摘要
目的研究含左氧氟沙星(3HRZELfx5HRLfx)化疗方案联合氯法齐明治疗耐药性肺结核的效果及对免疫平衡、血清可溶性T细胞免疫球蛋白黏蛋白分子3(sTim-3)、视黄醇结合蛋白-4(RBP-4)水平的影响。方法 2017年6月至2018年6月在第906医院进行治疗的124例耐药性肺结核患者被随机分为对照组和观察组,每组62例。对照组给予3HRZELfx5HRLfx化疗,观察组在同样化疗基础上联合氯法齐明,治疗8个月。比较两组患者治疗3、8个月时的痰菌转阴率、病灶吸收率、临床疗效。分别于治疗前、治疗8个月时测定辅助性T细胞(Th)1、Th2及IFN-γ、IL-4、sTim-3、RBP-4水平;关注治疗期间的不良反应。结果治疗前,两组患者的一般资料和各项指标差异无统计学意义(P>0.05);观察组治疗3、8个月的痰菌转阴率、病灶吸收率均显著高于对照组(P<0.05,P<0.01)。治疗8个月评价,观察组和对照组的临床总有效率分别为96.77%、79.03%,差异有统计学意义(P<0.01)。治疗8个月时,观察组Th1和Th1/Th2显著高于对照组,Th2显著低于对照组(P<0.05,P<0.01);INF-γ显著高于对照组,IL-4显著低于对照组(P<0.05,P<0.01);sTim-3显著低于对照组,RBP-4显著高于对照组(P<0.01)。两组胃肠道反应发生率差异无统计学意义(P>0.05),观察组皮肤颜色改变发生率显著高于对照组(P<0.01),但停药后患者皮肤颜色改变均恢复。结论 3HRZELfx5HRLfx化疗方案联合氯法齐明能够提高耐药性肺结核的临床疗效,改善Th1/Th2及相应细胞因子的平衡,下调sTim-3而减轻免疫抑制,上调RBP-4而改善免疫功能。
Objective To analyze the effect of levofloxacin-containing chemotherapy regimen(3 HRZELfx5 HRLfx) combined with clofazimine in the treatment of drug-resistant pulmonary tuberculosis and its influence on immune balance,soluble T-cell immunoglobulin and mucin domain 3(sTim-3) and retinol-binding protein 4(RBP-4).Methods A total of 124 patients with drug-resistant pulmonary tuberculosis who received treatment at 906 th Hospital from June 2017 to June 2018 were randomly divided into control group and observation group(n=62,each).3 HRZELfx5 HRLfx was given in control group,and clofazimine was added based on 3 HRZELfx5 HRLfx chemotherapy in observation group for 8 months.The bacteriological sputum conversion rate,lesion absorption rate and clinical efficacy were compared at 3 months and 8 months of treatment between two groups.T helper cell(Th)1,Th2,interferon(IFN)-γ,interleukin-4(IL-4),sTim-3 and RBP-4 were detected before treatment and 8 months after treatment.The adverse reactions were observed during the treatment.Results Before treatment,there were no significant differences in general information and indicators between two groups(P>0.05).At 3 months and 8 months of treatment,the bacteriological sputum conversion rate and lesion absorption rate in observation group were significantly higher than those in control group(P<0.05,P<0.01).At 8 months of treatment,the total effective rate in observation group was significantly higher than that in control group(96.77% vs 79.03%,P<0.01).Compared with control group,Th1 and Th1/Th2 significantly increased,Th2 decreased,the levels of INF-γ and RBP-4 increased,and the levels of IL-4 and sTim-3 decreased significantly in observation group(P<0.05,P<0.01).There was no significant difference in the incidence of gastrointestinal reactions between two groups(P>0.05).The incidence of skin color change in observation group was significantly higher than that in control group(P<0.01),and changes in the skin returned to normal after drug withdrawal in patients.Conclusion 3 HRZELfx5 HRL
作者
程茹
张素霞
余史丹
CHENG Ru;ZHANG Su-xia;YU Shi-dan(College of Chemistry and Environmental Engineering,Shanghai Institute of Technology,Shanghai 201418,China;不详)
出处
《中国临床研究》
CAS
2021年第7期921-926,共6页
Chinese Journal of Clinical Research
