中西医结合治疗肺结核的临床疗效观察及对患者肝功能、肝纤维化指标的影响
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摘要
目的观察中西医结合治疗肺结核的临床疗效,及其对患者肝功能、肝纤维化指标的影响。方法将90例肺结核患者按随机数字表法分为2组。对照组45例予西医常规治疗;治疗组45例在对照组治疗基础上加用月华丸加减治疗。1个化疗疗程结束后观察结核杆菌转阴情况并以转阴情况统计治愈率。比较2组治疗前后肝功能指标血清丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)及总胆红素(TBiL)水平变化情况,比较2组治疗前后血清肝纤维化指标透明质酸酶(HA)、Ⅳ型胶原(CⅣ)、Ⅲ型前胶原氨基末端肽(PCⅢ)及层粘连蛋白(LN)水平变化情况。结果治疗组治愈率88.9%,对照组治愈率77.8%,治疗组治愈率高于对照组(P<0.05); 2组治疗后肝功能指标ALT、AST及TBiL水平与本组治疗前比较均明显升高(P<0.05),且治疗组治疗后肝功能指标ALT、AST及TBi L水平均低于对照组(P<0.05); 2组治疗后血清肝纤维化指标HA、CⅣ、PCⅢ及LN水平与本组治疗前比较均明显降低(P<0.05),且治疗组治疗后血清肝纤维化指标HA、CⅣ、PCⅢ及LN水平均低于对照组(P<0.05)。结论加用月华丸加减中西医结合治疗肺结核疗效确切,可明显改善患者临床症状,提高治愈率,减少抗结核药物的副作用,保护肝功能,抑制肝纤维化,具有明显减毒增效的作用。
Objective To observe the effect of the treatment of pulmonary tuberculosis with integrated traditional Chinese and western medicine and its effect on liver function and liver fibrosis index.Methods 90 patients with pulmonary tuberculosis were divided into 2 groups according to the random number table method.45 patients in the control group were treated by conventional western medicine.45 patients in the treatment group were treated by modified Yuehua Pill on the basis of the control group.After the end of the treatment course,the tuberculosis bacillus was observed and the cure rate was counted as a negative condition.The changes of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST) and total bilirubin(TBiL) levels in liver function indexes before and after treatment were compared between the two groups.The levels of hyaluronan(HA),type Ⅳ collagen(CⅣ),type III procollagen(PCⅢ) and laminin(LN) in serum fibrosis before and after treatment were compared between the two groups.Results The cure rate was 88.9 % in the treatment group and 75.00 % in the control group.The cure rate of the treatment group was higher than that of the control group(P< 0.05).The levels of ALT,AST and TBi L in the two groups were significantly higher than those in the group before treatment(P< 0.05),and the levels of ALT,AST and TBi L in the treatment group were lower than those in the control group(P< 0.05).The levels of serum fibrosis HA,CⅣ,PCⅢ and LN in the two groups were significantly lower than those in the group before treatment(P< 0.05),and these serum fibrosis in the treatment group were treated were lower than the control group(P< 0.05).Conclusion The treatment of pulmonary tuberculosis with integrated traditional Chinese and western medicine modified Yuehua Pills can effectively improve the clinical symptoms,improve the cure rate,reduce the side effects of anti-tuberculosis drugs,protect liver function,inhibit liver fibrosis,and have obvious attenuation and synergy effect.
Objective To observe the effect of the treatment of pulmonary tuberculosis with integrated traditional Chinese and western medicine and its effect on liver function and liver fibrosis index.Methods 90 patients with pulmonary tuberculosis were divided into 2 groups according to the random number table method.45 patients in the control group were treated by conventional western medicine.45 patients in the treatment group were treated by modified Yuehua Pill on the basis of the control group.After the end of the treatment course,the tuberculosis bacillus was observed and the cure rate was counted as a negative condition.The changes of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST) and total bilirubin(TBiL) levels in liver function indexes before and after treatment were compared between the two groups.The levels of hyaluronan(HA),type Ⅳ collagen(CⅣ),type III procollagen(PCⅢ) and laminin(LN) in serum fibrosis before and after treatment were compared between the two groups.Results The cure rate was 88.9 % in the treatment group and 75.00 % in the control group.The cure rate of the treatment group was higher than that of the control group(P< 0.05).The levels of ALT,AST and TBi L in the two groups were significantly higher than those in the group before treatment(P< 0.05),and the levels of ALT,AST and TBi L in the treatment group were lower than those in the control group(P< 0.05).The levels of serum fibrosis HA,CⅣ,PCⅢ and LN in the two groups were significantly lower than those in the group before treatment(P< 0.05),and these serum fibrosis in the treatment group were treated were lower than the control group(P< 0.05).Conclusion The treatment of pulmonary tuberculosis with integrated traditional Chinese and western medicine modified Yuehua Pills can effectively improve the clinical symptoms,improve the cure rate,reduce the side effects of anti-tuberculosis drugs,protect liver function,inhibit liver fibrosis,and have obvious attenuation and synergy effect.
