母牛分枝杆菌菌苗辅助治疗初治菌阳肺结核的临床分析

The clinic analysis on the effect of Mycobacterium vaccae vaccine to treatment outcome of new bacteriological positive pulmonary tu berculosis cases

目的 观察和评价母牛分枝杆菌菌苗 (微卡菌苗)在初治菌阳肺结核治疗中的作用。方法 采用随机配对分组法 ,分微卡菌苗治疗组 (A组 ,84例 )和对照组 (B组 ,84例 )。 2组化疗方案均为2HRZE 4HR ,A组加用微卡菌苗治疗 2月 ,B组不用微卡菌苗。结果 A组第 1月涂片阴转率36 .9% ,培养阴转率 47.6 % ;第 2月涂片阴转率 79.8% ,培养阴转率 85 .7%。B组第 1月涂片阴转率1 9.0 % ,培养阴转率 1 7.9% ;第 2月涂片阴转率 53 .8% ,培养阴转率 67.9%。前 2月痰菌阴转率A组显著高于B组 (P <0 .0 1 )。疗程满 6个月后A组涂片阴转率 98.8% ,培养阴转率 97.6% ;B组涂片阴转率 96 .4% ,培养阴转率 97.6 %。A组和B组治疗 6个月痰菌阴转率无显著性差异 (P >0 .0 5)。病灶吸收好转及空洞缩小关闭速度 ,A组优于B组。A组的细胞免疫功能显著改善。随访A组和B组的细菌学复发率分别为 1 .3 %和 2 .6 % (P >0 .0 5)。结论 微卡菌苗能改善初治菌阳肺结核患者的细胞免疫功能 ,加快痰菌阴转、病灶吸收及空洞缩小关闭的速度 ,不良反应少且轻微。

Objective To evaluate the effect and safety of M ycobacterium vaccae vaccine (M.vaccae vaccine) to treatment outcome of new pulmona ry tuberculosis cases.Methods 168 new bacteriological positive pulmonary tuberculosis cases were divided into immunotherapy (A,84 cases)group a nd control (B,84 cases) group randomly.The cases in two groups were treated by t he same chemotherapy regimen of 2HRZE/4HR.The group A were treated immunotherapy with M.vaccae vaccine for 2 months.There was no immonotherapy with M.vac cae in group B.Results The sputum smear negative conversion rates i n group A 1,2 and 6 months after treatment were 36.9%, 79.8% and 97.6% respec tively;those in group B were 19.0%,53.8% and 96.4% respectively.The sputum cult ure-negative conversion rates in group A the end of 1,2 and 6 months treatment were 47.6%,85.7% and 98.8% respectively;those in group B were 17.9% ,67.9% an d 97.6% respectively.The sputum negative conversion rates of group A were signi ficantly higher than those of group B after 1 and 2 months treatment(P<0.01 ).But there were no statistically significant differences between the two group s at the end of 6 months after treatment (P>0.05).Compared with group B,t he effect on improving of X ray manifestation in group A were better (P<0 .01).The side effects of M.vaccae vaccine were rare and slight.The bacterio logical relapse rates in group A,B were 1.3%,2.6% respectively(P>0.05). Conclusion M.vaccae vaccine is helpful on speeding negative c onversion,improving of X ray monifestation for new bacteriological positive pul monary tuberculosis.