目的 观察中西医结合治疗肺结核强化期的疗效.方法 将108例初治继发性肺结核随机分为试验组和对照组,均用2HREZ/4HR方案抗结核治疗,试验组辨证加用中成药,肺阴虚证用滋阴润肺免煎颗粒,阴虚火旺证用肺泰胶囊,气阴两虚证用双百口服液.每月复查血常规、肝肾功、痰涂片、胸片,隔月复查T细胞亚群并进行中医证候评分,共治疗6个月.结果 2组在抗痨治疗1、2个月后,丙氨酸氨基转移酶、门冬氨酸氨基转移酶、尿素氮、肌酐等指标无明显变化,血小板均低于治疗前,试验组低于对照组;2组尿酸水平均明显高于治疗前,组间比较差异无统计学意义.对照组白细胞较治疗前明显降低而血糖升高,试验组血糖和中医证候评分明显低于对照组.治疗1个月后,试验组胸片吸收和痰涂片阴转情况均优于对照组;治疗2个月后,试验组总胆红素水平较治前明显下降,血红蛋白浓度与治疗前和对照组相比明显升高,胸片吸收优于对照组,痰涂片阴转情况和对照组相似.结论 中西医结合疗法在缓解肺结核症状、促进病情改善和减轻抗痨药不良反应方面有一定优势.%Objective To observe the curative effect of integrated traditional Chinese and western medicine treatment of pulmonary tuberculosis in anti-tuberculosis strengthening period. Methods Total of 108 cases of initial treatment secondary tuberculosis were randomly divided into experimental group and control group. Both groups were treated with 2HREZ/4HR antitubercular scheme, and the experimental group with corresponding Chinese medicine according to TCM syndrome differentiation for 6 months: lung yin deficiency syndrome with Ziyin Runfei particles, yin deficiency and fire excess syndrome with Feitai capsule, qi and yin deficiency syndrome with Shuangbai oral liquid. The blood rountine examination, hepatorenal function, sputum smear and chest radiograph were reexamined monthly, and T lymphocyte subsets and syndromes score were observed every other month. Results After the treatment of 1 month and 2 months, ALT, AST, BUN and Cr of both groups had no obvious change, PLT were lowered, and the experimental group was lower than the control group. Uric acid levels of both groups were significantly higher, and there was no significance difference between the two groups. WBC of the control group was significantly decreased while GLU was increased. TCM syndrome score and GLU of the experimental group were obviously lower than the control group. After 1 month, chest radiograph absorption and sputum smear negative turn rate of the experimental group were superior to the control group. After 2 months, TB level of the experimental group was dropped significantly, HGB was significantly higher than the former and the control group, chest radiograph absorption was superior to the control group, sputum smear negative turn rate was similar to the control group. Conclusion TCM syndrome differentiation has certain advantages in alleviating tuberculosis symptoms, improving patient's condition and reducing side effects of anti-tuberculosis medication.
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