摘要
目的 探究糖皮质激素联合基础抗结核治疗对活动性肺结核患者疗效及免疫炎症水平的影响,为进一步规范糖皮质激素辅助治疗活动性肺结核提供参考.方法 收集2020年2月-2022年2月在海口市人民医院确诊的活动性肺结核患者106例,按照随机数字表法将其平均分为试验组(n=53)和对照组(n=53).对照组患者采取异烟肼+利福平+乙胺丁醇+吡嗪酰胺2个月/异烟肼+利福平4个月(2HREZ/4HR)的抗结核药物治疗方案连续治疗6个月,试验组在对照组基础上在治疗前3个月应用甲泼尼龙琥珀酸钠.比较两组患者治疗前后肺功能指标[肺总量(TLC)、第一秒用力呼气量(FEV1)、用力肺活量(FVC)占预计值的百分比、FEV1/FVC]及血清炎症相关指标[白细胞介素-6(IL-6)、IL-8、IL-17、IL-34、IL-37]表达水平,以及治疗6个月后的治疗效果及不良反应发生率.结果 两组患者治疗前TLC、FEV1、FVC、FEV1/FVC、IL-6、IL-8、IL-17、IL-34、IL-37比较差异均无统计学意义(P均＞0.05).经过6个月抗结核治疗,两组患者TLC、FEV1及FVC较治疗前均显著升高,差异均有统计学意义(P＜0.05);但两组组间比较差异均无统计学意义(t=0.382、1.026、0.315,均P＞0.05);FEV1/FVC在治疗前后及组间均无显著变化(P均＞0.05);两组患者血清IL-6、IL-8、IL-17、IL-34及IL-37水平较治疗前均显著降低,差异均有统计学意义(P均＜0.05);且试验组患者IL-6、IL-8、IL-17、IL-34及IL-37水平较对照组降低更显著,差异均有统计学意义(t=6.856、8.873、3.762、5.116、11.587,P均＜0.05).试验组和对照组患者治疗总有效率比较(96.23％vs.90.57％)差异无统计学意义(x2=1.377,P=0.241);但试验组患者治疗显效率高于对照组(64.15％vs.43.40％),差异有统计学意义(x2=4.592,P=0.032).治疗过程中,试验组与对照组患者总不良反应发病率比较(22.64％vs.16.98％)差异无统计学意义(x2=0.534,P=0.465).结论 在传统抗结核治疗基础上联合应用糖皮质激素能够显著提高活动性肺结核患者的治疗质量,降低患者炎症反应水平,改善患者预后,具有较为广阔的临床应用前景.
Abstract
Objective To investigate the effect of glucocorticoid combined with basic anti-tuberculosis treatment on the efficacy and inflammation level of patients with active pulmonary tuberculosis,to provide reference for further regulating glucocorticoid-assisted treatment of active pulmonary tuberculosis.Methods A total of 106 patients with active pulmonary tuberculosis diagnosed in Haikou People's Hospital from February 2020 to February 2022 were included and equally and randomly divided into test group(n=53)and control group(n=53).The patients in the control group were treated with isoniazid+rifampicin+ethambutol+pyrazinamide for 2 months/isoniazid+rifampicin for 4 months(2HREZ/4HR)anti-tuberculosis drug regimen for 6 months continuously,while the test group was treated with methylprednisolone sodium succinate for 3 months before treatment on the basis of the control group.The expression levels of lung function indexes[total lung capacity(TLC),forced expiratory volume in first second(FEV1),forced vital capacity(FVC),FEV1/FVC]and serum inflammation-related indexes[interleukin-6(IL-6),IL-8,IL-17,IL-34,IL-37]were compared between the two groups.And the treatment effect and incidence of adverse reactions were compared between the two groups after 6 months of treatment.Results There were no significant differences in TLC,FEV1,FVC,FEV1/FVC,IL-6,IL-8,IL-17,IL-34 and IL-37 levels between two groups before treatment(all P＞0.05).After 6 months of anti-tuberculosis treatment,TLC,FEV,and FVC levels in two groups were significantly higher than before treatment,the differences were statistical significance(all P＜0.05);but there was no significant difference between the two groups(t=0.382,1.026,0.315;all P＞0.05);and no significant changes in FEV1/FVC before and after treatment or between groups(both P＞0.05).Serum levels of IL-6,IL-8,IL-17,IL-34 and IL-37 in two groups were significantly lower than before treatment,with statistical significance(all P＜0.05);Moreover,the levels of IL-6,IL-8,IL-17,IL-34 and IL-37 in test group were significantly decreased compared with control group,with statistical significance(t=6.856,8.873,3.762,5.116,11.587;all P＜0.05).There was no significant difference in the total effective rate between test group and control group(96.23％vs.90.57％)(x2=1.377,P=0.241).However,the therapeutic efficacy of experimental group was higher than that of control group(64.15％vs.43.40％),and the difference was statistically significant(x2=4.592,P=0.032).During treatment,there was no significant difference in the incidence of total adverse reactions between test group and control group(22.64％vs.16.98％),the difference was not statistical significance(x2=0.534,P=0.465).Conclusion Combined application of glucocorticoid on the basis of traditional anti-tuberculosis therapy could significantly improve the treatment quality,reduce the level of inflammatory reaction and improve the prognosis of patients with active pulmonary tuberculosis.
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