含环丝氨酸联合胸腺肽方案治疗耐多药肺结核的效果

目的：观察和评价含环丝氨酸联合胸腺肽方案治疗耐多药肺结核的疗效及安全性。方法选取确诊为耐多药肺结核并纳入中国全球基金耐多药肺结核病防治项目治疗的病例60例作为研究对象，按数字表法随机分为观察组和对照组各30例，对照组采用中国全球基金耐多药肺结核病防治项目的标准化治疗方案，即6VZthKP／18VZthP，观察组在此基础上在注射期加用胸腺肽肠溶片，并在全疗程加用环丝氨酸（ Cs）胶囊，即6VZthKP＋Cs＋胸腺肽／18VZthP＋Cs，所有患者均常规加用葡醛内酯片进行保肝治疗。对两组治疗后不同时期的细胞免疫指标、痰菌阴转率、影像学好转率、治疗转归及不良反应等进行分析比较。结果治疗6个月末，观察组CD4＋T淋巴细胞（40.7±5.6）％]、CD4＋／CD8＋值（1.8±0.7）明显高于治疗前，分别为（32.6±3.2）％、1.1±0.3，差异有统计学意义（t＝6.88、5.04，P＜0.01），而CD8＋T淋巴细胞则明显降低，分别为（27.6±5.8）％、（32.0±3.3）％，差异有统计学意义（t＝3.61，P＜0.01），且与对照组（32.5±6.1）％、1.1±0.7、（32.2±4.9）％]比较，差异有统计学意义（ t＝5.42、3.87、3.32，P＜0.01）。治疗3个月末，观察组的痰菌阴转率为40.00％，同对照组差异无统计学意义（χ2＝1.93，P＞0.05）；治疗6、12和24个月末，观察组的痰菌阴转率分别为70.00％、76.67％、86.67％，显著高于对照组的36.67％、43.33％、53.33％，两组比较差异均有统计学意义（χ2＝6.70、6.94、7.94，P＜0.01）。治疗12个月末，观察组的病灶吸收有效率和空洞闭合有效率分别为76.67％和75.00％，均高于对照组的46.67％和40.74％，差异有统计学意义（χ2＝5.71、6.63，P＜0.05）；治疗24个月末，观察组的病灶吸收有效率和空洞闭合有效率分别为86.67％和78.57％，明显高于对照组的53.33％和40.74％，两组比较差异有统计学意义（χ2＝7.94、8.20，P＜0.01）。观察组的治疗成功率为93.33％，显著高于对照组的63.33％，差异有统计学意义（χ2＝7.95，P＜0.01）。两组在不良反应发生率方面差异无统计学意义（ P＞0.05）。结论含Cs联合胸腺肽方案治疗耐多药肺结核，能够增强机体的细胞免疫功能，加快痰菌阴转，促进病灶吸收及空洞闭合，提高治疗成功率，且无严重不良反应发生。

Clinic observations of the Scheme Combining Cycloserine with Thymosin for the Therapy of Multi-drug Resist-ant

Objective To observe and evaluate the efficacy and safety of the scheme combining cycloserine with thymosin for the therapy of multi -drug resistant tuberculosis ( MDR-TB) .Methods The clinical research was con-ducted among 60 clinical cases , which were diagnosed as MDR -TB by the Outpatient Service of Tuberculosis Dispensary in Shantou City, Guangdong Province.These cases were also categorized into the global fund treatment item for the MDR -TB.They were randomly divided into experimental group and control group ( n=30 ) .The control group received the standardized treatment plan from the global fund program , namely 6 VZthKP/18VZthP;and on the basis of which , the ex-perimental group received additional thymopeptides enteric -coated tablets during the intensive phase , and the cycloserine capsule during the whole course of treatment , as 6VZthKP+Cs+thymosin/18VZthP+Cs.All of the patients should ac-cept the liver protection therapy with the help of Gantaile tablets .After the treatment course , the research group has to an-alyze and compare the different statistics between both groups such as cellular immunity markers , sputum negative conver-sion rates, therapy outcomes and adverse reactions .Results Aspect of cell -mediated immunity, the 6th month after treatment, CD4+lymphocyte, CD4+/CD8+ratio were significantly elevated while CD8+lymphocyte significantly de-scended contrasted with untreated in the experimental group (t=6.88, 5.04 and 3.61, P<0.01), and contrasted with the control group (t=5.42, 3.32 and 3.87, P<0.01).After three months of therapy, the sputum negative conversion rate of the experimental group was 40.00%, which has no significant difference with that of the control group (χ2 =1.93,P>0.05).However, after 6, 12 and 24 months of therapy, the sputum negative conversion rates of the experimental group were 70.00%, 76.67%and 86.67%, respectively , which were significantly higher than those of the control group (36.67%, 43.33%and 53.33%, respectively, P<0.01).Meanwhile, after 12 months of therapy, the response rates of focal absorption and cavity occlusion were 76.67% and 75.00%, respectively (χ2 =5.71, P<0.05), which were significantly higher than those of the control group (46.67%and 40.74%, respectively) (χ2 =6.63, P<0.05).After 24 months of therapy , the response rates of focal absorption and cavity occlusion were 86.67%and 78.57%, respectively (χ2 =7.94, P<0.01), which were significantly higher than those of the control group (53.33%and 40.74%, respec-tively) (χ2 =8.20, P<0.01).Besides, the treatment success rate of the experimental group (93.33%) was signifi-cantly higher than that of the control group (63.33%) (χ2 =7.95, P<0.01).And both groups had no significant differ-ence in the occurrence rates of adverse reactions (χ2 =0.00, P >0.05 ) .Conclusion The scheme combining cy-closerine with thymosin for the therapy of MDR -TB can effectively enhance the cellular immune function and accelerate the sputum negative conversion .Moreover, it can also facilitate the focal absorption and cavity closure , increase the treat-ment success rate without any severe adverse reactions .