百合固金汤合秦艽鳖甲散加减治疗阴虚火旺型肺结核疗效及对免疫功能的影响

Clinical Observation on the Therapeutic Effect of Therapy of Modified Baihe Gujin Tang Combined with Qinjiao Biejia Powder for Hyperactivity of fire due to Yin Deficiency Pulmonary Tuberculosis and Its Effect on Immune Function

目的:探讨百合固金汤联合秦艽鳖甲散加减治疗初治肺结核(阴虚火旺证)的临床疗效以及对免疫功能的影响。方法:选取本院2017年1月至2017年5月收治的确诊为肺结核且辨证分型为阴虚火旺证的60例病患作为研究对象,按随机数字表法分为治疗组与对照组,每组30例。对照组给予常规的抗痨治疗,治疗组患者在常规抗痨治疗的基础上加用百合固金汤联合秦艽鳖甲散加减治疗,2组患者的疗程均为6个月。疗程结束后比较分析2组患者治疗后3个月、6个月痰结核菌的转阴率、胸部CT检查结果;治疗前后中医证候积分及免疫功能相关指标变化情况;治疗后临床总有效率及不良反应发生率。结果:治疗组患者治疗3个月、6个月痰结核菌转阴率以及胸部CT检查好转率均显著高于对照组(P <0.05)。与治疗前比较,治疗后治疗组与对照组患者中医证候评分变化均显著下降(P <0.05),且对照组显著低于治疗组(P <0.05)。与治疗前比较,2组患者CD3+、CD4+淋巴细胞及CD4+/CD8+比值均显著升高,CD8+显著降低(P <0.05),与对照组比较,治疗组患者CD3+、CD4+及CD4+/CD8+均显著升高,CD8+显著降低(P <0.05)。对照组与治疗组患者治疗后临床总有效率分别为73.3%和93.3%,2组比较,差异有统计学意义(P <0.05)。对照组和治疗组治疗6个月不良反应的发生率分别为90.0%和63.3%,2组比较,差异有统计学意义(P <0.05)。结论:百合固金汤联合秦艽鳖甲散加减治疗肺结核(阴虚火旺证)能够有效缓解患者的临床症状,提高病原菌的清除率,改善机体的免疫功能,降低不良反应的发生率。

Objective: To explore the clinical therapeutic effect of the therapy of modified Baihe Gujin Tang combined with Qinjiao Biejia powder for initially-treated pulmonary tuberculosis with syndrome of hyperactivity of fire due to yin deficiency and its effect on the immune function. Methods: The study was conducted on 60 patients diagnosed with tuberculosis differentiated into the syndrome of hyperactivity of fire due to yin deficiency who were admitted into our hospital from January2017 to May 2017. The patients were divided into the treatment group and the control group according to the random number table method,with 30 cases in each group. The control group received conventional anti-tuberculosis treatment,and the treatment group was additionally treated with modified Baihe Gujin Tang combined with Qinjiao Biejia powder based on the treatment of the control group. Both groups were treated for six months. After treatment, the negative conversion rate of sputum tubercle bacillus and the result of CT examination on chest after 3 months and 6 months of treatment, changes in Chinese medicine syndrome scores and immune function-related indexes before and after treatment,as well as the total effective rate and the incidence of adverse reactions after treatment were compared and analyzed. Results: The negative conversion rate of sputum tubercle bacillus and the improvement rate of CT examination on chest after 3 months and 6 months of treatment in the treatment group were significantly higher than those in the control group(P < 0.05). Compared with those before treatment, Chinese medicine syndrome scores in both the treatment group and the control group after treatment were significantly decreased(P < 0.05), and that in the control group was significantly lower than that in the treatment group(P < 0.05). Compared with those before treatment, levels of CD3^+ and CD4^+ as well as CD4^+/CD8^+ in the two groups were significantly increased,and the level of CD8^+ was significantly decreased(P< 0.05). Compared with those in the control group,levels of CD3^+ and CD4^+ as well as CD4^+/CD8^+ in the treatment group were significantly increased, and the level of CD8^+ was significantly decreased(P< 0.05). The total effective rates in the control group and the treatment group were 73.3% and 93.3%respectively, the difference being significant(P < 0.05). The incidence of adverse reactions was 90.0% in the control group and63.3% in the treatment group after 6 months of treatment, the difference being significant(P < 0.05). Conclusion: The therapy of modified Baihe Gujin Tang combined with Qinjiao Biejia powder for pulmonary tuberculosis with syndrome of hyperactivity of fire due to yin deficiency can effectively alleviate the clinical symptoms of patients, improve the clearance rate of pathogenic bacteria, improve the immune function of body and reduce the incidence of adverse reactions.