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目的探讨耐多药肺结核患者机体免疫状况及使用免疫增强剂治疗的疗效。方法130例耐多药肺结核患者随机分为2组,均以力克肺疾治疗为基础,并与临床可供配伍的3种以上抗结核药物组成联合治疗方案,总疗程为18个月。Ⅰ组患者在抗结核治疗基础上,最初6个月加用白细胞介素2;Ⅱ组不用白细胞介素2。观察两组病例血清白细胞介素2受体水平、痰菌阴转率、空洞好转率和远期复发率。结果疗程结束时Ⅰ组和Ⅱ组痰菌阴转率分别为87.5%、72.7%,两组比较差异有显著性意义(P<0.05);空洞缩小或闭合率分别为70.7%、44.4%,两组比较差异有显著性意义(P<0.05);治疗6个月时血清白细胞介素2受体水平Ⅰ组与Ⅱ组分别为(321.0±38.4)和(382.0±61.5)U/ml,两组比较差异有显著性意义(P<0.01)。随访18个月痰菌复阳率Ⅰ组为11.1%明显高于Ⅱ组的23.9%(P<0.05)。结论耐多药肺结核患者存在免疫功能低下,采用白细胞介素2长程间歇治疗,可明显提高疗效和降低远期复发率,不良反应较轻。
Objective To investigate the immune status of patients with multidrug-resistant pulmonary tuberculosis and the efficacy of immunostimulant therapy. Methods A total of 130 MDR-TB patients were randomly divided into 2 groups. All of them were based on Lectra Pulmonary Disease and combined with 3 kinds of anti-TB drugs clinically available for combination therapy. The total course of treatment was 18 months. Group Ⅰ patients on the basis of anti-TB treatment, the first 6 months plus interleukin 2; Ⅱ group without interleukin 2. Serum interleukin 2 receptor levels, sputum negative conversion rate, void turnover rate and long-term recurrence rate were observed in two groups. Results At the end of the treatment, the sputum negative conversion rates in group Ⅰ and group Ⅱ were 87.5% and 72.7%, respectively. There was significant difference between the two groups (P <0.05). The shrinking or closing rates of cavities were 70.7% and 44.4% (P <0.05). The level of serum IL-2 at 6 months after treatment was (321.0 ± 38.4) and (382.0 ± 61.5) U / ml in group Ⅰ and group Ⅱ, respectively The difference was significant (P <0.01). After 18 months of follow-up, the rate of sputum positive recovery in group Ⅰ was 11.1%, which was significantly higher than that in group Ⅱ (23.9%, P <0.05). Conclusions There are immunocompromised patients with multidrug-resistant pulmonary tuberculosis. Intermittent Interleukin-2 treatment can significantly improve the curative effect and reduce the long-term recurrence rate with less adverse reactions.