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投稿时间：2020-11-18 网络发布日期：2021-07-20
投稿时间：2020-11-18 网络发布日期：2021-07-20
中文摘要: 目的研究含左氧氟沙星（3HRZELfx5HRLfx）化疗方案联合氯法齐明治疗耐药性肺结核的效果及对免疫平衡、血清可溶性T细胞免疫球蛋白黏蛋白分子3(sTim-3)、视黄醇结合蛋白-4(RBP-4)水平的影响。方法2017年6月至2018年6月在第906医院进行治疗的124例耐药性肺结核患者被随机分为对照组和观察组,每组62例。对照组给予3HRZELfx5HRLfx化疗,观察组在同样化疗基础上联合氯法齐明,治疗8个月。比较两组患者治疗3、8个月时的痰菌转阴率、病灶吸收率、临床疗效。分别于治疗前、治疗8个月时测定辅助性T细胞(Th)1、Th2及IFN-γ、IL-4、sTim-3、RBP-4水平;关注治疗期间的不良反应。结果治疗前,两组患者的一般资料和各项指标差异无统计学意义(P>0.05);观察组治疗3、8个月的痰菌转阴率、病灶吸收率均显著高于对照组(P<0.05,P<0.01)。治疗8个月评价,观察组和对照组的临床总有效率分别为96.77%、79.03%,差异有统计学意义(P<0.01)。治疗8个月时,观察组Th1和Th1/Th2显著高于对照组,Th2显著低于对照组(P<0.05,P<0.01);INF-γ显著高于对照组,IL-4显著低于对照组(P<0.05,P<0.01);sTim-3显著低于对照组,RBP-4显著高于对照组(P<0.01)。两组胃肠道反应发生率差异无统计学意义(P>0.05),观察组皮肤颜色改变发生率显著高于对照组(P<0.01),但停药后患者皮肤颜色改变均恢复。结论3HRZELfx5HRLfx化疗方案联合氯法齐明能够提高耐药性肺结核的临床疗效,改善Th1/Th2及相应细胞因子的平衡,下调sTim-3而减轻免疫抑制,上调RBP-4而改善免疫功能。
中文关键词: 氯法齐明 辅助性T细胞 免疫平衡 可溶性T细胞免疫球蛋白黏蛋白分子3 视黄醇结合蛋白-4
Abstract:Objective To analyze the effect of levofloxacin-containing chemotherapy regimen (3HRZELfx5HRLfx) combined with clofazimine in the treatment of drug-resistant pulmonary tuberculosis and its influence on immune balance,soluble T-cell immunoglobulin and mucin domain 3 (sTim-3) and retinol-binding protein 4 (RBP-4).
Methods A total of 124 patients with drug-resistant pulmonary tuberculosis who received treatment at 906th Hospital from June 2017 to June 2018 were randomly divided into control group and observation group(n=62,each).3HRZELfx5HRLfx was given in control group,and clofazimine was added based on 3HRZELfx5HRLfx chemotherapy in observation group for 8 months.The bacteriological sputum conversion rate,lesion absorption rate and clinical efficacy were compared at 3 months and 8 months of treatment between two groups.T helper cell(Th)1,Th2,interferon (IFN)-γ,interleukin-4(IL-4),sTim-3 and RBP-4 were detected before treatment and 8 months after treatment.The adverse reactions were observed during the treatment.
Results Before treatment,there were no significant differences in general information and indicators between two groups (P>0.05).At 3 months and 8 months of treatment,the bacteriological sputum conversion rate and lesion absorption rate in observation group were significantly higher than those in control group (P<0.05,P<0.01).At 8 months of treatment,the total effective rate in observation group was significantly higher than that in control group (96.77% vs 79.03%,P<0.01).Compared with control group,Th1 and Th1/Th2 significantly increased,Th2 decreased,the levels of INF-γ and RBP-4 increased,and the levels of IL-4 and sTim-3 decreased significantly in observation group(P<0.05,P<0.01).There was no significant difference in the incidence of gastrointestinal reactions between two groups (P>0.05).The incidence of skin color change in observation group was significantly higher than that in control group (P<0.01),and changes in the skin returned to normal after drug withdrawal in patients.
Conclusion 3HRZELfx5HRLfx chemotherapy combined with clofazimine can improve the clinical efficacy of drug-resistant pulmonary tuberculosis and have advantages in improving the balance of Th1/Th2 and corresponding cytokines,down-regulating sTim-3 to reduce immunosuppression,up- regulating RBP-4 to improve immune function.
keywords: Clofazimine Helper T cells Immune balance Soluble T-cell immunoglobulin and mucin domain 3 Retin-binding protein-4
文章编号： 中图分类号：R521 文献标志码：B
基金项目:
| 作者 | 单位 |
| 程茹1 | 1.上海应用技术大学化学与环境工程学院,上海 201418； |
| 张素霞1 | 1.上海应用技术大学化学与环境工程学院,上海 201418； |
| 余史丹2 | 2.中国人民解放军联勤保障部队第906医院，浙江 宁波 315300 |
| Author Name | Affiliation |
| CHENG Ru*,ZHANG Su-xia,YU Shi-dan | *College of Chemistry and Environmental Engineering,Shanghai Institute of Technology,Shanghai 201418,China |
引用文本：
程茹,张素霞,余史丹.含左氧氟沙星化疗方案联合氯法齐明治疗耐药肺结核的效果及对血清sTim-3、RBP-4水平的影响[J].中国临床研究,2021,34(7):921-926.
程茹,张素霞,余史丹.含左氧氟沙星化疗方案联合氯法齐明治疗耐药肺结核的效果及对血清sTim-3、RBP-4水平的影响[J].中国临床研究,2021,34(7):921-926.