草分枝杆菌联合利奈唑胺对耐多药肺结核患者临床疗效和肠道菌群的影响

Impacts of Mycobacterium phlei combined with Linezolid on clinical efficacy and gut microbiota of patients with multidrug-resistant pulmonary tuberculosis

目的探究草分枝杆菌联合利奈唑胺对耐多药肺结核(MDR-PTB)患者临床疗效及肠道菌群的影响,为该类患者的治疗提供参考。方法选取于2021年5月至2022年5月来我院进行MDR-PTB治疗的患者100例,按照随机数表法分为对照组(50例,常规治疗+利奈唑胺)和观察组(50例,常规治疗+利奈唑胺+草分枝杆菌),比较两组患者的免疫功能、实验室指标、肠道菌群、临床疗效、不良反应。结果治疗后两组患者IgM、IgG、CD4+细胞水平均升高,CD8+细胞水平均降低,且观察组患者指标变化幅度更显著(均P<0.05)。治疗后,两组患者可溶性细胞间黏附分子(sICAM-1)、前列腺素E2(PGE2)、超敏C反应蛋白(hs-CRP)水平均下降,且观察组下降幅度更显著(均P<0.05)。观察组患者肠道菌群Ace指数、Chao指数、Shannon指数水平和大肠埃希菌、瘤胃球菌、双歧杆菌数量均显著高于对照组,Simpson指数水平和肠球菌、链球菌、克雷伯菌数量均低于对照组(均P<0.05)。观察组患者临床总有效率显著高于对照组(98.00%vs 84.00%,P<0.05);而观察组不良反应发生率显著低于对照组(8.00%vs 26.00%,P<0.05)。结论草分枝杆菌联合利奈唑胺能够有效提高MDR-PTB患者的临床疗效,调节肠道菌群。

Objective To observe the impacts of Mycobacterium phlei combined with Linezolid on clinical efficacy and gut microbiota of patients with multidrug-resistant pulmonary tuberculosis(MDR-PTB),proviving a reference for the treatment.Methods A total of 100 patients who underwent MDR-PTB treatment in our hospital from May 2021 to May 2022 were randomly grouped into Control group(50 cases,conventional treatment+Linezolid)and Observation group(50 cases,conventional treatment+Linezolid+Mycobacterium phlei)randomly.The immune function,laboratory indicators,gut microbiota,clinical efficacy,and adverse reactions were compared between the two groups.Results After treatment,both groups showed an increase in IgM,IgG and CD4+cells,and a decrease in CD8+cells;the observation group showed a more obvious changes in the indicators(all P<0.05).After treatment,soluble intercellular adhesion molecule(sICAM-1),prostaglandin E2(PGE2),and hypersensitive C-reactive protein(hs-CRP)decreased in both groups,and the observation group showed a more obvious decrease(all P<0.05).In the observation group,the levels of Ace index,Chao index,Shannon index and the counts of Escherichia coli,Ruminococcus and Bifidobacterium were higher,while the Simpson index,Enterococcus,Streptococcus and Klebsiella were lower than those in control group,respectively(all P<0.05).The total clinical efficiency rate in observation group was higher than that in control group(98.00%vs 84.00%,P<0.05).The incidence of adverse reactions in observation group was obviously lower than that in control group(8.00%vs 26.00%,P<0.05).Conclusion The combination of Mycobacterium phlei and Linezolid can effectively improve the clinical efficacy and regulate gut microbiota in MDR-PTB patients.