目的 探讨黄芪注射液联合抗结核药物对肺结核合并糖尿病患者的临床疗效.方法 选取2014年6月至2016年3月陕西省结核病防治院收治的76例初治涂阳肺结核合并糖尿病患者,采用随机数字表法随机分成两组,每组38例.均予胰岛素皮下注射控制血糖,在此基础上对照组予2H3R3Z3E3/4H3R3抗结核方案(强化2个月,巩固4个月),研究组在上述基础上再予黄芪注射液静脉滴注.检测治疗前后血糖、血清瘦素(LEP)和脂联素(APN)水平以及痰菌阴转率,参照X线胸片、CT等影像学检查评价肺部病灶和空洞变化情况,并观察其安全性.结果与治疗前比较,两组空腹血糖(FPG)、糖化血红蛋白(HbA1c)、餐后2h血糖(2hPG)水平降低,LEP水平降低(P＜0.01),APN水平升高(P＜0.01),研究组CD3+、CD4+及CD4+/CD8+水平升高(P＜0.05),CD8+水平降低(P＜0.05);与对照组比较,研究组FPG、HbA1c和2hPG水平较低,LEP水平较低(P＜0.01),APN水平较高(P＜0.01),CD3+、CD4圾CD4-/CD8+水平较高(P＜0.05),CD8+水平较低(P＜0.05),1个月末、3个月末和6个月末痰菌阴转率较高(P＜0.05),病灶及空洞变化较优(P＜0.05).结论 黄芪注射液联合抗结核药物能促进肺结核伴糖尿病患者结核病灶吸收及痰菌阴转,一定程度上改善血糖和免疫功能.%Objective To study the clinical effect of Astragalus Injection on tuberculosis and diabetes mellitus patients.Methods Seventy-six newly diagnosed smear positive pulmonary tuberculosis patients with diabetes mellitus from June 2014 to March 2016 from Institute of Tuberculosis Prevention and Control of Shaanxi Province were randomly divided into two groups (n=38) by random number table method.All patients received subcutaneous injection of insulin to control blood glucose,in addition,the control group was given 2H3R3Z3E3/4H3R3 anti-tuberculosis regimen (fortified for 2 months and consolidated for 4 months),and the study group received Astragalus Injection based on the control group.The levels of blood glucose,serum LEP and APN and the conversion rate of sputum were measured before and after the treatment.The lung lesions and cavitation were compared by radiographic examination,and the safety was also compared.Results Compared with before treatment,the levels of FPG,HbA1c and 2hPG in 2 groups decreased,levels of LEP decreased (P ＜ 0.01),levels of APN increased (P ＜ 0.01),levels of CD3+,CD4+ and CD4+/CD8+ in the study group increased (P ＜ 0.05),and the levels of CD8+ decreased (P ＜ 0.05).Compared with the control group,levels of FPG,HbA1c and 2hPG in the study group were lower,levels of LEP were lower (P ＜ 0.01),levels of APN were higher (P ＜ 0.01),CD3+,CD4+ and CD4+/CD8+ levels were higher (P ＜ 0.05) and CD8+ levels were lower (P ＜ 0.05).At 1 month,3 months and 6 months,sputum negative rates of the study group were higher than those of the control group (P ＜ 0.05).Change of lesions and cavities in the study group was better than that in the control group (P ＜ 0.05).Conclusion Astragalus Injection combined with anti-tuberculosis drugs can promote the absorption of PTB and the sputum negative conversion of PTB,improve the blood glucose and immune function to a certain extent.
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