引文
[1]何国钧,肖和平.肺结核病诊断进展[J].中华结核和呼吸杂志,2001,24(8):455-457.
[2]姜世闻,张慧,王黎霞.我国结核病防治服务体系的发展与展望[J].中国防痨杂志,2012,34(9):557-559.
[3]周应初,刘斌.抗结核药致肝损害的研究进展[J].国际病理科学与临床杂志,2011,31(4):361-365.
[4]Takaya H,Uemura M,Fujimura Y,et al.ADAMTS13activity may predict the cumulative survival of patients with liver cirrhosis in comparison with the Child-Turcotte-Pugh score and the Model for End-Stage Liver Disease score[J].Hepatol Res,2012,42(5):459-472.
[5]中华人民共和国卫生部.中华人民共和国卫生行业标准:肺结核诊断标准(WS288-2008)[S].北京:2008:1-3.
[6]谭守勇,丁秀秀,谭耀驹,等.异烟肼和利福平治疗方案对单耐异烟肼或利福平肺结核患者的治疗效果[J].中华结核和呼吸杂志,2014,37(12):915-918.
[7]穆克利,陈红兵.利福喷丁与利福平治疗肺结核的临床对比研究[J].现代药物与临床,2014,29(9):1007-1010.
[8]李亚飞,金利群,柳志强,等.吡嗪酰胺的研究进展[J].中国现代应用药学,2010,27(4):307-312.
[9]李群辉,肖成志,宋文虎,等.含链毒素和含乙胺丁醇方案的对比研究[J].中华结核和呼吸杂志,1998,21(2):76-78.
[10]李进升,黄秋霞,余少英,等.含利福喷丁或利福平联合化疗方案对老年肺结核患者药物性肝损伤的临床比较[J].中国防痨杂志,2014,36(6):514-516.
[11]方毅敏,陈志成,潘四珍.异烟肼利福平吡嗪酰胺对结核病患者肝功能的影响[J].实用医学杂志,1997,13(9):609-610.
[12]杨慧媛,宋育林,许建明,等.异烟肼利福平合用致大鼠肝损伤的实验模型[J].安徽医科大学学报,2008,43(2):185-189.
[13]Van Hest R,Baars H,Kik S,et al.Hepatotoxicity of rifampin-pyrazinamide and isoniazid preventive therapy and tuberculosis treatment[J].Clin Infect Dis,2004,39(4):488-496.
[14]刘备,丁鹏,冯国清.抗结核药物肝损伤研究进展[J].海峡药学,2016,28(3):5-9.
[15]叶长根,孙水林,刘亮明.抗结核药物肝毒性危险因素研究进展[J].中华临床医师杂志(电子版),2012,6(6):1546-1549.
[16]叶艳菊,俞建平,陈红娟,等.肺结核合并乙型肝炎病毒感染患者抗病毒与护肝治疗的疗效分析[J].中华医院感染学杂志,2016,26(1):90-91,114.
[17]潘勤,谢渭芬,张忠兵.肝纤维化可逆性的研究进展[J].临床荟萃,2005,20(20):1195-1197.
[18]熊钻,梅玉峰,王春阳,等.透明质酸、Ⅲ型前胶原、Ⅳ型胶原、层黏连蛋白对肝硬化的诊断价值分析[J].中国处方药,2018,16(1):137-138.
[19]郑艳,胡汉昆.甘草次酸与甘草酸二铵抗炎护肝作用的实验研究[J].中国药师,2012,15(5):604-606.
[20]邓庆平,周志添,刘擎,等.当代名老中医治疗肺结核医案的中药配伍及方证规律的关联分析[J].新中医,2013,45(3):156-158.
[21]欧阳建军,刘伍立,陈国茜,等.月华丸(胶囊)治疗结核研究进展[J].中医药导报,2016,22(2):109-112.
[22]欧阳建军,伍参荣,曾姣飞,等.月华胶囊对结核鼠体温、体质量的动态影响[J].湖南中医学院学报,2005,25(6):7-9.
