加味葶苈大枣泻肺汤联合抗结核药物治疗结核性胸膜炎疗效及对免疫功能的影响
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摘要
目的观察加味葶苈大枣泻肺汤联合抗结核药物治疗结核性胸膜炎效果及对免疫功能的影响。方法选取2015年2月-2017年6月收治的100例结核性胸膜炎患者,按随机数字表法分为观察组和对照组,每组50例,其中对照组选取抗结核药物治疗,观察组在对照组的基础上联合加味葶苈大枣泻肺汤治疗。观察并比较两组治疗前后免疫因子水平,治疗后的临床症状改善情况以及临床效果。结果治疗后,观察组患者的临床疗效优于对照组(Z=-2. 941,P <0. 05),同时,观察组总有效率明显高于对照组(X~2=4. 574,P <0. 05);观察组的胸水和胸痛消失时间明显短于对照组(t=18. 556、15. 715,P <0. 001),且观察组的胸膜厚度明显低于对照组(t=4. 898,P <0. 001),差异具有统计学意义;两组治疗前各免疫因子水平比较差异无统计学意义(P> 0. 05),治疗后观察组各免疫因子水平均高于本组治疗前(P <0. 05),但对照组治疗前后无明显变化;治疗后观察组的血清CD3~+,CD4~+,CD8~+水平均高于对照组(t=2. 268、6. 1、2. 578,P <0. 05),差异具有统计学意义;观察组不良反应率为2%,对照组为4%,差异比较无统计学意义(P> 0. 05)。结论加味葶苈大枣泻肺汤联合抗结核药物治疗结核性胸膜炎有助于提高患者的免疫功能,临床疗效显著,患者的临床症状得到缓解。
Objective To explore the effects on tuberculous pleuritis and the impacts on immune function in the patients treated with the modified tingli dazao xiefei decoction and anti-tuberculous drugs. Methods From February2015 to June 2017,100 patients of tuberculous pleuritis were collected and divided into an observation group and a control group according to the random number table,50 cases in each one. In the control group,the anti-tuberculous drugs were selected. In the observation group,on the base of the treatment as the control group,the modified tingli dazao xiefei decoction was added. The immune factors were observed and compared before and after treatment in the two groups,as well as the improvements in the clinical symptoms and the clinical effects after treatment. Results After treatment,the clinical therapeutic effects in the observation group were generally better than the control group( Z =-2. 941,P < 0. 05),and the total effective rate in the observation group was higher obviously than the control group( X~2= 4. 574,P < 0. 05). The disappearance time of hydrothorax and chest pain in the observation group was earlier obviously than the control group( t = 18.556,15. 715,both P < 0. 001),and the pleura thickness in the observation was lower than the control group,indicating the significant difference( t = 4. 898,P < 0. 001). The differences in the levels of immune factors were not significant before and after treatment in the two groups( P > 0. 05). After treatment,the levels of immune factors in the observation group were all higher than the levels before treatment( P < 0. 05). The differences were not significant before and after treatment in the control group. After treatment,the levels of serum CD3~+,CD4~+and CD8~+in the observation group were higher than the control group,indicating the significant differences( t = 2. 268,6. 1,2. 578,all P < 0. 05). The incidence of adverse reaction was 2% in the observation group and was 4% in the control group,without significant difference in comparison of the two groups( P > 0. 05). Conclusion The combined treatment with the modified tingli dazao xiefei decoction and anti-tuberculous drugs improves the immune function in the patients of tuberculous pleuritis. It achieves the significant therapeutic effects and relieves the clinical symptoms.
Objective To explore the effects on tuberculous pleuritis and the impacts on immune function in the patients treated with the modified tingli dazao xiefei decoction and anti-tuberculous drugs. Methods From February2015 to June 2017,100 patients of tuberculous pleuritis were collected and divided into an observation group and a control group according to the random number table,50 cases in each one. In the control group,the anti-tuberculous drugs were selected. In the observation group,on the base of the treatment as the control group,the modified tingli dazao xiefei decoction was added. The immune factors were observed and compared before and after treatment in the two groups,as well as the improvements in the clinical symptoms and the clinical effects after treatment. Results After treatment,the clinical therapeutic effects in the observation group were generally better than the control group( Z =-2. 941,P < 0. 05),and the total effective rate in the observation group was higher obviously than the control group( X~2= 4. 574,P < 0. 05). The disappearance time of hydrothorax and chest pain in the observation group was earlier obviously than the control group( t = 18.556,15. 715,both P < 0. 001),and the pleura thickness in the observation was lower than the control group,indicating the significant difference( t = 4. 898,P < 0. 001). The differences in the levels of immune factors were not significant before and after treatment in the two groups( P > 0. 05). After treatment,the levels of immune factors in the observation group were all higher than the levels before treatment( P < 0. 05). The differences were not significant before and after treatment in the control group. After treatment,the levels of serum CD3~+,CD4~+and CD8~+in the observation group were higher than the control group,indicating the significant differences( t = 2. 268,6. 1,2. 578,all P < 0. 05). The incidence of adverse reaction was 2% in the observation group and was 4% in the control group,without significant difference in comparison of the two groups( P > 0. 05). Conclusion The combined treatment with the modified tingli dazao xiefei decoction and anti-tuberculous drugs improves the immune function in the patients of tuberculous pleuritis. It achieves the significant therapeutic effects and relieves the clinical symptoms.
