扰素(IFN-γ)等。结果治疗后,两组治疗总有效率比较差异无显著性(P>0.05)。治疗后,联合组血清白蛋白水平高于化疗组,总胆红素、谷草转氨酶、谷丙转氨酶、碱性磷酸酶、高密度脂蛋白胆固醇水平均低于化疗组(P<0.05)。与治疗前比较,两组治疗后CD4^(+)/CD8^(+)比值、IFN-γ升高,CD4^(+)CD25^(+)、CD4^(+)PD-1^(+)、CD8^(+)CD28^(-)、CD8^(+)PD-1^(+)比值、CRP、IL-6降低;且治疗后联合组较化疗组变化更显著(P<0.05)。结论还原型谷胱甘肽联合个体化抗结核化疗方案治疗耐多药肺结核有效,且可解除患者免疫耐受,抑制炎症反应,规避化疗后肝损伤,可在临床上应用和推广。

Aim To explore the efficacy of reduced glutathione combined with individualized anti-tuberculosis chemotherapy in the treatment of multidrug-resistant pulmonary tuberculosis(MDR-PTB).Methods 80 MDR-PTB patients were selected and randomly divided into a chemotherapy group(anti-tuberculosis chemotherapy)and a combination group(anti-tuberculosis chemotherapy+reduced glutathione).The efficacy,liver function indicators,CD4^(+)/CD8^(+),propertion of CD4^(+)CD25^(+),CD4^(+)PD-1^(+),CD8^(+)CD28^(-),CD8^(+)PD-1^(+),serum C-reactive protein(CRP),interleukin-6(IL-6),γInterferon(IFN-γ)and related indicatorswere compared.Results After treatment,there was no significant difference in the total effective rate between the two groups(P>0.05).After treatment,the serum albumin level in the combination group was higher than that in the chemotherapy group,while total bilirubin,glutathione aminotransferase,alanine aminotransferase,alkaline phosphatase,and high-density lipoprotein cholesterol were all lower than those in the chemotherapy group(P<0.05).After treatment,the CD4^(+)/CD8^(+)ratio and IFN-γof the two groups were elevated,and CD4^(+)CD25^(+),CD4^(+)PD-1^(+),CD8^(+)CD28^(-),CD8^(+)PD-1^(+)proportion,CRP,IL-6 were decreased.After treatment,the combination group showed more significant changes compared with the chemotherapy group(P<0.05).Conclusion The combination of reduced glutathione and individualized anti-tuberculosis chemotherapy regimen is effective in treating multidrug-resistant pulmonary tuberculosis,and can relieve patients immune tolerance,suppress inflammatory reactions,and avoid liver damage after chemotherapy.It can be applied and promoted in clinical practice.