周忠进 　左文涛

【摘要】 目的：探討纤维支气管镜介入治疗肺结核的效果及对免疫功能的影响。方法：选取120例初治涂阳肺结核患者作为研究对象，随机分为研究组和对照组，各60例。所有患者均采用传统化学治疗，研究组每周另给予一次纤维支气管镜注射辅助治疗。比较两组治疗2、6、9个月后的痰菌转阴率，6个月后病灶好转率及治疗前后T细胞亚群、IFN-γ、IL-4水平变化情况。结果：研究组治疗后不同时间点痰菌转阴率和病灶好转率均高于对照组（P<0.05）;治疗后两组CD4+与CD4+/CD8+水平较治疗前升高，CD8+水平较治疗前降低，且研究组变化幅度较对照组更显著（P<0.05）;治疗后两组IFN-γ水平较治疗前升高，IL-4水平较治疗前降低，且研究组变化幅度较对照组更显著（P<0.05）。结论：纤维支气管镜介入治疗肺结核效果显著，且能有效改善机体免疫功能。

【关键词】 肺结核 纤维支气管镜 痰菌转阴率

doi：10.14033/j.cnki.cfmr.2019.28.010 文献标识码 B 文章编号 1674-6805（2019）28-00-03

Effect of Interventional Therapy with Fiberoptic Bronchoscope on Tuberculosis and Its Influence on Immune Function/ZHOU Zhongjin， ZUO Wentao. //Chinese and Foreign Medical Research， 2019， 17（28）： -26

[Abstract] Objective： To investigate the effect of interventional therapy with fiberoptic bronchoscope on tuberculosis and its influence on immune function. Method： A total of 120 cases of primary smear positive tuberculosis were selected as research objects and randomly divided into the study group and the control group， 60 cases in each group. All patients were treated with traditional chemotherapy， and the study group was given additional fiberoptic bronchoscope injection as adjuvant therapy once a week. The sputum negative conversion rate after treatment 2， 6 and 9 months， improvement rate of lesions after 6 months and the levels of T lymphocyte subsets， IFN-γ， IL-4 before and after treatment were compared between the two groups. Result： The sputum negative conversion rate and improvement rate of lesions in the study group were higher than those of the control group at different time points after treatment （P<0.05）. After treatment， the levels of CD4+ and CD4+/CD8+ in the two groups were increased compared with those before treatment and CD8+ in the two groups were decreased compared with those before treatment， and the changes range of the study group were more significant than those of the control group （P<0.05）. After treatment， the levels of IFN-γ in the two groups were increased compared with those before treatment and IL-4 in the two groups were decreased compared with those before treatment， and the changes range of the study group were more significant than those of the control group （P<0.05）. Conclusion： Interventional therapy with fiberoptic bronchoscope for tuberculosis is effective， and can effectively improve the bodys immune function.

[Key words] Tuberculosis Fiberoptic bronchoscope Sputum negative conversion rate

First-authors address： Guangshui First Peoples Hospital， Guangshui 432700， China

结核病是由结核杆菌感染引起的慢性传染病，具有传染性强、病情易反复、传统药物治疗疗程较长的特点[1]。肺结核是结核病的一种，是常见的呼吸系统传染病，对人类健康危害大，需要重点防治[2]。消除感染源及控制流行的最根本措施是早期诊断和及时治疗[3]。典型肺结核患者表现为咳嗽、咯血、胸痛等结核中毒症状，较容易被确诊。不典型肺结核患者的临床症状、体征及胸部影像学表现与典型肺结核患者不同，确诊难度较大，容易发生误诊或漏诊[4-5]。另外，随着各种抗菌药物广泛使用，新的耐药菌株大量出现，耐多药肺结核发病率增高，成为治疗肺结核的重大威胁[6]。纤维支气管镜能够直视支气管内膜病变，直观观察病灶情况，能够对局部病灶分泌物进行有效抽吸，并向病灶直接注射抗结核药物，提高局部药物浓度，促进药物吸收[7]。因此近年来，纤维支气管镜成为诊断和治疗肺结核的有效手段。……