母牛分枝杆菌菌苗联合化疗对肺结核患儿的疗效及免疫功能的影响

摘要

目的：探讨母牛分枝杆菌菌苗联合化疗对肺结核患儿的疗效以及对患儿免疫功能的影响。方法选取2010年12月至2013年12月在新乡医学院第一附属医院、卫辉市人民医院和卫辉市第三人民医院等三家医院接受治疗的89例肺结核患者，随机分为对照组和观察组。对照组予常规抗结核化疗，观察组在化疗基础上联合母牛分枝杆菌菌苗治疗。2组患儿于治疗前、后抽取外周静脉血，采用流式检测外周血CD4＋、CD8＋、CD16＋CD56＋细胞比例以及CD4＋/CD8＋比值，采用ELISA法检测外周血血清TNF-α和IL-10的水平。取2组患儿每人3份痰标本（夜间痰、清晨痰和即时痰）进行涂片统计2组患儿治疗后结核菌阴转率。结果治疗前，2组患儿各项指标差异比较不具统计学意义。治疗后，观察组组外周血CD4＋T淋巴细胞、CD16＋CD56＋细胞比例以及CD4＋/CD8＋比值显著高于治疗前和对照组治疗后（P＜0.05），2组患儿CD8＋T淋巴细胞细胞比例均较治疗前显著下降（P＜0.05），组间差异不具统计学意义；治疗后，观察组外周血血清TNF-α和IL-10的水平较治疗前下降且明显高于对照组（P＜0.05）。疗程结束后，对照组40例患儿涂片呈阴性，阴转率为90.9％，观察组45例患儿涂片呈阴性，阴转率为100％，2组患儿阴转率差异比较具有统计学意义（P＜0.05）。结论母牛分枝杆菌菌苗联合化疗对肺结核患儿具有显著疗效，能够显著改善患儿免疫功能。%Objective To investigate the effect of Mycobacterium vaccae vaccine combined with chemotherapy on immune function in treatment of children with pulmonary tuberculosis.Methods 89 cases with pulmonary tuberculosis from December 2010 to December 2013 treated in three hospitals in xinxiang city were randomly divided into control group and observation group.The control group was given regular chemotherapy,the observation group was given chemotherapy combined with Mycobacterium vaccae vaccine therapy.CD4 +,CD8 +,CD8 +/CD4 +and CD16 +CD56 +in peripheral blood were evaluated by FCM before and after treatment.Serum TNF- αand IL-10 levels were detected by the method of ELISA.Taking 3 sputum samples (night sputum,morning sputum and sputum at moment)of each patient to smear after treatment.Results Before treatment,there was no significant difference of each index between two groups.After treatment,CD4 +,CD4 +/CD8 +and CD16 +CD56 +in the observation group were significantly higher than that before treatment and the control group(P<0.05).The proportion of CD8 +in two groups was significantly lower than before treatment(P<0.05),the difference between groups was not statistically significant.Serum TNF- αand IL-10 levels decreased significantly in two groups than those before treatment and the control group(P<0.05).After treatment,the negative conversion rate in the control group was 90.9%(n=40),while 100%(n=45)in the observation group.The difference between two groups was statistically significant(P<0.05).Conclusion Mycobacterium vaccae vaccine combined with chemotherapy has a significant effect on children with pulmonary tuberculosis.It could significantly improve the immune function of children.