支气管镜局部注射联合免疫治疗对耐药肺结核的临床疗效及机体免疫改善作用

The clinical effect of bronchoscope injection combined with immunotherapy on patients with drug resistance pulmonary tuberculosis and its role in immunological regulation

目的 :探究支气管镜局部注射联合免疫治疗对耐药肺结核的临床疗效及机体免疫改善作用。方法 :2012年10月~2014年10月收治的86例肺结核患者,根据个人意愿,经济状况,身体条件平均分为观察组及对照组,每组43例。比较两组患者痰菌转阴率、临床症状改善情况、炎症因子水平、细胞免疫以及体液免疫水平。结果:治疗后,观察组患者的痰菌转阴率为89.5%,显著高于对照组的65.63%;两组患者的临床症状均得到有效缓解,观察组患者的临床症状改善情况显著优于对照组;两组患者的CRP、IL-4水平显著降低,且观察组显著低于对照组;两组患者IFN-γ水平均明显增加,观察组显著高于对照组;观察组患者T淋巴细胞群CD4+、CD4+/CD8+水平显著升高,CD8+水平显著下降,对照组与治疗前相比无显著改善;观察组患者Ig A、Ig G均有轻微上升,但与治疗前相比无统计学差异;对照组患者Ig A、Ig G水平也无显著改善。结论 :与常规多药物联合方案相比,支气管镜下注射联合免疫治疗可显著提高耐药肺结核患者的临床疗效,积极改善患者机体免疫机能,增强抗结核能力,值得临床推广。

Objective To explore the clinical effect of bronchoscope injection combined with immunotherapy on patients with drug resistance pulmonary tuberculosis and its role in immunological regulation. Methods According to personal willing-ness, financial condition and physical condition, the 86 cases treated in our hospital from October, 2012 to October, 2014 were divided into the observation group and control group, with each group of 43 cases. The sputum negative conversion rate, clinical symptoms improved conditions, the level of inflammatory factors、cellular immunity, humoral immunity were compared in the two groups. Results After therapy, the sputum negative conversion rate of the observation group was 89.5%, and was signifi-cantly higher than that of control group; the clinical symptoms in both groups were relieved, and the clinical symptoms improved conditions in observation group were significantly better than the control group; the level of CRP, IL-4 of the both groups were significantly decreased, and those of the observation group were significantly lower than the control group; the level of IFN-γ of the both groups were significantly increased, and that of the observation group were significantly higher than the control group;compared with the level of CD4+ and CD4+/CD8+ of the observation group significantly increased, and CD8+ decreased appar-ently, whereas the level of t lymphocyte subpopulation in control group did not show marked improvement; the level of immune globulin in the observation group increased lightly, but in both groups the level of immune globulin showed no statistical dif-ference. Conclusion Compared with conventional chemotherapy, Bronchoscope injection combined with immunotherapy could effectively improve clinical effect of drug resistance pulmonary tuberculosis, and positively regulate immune function, which deserves clinical expansion.