引文
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[11]闫宝环,董玉霞,赵莲萍,等.温阳化湿利水法治疗结核性渗出性胸膜炎研究[J].中国中医基础医学杂志,2013,18(3):299-300.
[12]薛卫林,胡海波,赵国靖.和解通利法治疗结核性胸腔积液的实验研究[J].中华中医药学刊,2014,32(1):154-156.
[13]顾浏樱.小柴胡汤合葶苈大枣汤加减对结核性胸膜炎的疗效分析[J].中国热带医学,2014,14(12):1502-1504.
[14]黄小琪,林英辉,陈松林,等.结核性胸膜炎患者外周血及胸水中CD4+CD25+CD127+调节性T细胞表达水平的临床意义[J].细胞与分子免疫学杂志,2011,27(4):448-449.
[15]苏宏伟,王鹏,齐海亮,等. CD3、CD4、CD8T细胞亚群的表达对治疗结核性胸膜炎的疗效观察[J].河北医科大学学报,2014,35(8):930-932.
[16]史祥,唐亮,粟波.结核性胸膜炎患者胸腔积液T淋巴细胞及白细胞介素-2的变化[J].中国防痨杂志,2014,36(12):1067-1070.
[17]杜翠珍.葶苈大枣泻肺汤合三子养亲汤治疗肺心病疗效观察[J].陕西中医,2013,34(4):392-393.
[18]罗斌,田建辉.健脾益肺、峻泻利水法治疗肺癌并恶性胸腔积液1例[J].中医杂志,2016,57(24):2159-2160.
[19]张军国,王新宏,万月强,等.加味葶苈大枣泻肺汤对肺结核免疫调节及临床疗效研究[J].世界中医药,2016,11(9):1724-1727.
[2]高云,王涛,高月平,等.加味升降散对饮停胸胁型结核性胸膜炎患者胸腔积液ADA,外周血Treg细胞及DC细胞亚群的影响[J].中国实验方剂学杂志,2017(12):173-177.
[3]张兆奉.左氧氟沙星联合胸腔内注射尿激酶治疗结核性胸膜炎的临床观察[J].中国地方病防治杂志,2015(1):16-17.
[4]石菡,袁媛,李艳芳,等.结核感染T细胞斑点试验对结核性胸膜炎的临床诊断分析[J].中华医院感染学杂志,2016,26(7):1486-1488.
[5]唐神结,高文.临床结核病学[M].北京:人民卫生出版社,2011.
[6]郭榕,林存智,王彦斌,等.口服及胸腔注射糖皮质激素对结核性胸膜炎患者血清和胸腔积液中γ干扰素、肿瘤坏死因子-α表达水平的影响[J].中国全科医学,2010,13(13):1412-1415.
[7]Anai S,Hashisako M,Ikegame S,et al. Mantle cell lymphoma involvement of the pleura and tuberculous pleurisy with pulmonary tuberculosis:a case report and literature review[J]. Journal of Infection&Chemotherapy Official Journal of the Japan Society of Chemotherapy,2012,18(2):258-264.
[8]Fijakowski M,Graczyk J. Glucocorticoids in the treatment of tuberculous pleurisy[J]. Polski Merkuriusz Lekarski Organ Polskiego Towarzystwa Lekarskiego,2003,15(87):288.
[9]Zhou X,Lan J,Zhang T. A study on the use of mycobacterium vaccine in the treatment of tuberculous pleurisy[J]. Chinese journal of tuberculosis and respiratory diseases,2002,25(10):595.
[10]Lee CH,Wang WJ,Lan RS,et al. Corticosteroids in the treatment of tuberculous pleurisy. A double-blind,placebo-controlled,randomized study[J]. Chest,1996,94(6):333-338.
[11]闫宝环,董玉霞,赵莲萍,等.温阳化湿利水法治疗结核性渗出性胸膜炎研究[J].中国中医基础医学杂志,2013,18(3):299-300.
[12]薛卫林,胡海波,赵国靖.和解通利法治疗结核性胸腔积液的实验研究[J].中华中医药学刊,2014,32(1):154-156.
[13]顾浏樱.小柴胡汤合葶苈大枣汤加减对结核性胸膜炎的疗效分析[J].中国热带医学,2014,14(12):1502-1504.
[14]黄小琪,林英辉,陈松林,等.结核性胸膜炎患者外周血及胸水中CD4+CD25+CD127+调节性T细胞表达水平的临床意义[J].细胞与分子免疫学杂志,2011,27(4):448-449.
[15]苏宏伟,王鹏,齐海亮,等. CD3、CD4、CD8T细胞亚群的表达对治疗结核性胸膜炎的疗效观察[J].河北医科大学学报,2014,35(8):930-932.
[16]史祥,唐亮,粟波.结核性胸膜炎患者胸腔积液T淋巴细胞及白细胞介素-2的变化[J].中国防痨杂志,2014,36(12):1067-1070.
[17]杜翠珍.葶苈大枣泻肺汤合三子养亲汤治疗肺心病疗效观察[J].陕西中医,2013,34(4):392-393.
[18]罗斌,田建辉.健脾益肺、峻泻利水法治疗肺癌并恶性胸腔积液1例[J].中医杂志,2016,57(24):2159-2160.
[19]张军国,王新宏,万月强,等.加味葶苈大枣泻肺汤对肺结核免疫调节及临床疗效研究[J].世界中医药,2016,11(9):1724-1727.