摘要
目的:观察扶正抗痨方辅助化疗药物治疗阴虚血瘀型肺结核患者的临床疗效,并观察其对患者血清Foxp3、IL-2R、MCP-1及肝功能的影响。方法:136例肺结核患者根据入院顺序对所有患者进行编号,奇数编号纳入化疗组(n=68),偶数编号纳入联合组(n=68)。化疗组给予2EHRZ/4HR标准化疗方案,联合组给予扶正抗痨方联合2EHRZ/4HR标准化疗方案。比较两组患者临床疗效及肝功能[血清丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(aspartic transaminase,AST)及总胆红素(total bilirubin,TBiL)]、肝纤维[透明质酸酶(hyaluronidase,HA)、Ⅳ型胶原(collagenⅣ,CⅣ)、Ⅲ型前胶原氨基末端肽(procollagen type III N-terminal peptide,PCⅢ)及层粘连蛋白(laminin,LN)]及血清Foxp3、白细胞介素-2受体(interleukin-2 receptor,IL-2R),单核细胞趋化蛋白-1(monocyte chemoattractant protein-1,MCP-1)等指标。结果:联合组治疗3个月、6个月病灶吸收有效率、痰菌阴转率均显著高于化疗组(P<0.05)。联合组有效率为89.71%(61/68),化疗组有效率为76.47%(52/68),两组有效率比较,差异有统计学意义(P<0.05)。治疗前两组肝功能、肝纤维化指标和血清Foxp3 mRNA、IL-2R、MCP-1及中医证候积分比较,差异均无统计学意义(P>0.05);治疗后两组患者ALT、AST、TBiL水平均明显升高(P<0.05),联合组升高幅度低于化疗组(P<0.05);治疗后两组患者HA、CⅣ、PCⅢ、LN均明显降低(P<0.05),联合组降低幅度高于化疗组(P<0.05);治疗后两组患者血清IL-2R、MCP-1及Foxp3 mRNA均明显降低(P<0.05),联合组降低幅度高于化疗组(P<0.05);治疗后两组患者中医证候积分均明显降低,其中联合组降低幅度高于化疗组(P<0.05)。联合组肝功能损害发生率明显低于化疗组(P<0.05)。结论:扶正抗痨方辅助化疗药物治疗阴虚血瘀型肺结核患者能显著提高临床疗效,降低化疗不良反应,保护肝功能,抑制肝纤维化;其治疗机制可能与下调Foxp3 mRNA表达,降低血清IL-2R、MCP-1水平,提高免疫功能有关。
Objective:To observe the clinical effect of Fuzheng Kanglao Prescription in the treatment of pulmonary tuberculosis of yin deficiency and blood stasis type and the influence on the serum Foxp3,IL-2R,MCP-1 and liver function.Methods:136 patients were numbered according to the order of admission.The odd number was included in the chemotherapy group(n=68),and the even number was included in the combination group(n=68).The chemotherapy group was given 2EHRZ/4HR standard chemo-therapy plan,and the combined group was given Fuzheng Kanglao Prescription and 2EHRZ/4HR standard chemotherapy plan.The clinical efficacy and liver function[serum alanine aminotransferase(ALT),aspartic transaminase(AST),total bilirubin(TBiL)],liver fiber[hyaluronidase(HA),collagenⅣ(CⅣ),procollagen type III N-terminal peptide(PCⅢ),laminin(LN)],Foxp3,interleukin-2 receptor(IL-2R)and monocyte chemoattractant protein-1(MCP-1)of the two groups were compared.Re-sults:The effective rate of focus absorption and sputum negative conversion in the combined group were significantly higher than those in the chemotherapy group(P<0.05).The effective rate of the combination group was 89.71%,and that of the chemother-apy group was 76.47%.The difference between the two groups was statistically significant(P<0.05).There was no significant difference in liver function,liver fibrosis index,serum Foxp3 mRNA,IL-2R,MCP-1 and TCM syndrome score between the two groups before treatment(P>0.05);after treatment,the levels of alt,AST and TBi in the combined group were significantly higher than those in the chemotherapy group(P<0.05),and the levels of HA,CⅣ,PCⅢand LN in the combined group were signifi-cantly lower than those in the chemotherapy group(P<0.05);after treatment,the levels of IL-2R,MCP-1 and Foxp3 mRNA in the two groups were significantly reduced(P<0.05),and the decrease rate in the combined group was higher than that in the chemotherapy group(P<0.05);after treatment,the TCM syndrome scores in the two groups were significantly reduced,and the decrease rate in the combined group was higher than that in the chemotherapy group(P<0.05).The incidence of liver function damage in the combined group was significantly lower than that in the chemotherapy group(P<0.05).Conclusion:Fuzheng Kan-glao Prescription can significantly improve the clinical effect,reduce the adverse reactions of chemotherapy,protect the liver func-tion and inhibit the liver fibrosis in the treatment of pulmonary tuberculosis of yin deficiency and blood stasis type.The mechanism of its treatment may be related to the down regulation of Foxp3 mRNA expression,the reduction of serum IL-2R and MCP-1 levels and the improvement of immune function.
作者
王栋
贾米山
韩娜
WANG Dong;JIA Mishan;HAN Na(Affiliated Hospital of Hebei University,Baoding Hebei China 071000)
出处
《中医学报》
CAS
2020年第1期189-193,共5页
Acta Chinese Medicine
基金
河北省2017年度医学科学研究重点计划项目(201707809)。
关键词
扶正抗痨方
肺结核
阴虚血瘀证
化疗
肝功能
肝纤维化
FOXP3
白细胞介素-2受体
单核细胞趋化蛋白-1
中西医结合
Fuzheng Kanglao Prescription
pulmonary tuberculosis
yin deficiency and blood stasis syndrome
chemotherapy
liver function
liver fibrosis
Foxp3
interleukin-2 receptor
monocyte chemoattractant protein-1
integration of traditional and Western Medicine
