微卡方案辅助短期化疗治疗难治性尘肺合并肺结核的疗效观察及安全性评估
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摘要
目的研究微卡方案辅助短期化疗治疗难治性尘肺合并肺结核的疗效及安全性。方法将70例难治性尘肺合并肺结核患者纳入研究对象,按照治疗方案不同分为给予短期化疗方案联合微卡治疗的观察组和仅给予短期化疗方案的对照组,观察两组患者的结核杆菌阴转、病灶吸收、空洞闭合、呼吸功能指标以及不良反应。结果观察组复治涂阳组、耐多药结核病组、全部病例痰菌阴转阴(93.33%、75%、91.43%)、病灶吸收率(93.33%、75%、91.43%)、空洞闭合、缩小率(86.67%、62.50%、85.71%)、最大呼气流速(74.2±9.6)ml/s、呼气一秒率(57.85±7.03)、MMRC评分(4.7±0.8)、6分钟步行距离(394.3±52.4)均明显高于对照组;步行后心率和呼吸频率(81.5±8.2、26.4±3.8)次/min明显低于对照组;两组不良反应差异无统计学意义。结论微卡方案辅助短期化疗治疗有助于控制结核杆菌,促进病灶吸收,改善呼吸功能,且不会增加不良反应,是治疗难治性尘肺合并肺结核安全、有效的方案。
Objective To study the efficacy and safety of mycobacterium vaccae assisted short- term chemotherapy in treating refractory pneumoconiosis complicated with pulmonary tuberculosis. Methods Refractory pneumoconiosis complicated with pulmonary tuberculosis patients were enrolled and divided into observation group,given mycobacterium vaccae assisted short- term chemotherapy,and control group,given chemotherapy. Negative sputum conversion rate,focus absorption,pulmonary cavity closure,respiratory function,adverse reaction between two groups were studied and compared. Results Observation group,re- treatment smear positive group,multidrug resistance pulmonary tuberculosis group,all cases,the negative sputum conversion rate( 93. 33%,75%,91. 43%),focus absorption rate( 93. 33%,75%,91. 43%) pulmonary cavity closure( 86. 67% 、62. 50% 、85. 71%),PEF( 74. 2 ± 9. 6 ml / s,FEV1 / FVC%( 57. 85 ± 7. 03),MMRC score( 4. 7 ± 0. 8),6 MWD( 394. 3± 52. 4) were significantly higher than those of control group. Breathing and heart rates after walking were lower than those of control group. There were no significant difference between two groups of adverse reactions. Conclusion Mycobacterium vaccae assisted short- term chemotherapy were effective. This method is a safe treatment in treating refractory pneumoconiosis complicated with pulmonary tuberculosis. This method can control tuberculosis,promote the lesions absorption,improve respiratory function and did not increase adverse reactions.
Objective To study the efficacy and safety of mycobacterium vaccae assisted short- term chemotherapy in treating refractory pneumoconiosis complicated with pulmonary tuberculosis. Methods Refractory pneumoconiosis complicated with pulmonary tuberculosis patients were enrolled and divided into observation group,given mycobacterium vaccae assisted short- term chemotherapy,and control group,given chemotherapy. Negative sputum conversion rate,focus absorption,pulmonary cavity closure,respiratory function,adverse reaction between two groups were studied and compared. Results Observation group,re- treatment smear positive group,multidrug resistance pulmonary tuberculosis group,all cases,the negative sputum conversion rate( 93. 33%,75%,91. 43%),focus absorption rate( 93. 33%,75%,91. 43%) pulmonary cavity closure( 86. 67% 、62. 50% 、85. 71%),PEF( 74. 2 ± 9. 6 ml / s,FEV1 / FVC%( 57. 85 ± 7. 03),MMRC score( 4. 7 ± 0. 8),6 MWD( 394. 3± 52. 4) were significantly higher than those of control group. Breathing and heart rates after walking were lower than those of control group. There were no significant difference between two groups of adverse reactions. Conclusion Mycobacterium vaccae assisted short- term chemotherapy were effective. This method is a safe treatment in treating refractory pneumoconiosis complicated with pulmonary tuberculosis. This method can control tuberculosis,promote the lesions absorption,improve respiratory function and did not increase adverse reactions.
