母牛分支杆菌菌苗免疫治疗肺结核临床观察--2年随访结果

目的　评价母牛分支杆菌 (M.vaccae)菌苗免疫治疗缩短初治菌阳肺结核化疗疗程及对耐多药肺结核的疗效。方法 142例初治菌阳肺结核和46例耐多药肺结核，配对随机分为M.vaccae菌苗免疫治疗组和单纯化疗对照组。初治治疗组 (A组)采用M.vaccae菌苗深部肌肉注射6次及4个月化疗，初治对照组 (B组)采用6个月化疗而不行免疫治疗；耐多药肺结核 (C组、D组)均给予18个月化疗，但治疗组 (C组)给予M.vaccae菌苗免疫治疗6次，对照组 (D组)单用化疗。M.vaccae菌苗免疫治疗结束，A组痰菌阴转率为95.8% (68/71)，B组为97.2% (69/71)，P＞0.05；C组和D组痰菌阴转率分别为34.8% (823)和4.7% (123)，P＜0.05。本文对疗程结束痰菌阴转且未失访的141例病人进行了2年随访。结果 A组2年复发率为6.3% (464)，B组为4.5% (366)P＞0.05，C组、D组2年复发率分别为11.1% (1/9)和50.0% (1/2)，P＞0.05。结论 M.vaccae菌苗免疫治疗可将初治菌阳肺结核的化疗疗程缩短为4个月，痰菌阴转率、2年复发率与对照组无差异，耐多药肺结核痰菌阴转率明显提高，复发率与对照组无差异。因此，M.vaccae菌苗免疫治疗可缩短初治菌阳肺结核的疗程，提高耐多药肺结核的疗效，建议推广。

Immunotherapy with Mycobacterium vaccae vaccine in treating pulmonary tuberculosis--results after 2 years' follow-up

Objective To further shorten the therapeutic period of short course chemotherapy (SCC) of initially treated pulmonary tuberculosis (PTB) and to improve the Results of chemotherapy of MDR pulmonary tuberculosis by immunotherapy with Mycobacterium vaccae vaccine.Methods 142 patients of newly diagnosed pulmonary tuberculosis with bacteriological positive and 46 patients of MDR pulmonary tuberculosis were divided into immunotherapy groups (group A、C) control groups (group B、D) at randomized pair,group A (71 cases) of newly diagnosed PTB was received once monthly of injection of Mycobacterium vaccae vaccine as immunotherapy for 6 times and a 4 months chemotherapeutic regime,group B (71 cases) of newly diagnosed PTB was received a 6 months chemotherapentic regime,groups C、D of MDR pulmonary tuberculosis were received 18 months chemotherapeutic regime and group C (23 cases) was given six times injection once monthly of M.vaccae vaccine as immunotherapy.Results After 6 months,the sputum negative conversion rate of group A was 95.8%(68/71),group B was 97.2%(69/71), P＞0.05;group C was 34.8%(8/23),group D was 4.7%(1/23), P＜0.05,at the end of treatment of MDR pulmonary tuberculosis,group C was 39.1%(9/23),group D was 8.6%(2/23),at the final follow up after 2 years,the bacteriological relapse rate of group A was 6.3%(4/64),group B was 4.5%(3/66), P＞0.05;and group C was 11.1%(1/9),group D was 50.0%(1/2), P＞0.05.Conclusion As an adjunct to chemotherapy,M.vaccae vaccine was helpful for patients with pulmonary tuberculosis.