自拟补肺抗痨方合地黄饮子加减联合隔蒜灸及标准抗结核方案治疗耐多药肺结核阴阳两虚证的临床研究

Clinical study on the treatment of multi-drug resistant pulmonary tuberculosis syndrome of Yin and Yang deficiency syndrome by Bufei-antituberculosis prescription combined with Dihuang Yinzi plus reduction combined with garlic moxibustion and standard anti-tuberculosis regimen

目的:探讨自拟补肺抗痨方合地黄饮子加减联合隔蒜灸及标准抗结核方案治疗耐多药肺结核(MDR-PTB)阴阳两虚证的临床疗效。方法:选择我院2021年1月~2023年1月收治的124例MDR-PTB阴阳两虚证患者作为研究对象,按随机数字表法分为观察组和对照组各62例。对照组采用标准抗结核方案[6Lfx(Mfx)-Bdq(Lzd)-Cfz-Cs-Z(E,Pto)/12~14Lfx(Mfx)-Cfz-Cs-Z(E,Pto);Lfx:左氧氟沙星,Mfx:莫西沙星,Bdq:贝达喹啉,Lzd:利奈唑胺,Cfz:氯法齐明,Cs:环丝氨酸,Z:吡嗪酰胺,E:乙胺丁醇,Pto:丙硫异烟胺]治疗,观察组在对照组基础上联合采用自拟补肺抗痨方合地黄饮子加减及隔蒜灸治疗,连续治疗12周后对两组疗效进行评价。比较两组治疗前后中医证候积分以及治疗后痰菌转阴率、病灶吸收率、空洞缩小率。治疗前后检测患者血清炎症标志物[可溶性髓系细胞触发受体~1(sTREM-1)、基质金属蛋白酶-9(MMP-9)、白细胞介素-18(IL-18)]和外周血细胞免疫功能指标[CD3^(+)T细胞、CD4^(+)T细胞、CD8^(+)T细胞百分比以及CD4^(+)/CD8^(+)比值]。统计两组不良反应情况。结果:观察组总有效率为93.55%,与对照组的75.81%相比显著升高(P<0.05)。治疗后,两组形寒肢冷、盗汗、自汗、潮热、面浮肢肿、咳逆喘促少气积分均较治疗前显著降低(P<0.05),均以观察组为著(P<0.05)。治疗12周后,观察组痰菌转阴率、病灶吸收率、空洞缩小率分别为53.23%、64.52%、59.68%,较对照组(35.48%、45.16%、40.32%)均有明显升高(P<0.05)。治疗后,观察组血清sTREM-1、MMP-9、IL-18水平和外周血CD8^(+)水平均显著低于对照组(P<0.05),外周血CD3^(+)、CD4^(+)水平和CD4^(+)/CD8^(+)比值均显著高于对照组(P<0.05)。观察组不良反应发生率(33.87%)显著低于对照组(58.06%,P<0.05)。结论:自拟补肺抗痨方合地黄饮子加减联合隔蒜灸及标准抗结核方案治疗MDR-PTB阴阳两虚证能有效减轻患者机体内炎症反应,改善细胞免疫功能,促进痰菌转阴和病灶吸收,提高临床疗效。

Objective To investigate the clinical efficacy of Bufei anti-tuberculosis prescription combined with Dihuang Drink combined with garlic moxibustion and standard anti-tuberculosis regimen in the treatment of multidrug resistant pulmonary tuberculosis(MDR-PTB)with yin-yang deficiency syndrome.Methods 124MDR-PTB patients with Yin-yang deficiency syndrome admitted to our hospital from January 2021to January 2023were selected as the study objects,and were divided into observation group and control group with 62cases in each group according to random number table method.Control group was treated with standard anti-tuberculosis regimen[6Lfx(Mfx)-Bdq(Lzd)-Cfz-Cs-Z(E,Pto)/12~14Lfx(Mfx)-Cfz-Cs-Z(E,Pto);Lfx:Levofloxacin,Mfx:Moxifloxacin,Bdq:Bedaquinoline,Lzd:Linzolid,Cfz:Clofazimine,Cs:cycloserine,Z:pyrazinamide,E:ethambutol,Pto:propylthioisonicamide]treatment,observation group on the basis of the control group combined with the self-designed bufu antituberculosis prescription combined with Dihuang Drink and garlic moxibustion treatment,after continuous treatment for 12weeks to evaluate the efficacy of the two groups.TCM syndrome score before and after treatment,sputum negative conversion rate,lesion absorption rate and cavity shrinkage rate were compared between the two groups.Serum inflammatory markers[soluble myeloid cell trigger receptor-1(sTREM-1),matrix metalloproteinase-9(MMP-9),interleukin-18(IL-18)]and peripheral blood cell immune function indicators[percentage of CD3^(+)T cells,CD4^(+)T cells,CD8^(+)T cells,and CD4^(+)/CD]were detected before and after treatment 8^(+)ratio].The adverse reactions of the two groups were analyzed.Results The total effective rate of the observation group was 93.55%,which was significantly higher than that of the control group(75.81%,P<0.05).After treatment,the scores of cold limbs,night sweats,spontaneous sweats,hot flusher,floating face and swollen limbs,cough and counter-breathing and shortness of breath in two groups were significantly decreased compared with those before treatment(P<0.05),and the observation group was the only group(P<0.05).After 12weeks of treatment,the sputum negative conversion rate,focal absorption rate and cavity shrinkage rate in the observation group were 53.23%,64.52%and 59.68%,respectively,which were significantly higher than those in the control group(35.48%,45.16%and 40.32%)(P<0.05).After treatment,the levels of serum sTREM-1,MMP-9,IL-18and peripheral blood CD8^(+)in observation group were significantly lower than those in control group(P<0.05),and the levels of peripheral blood CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)ratio in observation group were significantly higher than those in control group(P<0.05).The incidence of adverse reactions in observation group(33.87%)was significantly lower than that in control group(58.06%,P<0.05).Conclusion The self-prepared Bufei-antituberculosis prescription combined with Dihuang Yinzi combined with garlic moxibustion and standard anti-tuberculosis regimen can effectively reduce the inflammation in the body,improve cellular immune function,promote sputum to negative and lesion absorption,and improve clinical efficacy.