母牛分枝杆菌菌苗辅助治疗老年复治菌阳肺结核临床观察

目的　观察和评价母牛分枝杆菌菌苗 (微卡 )辅助治疗老年复治菌阳肺结核的疗效、安全性。方法　将经细菌学证实的 6 4例老年复治菌阳肺结核患者随机分为微卡免疫治疗组 (M组 ,32例 )与对照组 (C组 ,32例 ) ,化疗方案为 4DZEO/ 8DEO ,M组加用微卡 11次。结果　在治疗 6、12个月末 ,M组痰菌阴转率分别为 6 2 .5 %、71.9% ,C组分别为 34.4 %、4 6 .9% ,两者比较有显著性差异 (P <0 .0 5 )。在治疗 4、6、12个月末 ,M组的病灶吸收率分别为 6 5 .6 %、78.1%、84 .1% ,C组分别为 37.5 %、4 6 .9%、5 0 .0 % ;M组的空洞缩小率分别为 5 9.4 %、6 8.8%、78.1% ,C组分别为 2 8.1%、37.5 %、4 6 .9% ,两组相应指标比较均有显著差异性 (P <0 .0 5 )。M组在治疗 6个月末起CD3 、CD4、CD4/CD8、IgA、ALB较治疗前显著升高 ,与同期C组对比 ,有显著差异性 (P <0 .0 0 1- 0 .0 5 )。治疗期间 ,未出现明显毒副作用。结论　微卡能提高老年复治菌阳肺结核患者痰菌阴转率及病灶吸收率 ,改善患者细胞免疫功能及营养状况。

Clinical observation on therapeutic efficacy of mycobacterium vaccae vaccine in treating the elderly patients with bacterium positive retreated pulmorar tuberalosis

Objective To observe and evaluate the therapeutic efficacy and security of Mycobacterium vaccae vaccine (M.vaccae vaccine) in treating the elderly patients with bacterium positive retreated pulmorary tuberalosis(RPTB).Methods 64 cases of the elderly patients with bacterium postive RPTB were divided into immunotherapy therament group (group M, 32 cases) and control (group C, 32 cases).The patients in the two groups were treated with the same chemotherapy regiment of 4DZEO/8DEO,and the group M were treated with 11 times M.vaccae additionally.Results The sputum smear-negative rates at the end of 6,12 months in group M were 62.5%,71.9% and 34.4%,40.6% respectively in the group C, There were significantly differences between the two groups(P<0.05). The lesions in provement rates on chest radiography at the end of 4,6 and 12 months in the group M were 65.6%,78.1%,84.1% and 37.5%,46.9%,50% respectively in the group C.The cavity closure rates at the end of 4,6 and 12 months in the group M 59.4%,68.8%,78.1% and 28.1%,37.5%,46.9% respectively in the group C, there were significantly differences between the two groups(P<0.05). The percentage of CD 3 and CD 4 T cell and ratio CD 4/CD 8 and IgA,ALB in the group M were greatly elevated after 6 months treatment,these had significant differentces with the group C(P< 0.001).The risk of M.vaccae were not significant side effect.Conclusion As andjunct to chemotherapy M.vaccae is helpful for elderly patients with bacterium positive RPTB by improving the sputum negative conversion,X-ray manifestaion and the cell-medicated immunity.