引文
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[6]黄茂平,张喜琴,刘波.微卡对预防煤工尘肺肺结核复发疗效观察[J].中国职业医学,2011,38(6):489-490.
[7]张锡林,黄丹.改善细胞免疫状态对耐多药肺结核患者化疗效果及预后的影响[J].实用医学杂志,2013,29(12):1964-1966.
[8]Dlugovitzky D,Stanford C,Stanford.Immunological basis for the introduction of immunotherapy with Mycobacterium vaccae into the routine treatment of TB[J].Immunotherapy,2011,3(4):557-568.
[9]孔冬青,陈东进,张满刚,等.223例住院煤工尘肺肺结核患者耐药情况分析[J].中国防痨杂志,2013,35(10):823-826.
[10]吴珂,李国栋,赵冠人,等.母牛分枝杆菌辅助治疗耐多药肺结核的Meta分析[J].中国药物应用与监测,2011,8(6):341-345.
[11]乐世峰,程小星.微卡(VACCAE)联合2H3R3Z3E3/4H3R3方案治疗初治涂阳肺结核的临床效果[J].中国现代医生,2012,50(27):58-59,61.
[12]梅月志,杨莉明.联用微卡菌苗治疗耐多药肺结核的疗效分析[J].中国热带医学,2010,10(6):693-694.
[13]Efremenko YY,Butov DA,Prihoda ND,et al.Randomized,placebocontrolled phase II trial of heat-killed Mycobacterium vaccae(Longcom batch)formulated as an oral pill(V7)[J].Hum Vaccin Immunother,2013,9(9):1852-1856.
[2]杨青国,刘芙蓉,郑贤义.母牛分枝杆菌治疗初治肺结核合并尘肺的临床疗效观察[J].临床肺科杂志,2013,18(8):1463-1465
[3]卫生部疾病预防控制司.卫生部医政司.中国疾病预防控制中心.全国结核防治规划实施工作指南(2008)[S].2008.
[4]Dlugovitzky D,Notario R,Martinel-Lamas D,et al.Immunotherapy with oral,heat-killed,Mycobacterium vaccae in patients with moderate to advanced pulmonary tuberculosis[J].Immunotherapy,2010,2(2):159-169.
[5]马立军,卜江龙.微卡方案治疗煤工尘肺耐多药结核12例疗效观察[J].临床肺科杂志,2010,15(4):552-552.
[6]黄茂平,张喜琴,刘波.微卡对预防煤工尘肺肺结核复发疗效观察[J].中国职业医学,2011,38(6):489-490.
[7]张锡林,黄丹.改善细胞免疫状态对耐多药肺结核患者化疗效果及预后的影响[J].实用医学杂志,2013,29(12):1964-1966.
[8]Dlugovitzky D,Stanford C,Stanford.Immunological basis for the introduction of immunotherapy with Mycobacterium vaccae into the routine treatment of TB[J].Immunotherapy,2011,3(4):557-568.
[9]孔冬青,陈东进,张满刚,等.223例住院煤工尘肺肺结核患者耐药情况分析[J].中国防痨杂志,2013,35(10):823-826.
[10]吴珂,李国栋,赵冠人,等.母牛分枝杆菌辅助治疗耐多药肺结核的Meta分析[J].中国药物应用与监测,2011,8(6):341-345.
[11]乐世峰,程小星.微卡(VACCAE)联合2H3R3Z3E3/4H3R3方案治疗初治涂阳肺结核的临床效果[J].中国现代医生,2012,50(27):58-59,61.
[12]梅月志,杨莉明.联用微卡菌苗治疗耐多药肺结核的疗效分析[J].中国热带医学,2010,10(6):693-694.
[13]Efremenko YY,Butov DA,Prihoda ND,et al.Randomized,placebocontrolled phase II trial of heat-killed Mycobacterium vaccae(Longcom batch)formulated as an oral pill(V7)[J].Hum Vaccin Immunother,2013,9(9):1852-1856.