抗结核药物联合滋阴利肺汤对老年复治涂阳肺结核患者血清炎症因子的影响及其临床意义

摘要

目的：探讨抗结核药物联合滋阴利肺汤对老年复治涂阳肺结核患者血清炎症因子的影响及其临床意义。方法复治涂阳老年肺结核患者60例，随机分为两组，治疗组30例给予抗结核药物联合滋阴利肺汤治疗；对照组30例单纯应用抗结核药物治疗。两组抗结核治疗方案相同，疗程均为6个月。于治疗前后分别检测患者血清白细胞介素-6（ IL-6）、白细胞介素-10（ IL-10）和肿瘤坏死因子-α（ TNF-α）水平，同时观察痰菌阴转率、肺部病灶的吸收显效率、临床症状完全消失及不良反应情况。结果两组治疗前血清IL-6、IL-10、TNF-α水平比较差异无统计学意义（ P＞0．05）。治疗后，两组IL-6、TNF-α水平均下降，且治疗组水平低于对照组（ P＜0．05）；IL-10水平均有升高，但治疗组水平高于对照组（ P＜0．05）；治疗后，两组血清IL-6、TNF-α水平均低于治疗前（P＜0．05），两组IL-10水平均高于治疗前（P＜0．05）。疗程结束后治疗组痰菌阴转率为96．6％，对照组为76．7％，两组比较差异有统计学意义（P＜0．05）。治疗结束后治疗组病灶吸收显效率为86．7％，对照组为63．3％，两组比较差异有统计学意义（P＜0．05）；治疗3个月后治疗组临床症状完全消失率为90．0％，对照组为63．3％，两组之间比较差异有统计学意义（P＜0．05）。两组不良反应发生率比较，差异无统计学意义（P＞0．05）。治疗组未发现明确为滋阴利肺汤出现的严重不良反应。结论抗结核药物联合滋阴利肺汤治疗可有效改善老年复治涂阳肺结核患者血清 IL-6、IL-10、TNF-α水平，明显改善临床症状，提高病变吸收率和痰菌转阴率，无严重不良反应。%Objective To investigate the effect of antituberculosis drugs combined with Nourishing Yin and Clearing Lung Soup on serum inflammatory cytokines of elderly patients with retreated smear positive pulmonary tuberculosis and its clinical significance.Methods Sixty elderly patients with retreated smear positive pulmonary tuberculosis were randomly divided into two groups:30 cases in the treatment group were treated with antituberculosis drugs combined with Nourishing Yin and Clearing Lung Soup ,30 cases in the control group were given antituberculosis drugs alone .Both groups were given a same antituberculosis therapy,and the treatment lasted for 6 months.The levels of interleukin-6(IL-6),interleukin-10 (IL-10) and tumor necrosis factor(TNF-α) were detected before and after treatment in both groups .The sputum negative conversion rate ,effective absorption rate of lung lesions ,clinical symptoms and adverse reactions were observed .Results Before treatment,the levels of serum IL-6,IL-10 and TNF-αshowed no significant difference between two groups ( P>0 .05 ) .After treatment ,the levels of serum IL-6,TNF-αin two groups decreased ,which were significantly lower in the treatment group compared with the controls (P<0.05);The levels of IL-10 increased in both groups,which was significantly higher in the treatment group compared with the controls (P<0.05).The levels of serum IL-6,TNF-αafter treatment were lower than those before treatment in two groups ( P<0 .05 ) , and the levels of IL-10 after treatment were higher than those before treatment in two groups (P<0.05).After the end of treatment,the sputum negative conversion rate was 96.6%in the treatment group,while in the control group was 76.7%,there was significant difference between two groups ( P<0 .05 ) .After the end of treatment ,the effective absorption rate of lung lesions in the treatment group was 86.7%,while in the control group was 63.3%,there was significant difference between two groups (P<0.05).Three months after treatment ,the complete disappearance rate of clinical symptoms in the treatment group was 90 .0%,while in the control group was 63.3%,there was significant difference between two groups (P<0.05).The adverse reaction rates showed no significant difference between two groups(P>0.05).No severe adverse reactions caused by Nourishing Yin and Clearing Lung Soup occurred in the treatment group .Conclusion Antituberculosis drugs combined with Nourishing Yin and Clearing Lung Soup can effectively improve the levels of serum IL-6,IL-10 and TNF-αof elderly patients with retreated smear positive pulmonary tuberculosis,it can significantly improve the clinical symptoms,improve the effective absorption rate of lung lesions and sputum negative conversion rate,and no severe adverse reactions are observed.