[23]欧阳建军,伍参荣,陈北阳,等.月华胶囊对耐多药结核鼠T淋巴细胞亚群及细胞因子的影响[J].中国实验方剂学杂志,2006,12(9):28-31.
[24]星海霞.月华胶囊对主要抗结核药物肝损害影响及其量效关系的实验研究[D].长沙:湖南中医药大学,2008.
[2]姜世闻,张慧,王黎霞.我国结核病防治服务体系的发展与展望[J].中国防痨杂志,2012,34(9):557-559.
[3]周应初,刘斌.抗结核药致肝损害的研究进展[J].国际病理科学与临床杂志,2011,31(4):361-365.
[4]Takaya H,Uemura M,Fujimura Y,et al.ADAMTS13activity may predict the cumulative survival of patients with liver cirrhosis in comparison with the Child-Turcotte-Pugh score and the Model for End-Stage Liver Disease score[J].Hepatol Res,2012,42(5):459-472.
[5]中华人民共和国卫生部.中华人民共和国卫生行业标准:肺结核诊断标准(WS288-2008)[S].北京:2008:1-3.
[6]谭守勇,丁秀秀,谭耀驹,等.异烟肼和利福平治疗方案对单耐异烟肼或利福平肺结核患者的治疗效果[J].中华结核和呼吸杂志,2014,37(12):915-918.
[7]穆克利,陈红兵.利福喷丁与利福平治疗肺结核的临床对比研究[J].现代药物与临床,2014,29(9):1007-1010.
[8]李亚飞,金利群,柳志强,等.吡嗪酰胺的研究进展[J].中国现代应用药学,2010,27(4):307-312.
[9]李群辉,肖成志,宋文虎,等.含链毒素和含乙胺丁醇方案的对比研究[J].中华结核和呼吸杂志,1998,21(2):76-78.
[10]李进升,黄秋霞,余少英,等.含利福喷丁或利福平联合化疗方案对老年肺结核患者药物性肝损伤的临床比较[J].中国防痨杂志,2014,36(6):514-516.
[11]方毅敏,陈志成,潘四珍.异烟肼利福平吡嗪酰胺对结核病患者肝功能的影响[J].实用医学杂志,1997,13(9):609-610.
[12]杨慧媛,宋育林,许建明,等.异烟肼利福平合用致大鼠肝损伤的实验模型[J].安徽医科大学学报,2008,43(2):185-189.
[13]Van Hest R,Baars H,Kik S,et al.Hepatotoxicity of rifampin-pyrazinamide and isoniazid preventive therapy and tuberculosis treatment[J].Clin Infect Dis,2004,39(4):488-496.
[14]刘备,丁鹏,冯国清.抗结核药物肝损伤研究进展[J].海峡药学,2016,28(3):5-9.
[15]叶长根,孙水林,刘亮明.抗结核药物肝毒性危险因素研究进展[J].中华临床医师杂志(电子版),2012,6(6):1546-1549.
[16]叶艳菊,俞建平,陈红娟,等.肺结核合并乙型肝炎病毒感染患者抗病毒与护肝治疗的疗效分析[J].中华医院感染学杂志,2016,26(1):90-91,114.
[17]潘勤,谢渭芬,张忠兵.肝纤维化可逆性的研究进展[J].临床荟萃,2005,20(20):1195-1197.
[18]熊钻,梅玉峰,王春阳,等.透明质酸、Ⅲ型前胶原、Ⅳ型胶原、层黏连蛋白对肝硬化的诊断价值分析[J].中国处方药,2018,16(1):137-138.
[19]郑艳,胡汉昆.甘草次酸与甘草酸二铵抗炎护肝作用的实验研究[J].中国药师,2012,15(5):604-606.
[20]邓庆平,周志添,刘擎,等.当代名老中医治疗肺结核医案的中药配伍及方证规律的关联分析[J].新中医,2013,45(3):156-158.
[21]欧阳建军,刘伍立,陈国茜,等.月华丸(胶囊)治疗结核研究进展[J].中医药导报,2016,22(2):109-112.
[22]欧阳建军,伍参荣,曾姣飞,等.月华胶囊对结核鼠体温、体质量的动态影响[J].湖南中医学院学报,2005,25(6):7-9.
[23]欧阳建军,伍参荣,陈北阳,等.月华胶囊对耐多药结核鼠T淋巴细胞亚群及细胞因子的影响[J].中国实验方剂学杂志,2006,12(9):28-31.
[24]星海霞.月华胶囊对主要抗结核药物肝损害影响及其量效关系的实验研究[D].长沙:湖南中医药大学,2008.