Abstract:

Objective　To investigate the effects of Baihe Dihuang decoction combined with standardized chemotherapy regimen on the sputum negative conversion rate and the levels of serum T lymphocyte subsets in elderly patients with pulmonary tuberculosis. Methods　This study was a randomized controlled trial. A total of 106 elderly patients with pulmonary tuberculosis who were treated in the Third Hospital of Yulin from January 2022 to January 2024 were selected and were divided into a control group and a study group by the random number table method. In the control group, 26 males and 27 females, aged (65.83±3.75) years, with a body mass index of (21.26±1.19) kg/m², received standardized chemotherapy regimen (2HRZE/4HR, H: isoniazid, R: rifampicin, Z: pyrazinamide, E: Ethambutol), oral isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months; after that, oral isoniazid tablets and rifampicin capsules were continued for 4 months. In the study group, 28 males and 25 females, aged (66.19±3.59) years, with a body mass index of (21.23±1.20) kg/m², were treated with Baihe Dihuang decoction on the basis of the control group, one dose per day, divided into two times before morning and evening meals, and continued to be administered during the treatment of standardized chemotherapy regimen for 6 months. The observation indicators included the sputum negative conversion rate, traditional Chinese medicine (TCM) syndrome score, lung function indices [forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), and peak expiratory flow (PEF)], blood gas indices [arterial oxygen pressure (PaO₂), arterial carbon dioxide pressure (PaCO₂), and oxygenation index (OI)], and changes in levels of serum T lymphocyte subsets (CD3+, CD4+, and CD4+/CD8+), and the occurrence of adverse reactions during treatment was recorded. χ² test and t test were used for statistical analysis. Results　After treatment, the sputum negative conversion rate in the study group was higher than that in the control group [86.79% (46/53) vs. 66.04% (35/53)], with a statistically significant difference (χ²=6.334, P=0.012); the scores of dry cough and fatigue, hot flusher and night sweats, hot hands and heart, and fine and rapid pulse were lower than those in the control group [(0.65±0.16) points vs. (0.78±0.15) points, (0.58±0.13) points vs. (0.66±0.19) points, (0.59±0.17) points vs. (0.71±0.16) points, (0.58±0.18) points vs. (0.69±0.20) points]; the levels of FEV₁, FVC, PEF, PaO₂, OI, CD3+, CD4+, and CD4+/CD8+ were higher than those in the control group [(1.23±0.26) L vs. (1.02±0.11) L, (2.06±0.28) L vs. (1.87±0.31) L, (1.29±0.22) L/s vs. (1.14±0.20) L/s, (63.28±5.88) mmHg (1 mmHg=0.133 kPa) vs. (60.17±6.24) mmHg, 400.65±30.90 vs. 387.16±29.42, (68.78±6.53) ×10⁹/L vs. (65.01±6.41) ×10⁹/L, (41.59±3.46) ×10⁹/L vs. (38.97±3.51) ×10⁹/L, 1.58±0.22 vs. 1.36±0.19], but the PaCO₂ was lower than that in the control group [(45.02±4.47) mmHg vs. (47.79±4.16) mmHg], with statistically significant differences (all P<0.05). The incidence of adverse reactions in the study group was 9.43% (5/53), which was lower than that in the control group [24.53% (13/53)], with a statistically significant difference (χ²=4.283, P=0.038). Conclusion　Baihe Dihuang decoction combined with standardized chemotherapy regimen significantly enhances the sputum negative conversion rate and may improve immune function via elevated CD4+ T cell level, offering a potential adjunct therapy for treating elderly patients with pulmonary tuberculosis.

Key words:

Pulmonary tuberculosis, Elderly, Baihe Dihuang , decoction, Standardized chemotherapy regimen, Sputum negative conversion rate, T lymphocyte subsets

摘要：

目的　探讨标准化疗方案联合百合地黄汤治疗对老年肺结核患者痰菌转阴率及血清T淋巴细胞亚群水平等的影响。方法　本研究为随机对照试验。选取2022年1月至2024年1月在榆林市第三医院就诊的老年肺结核患者106例，采用随机数字表法将患者分为对照组和研究组，每组53例。对照组男26例、女27例，年龄（65.83±3.75）岁，体重指数（21.26±1.19）kg/m²，接受标准化疗方案（2HRZE/4HR，H：异烟肼，R：利福平，Z：吡嗪酰胺，E：乙胺丁醇）治疗，口服异烟肼、利福平、吡嗪酰胺、乙胺丁醇，持续治疗2个月；之后，继续口服异烟肼、利福平，持续治疗4个月。研究组男28例、女25例，年龄（66.19±3.59）岁，体重指数（21.23±1.20）kg/m²，在对照组基础上联合百合地黄汤治疗，每日1剂，分2次于早、晚饭前服用；在标准化疗方案治疗期间连续服用，持续6个月。比较两组痰菌转阴率、中医证候积分、肺功能指标［第1秒用力呼气量（FEV₁）、用力肺活量（FVC）、呼气流量峰值（PEF）］、血气指标［动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、氧合指数（OI）］、血清T淋巴细胞亚群（CD3+、CD4+和CD4+/CD8+）水平变化，并记录治疗期间不良反应发生情况。采用χ²检验、t检验进行统计分析。结果　治疗6个月后，研究组的痰菌转阴率高于对照组［86.79%（46/53）比66.04%（35/53）］，差异有统计学意义（χ²=6.334，P=0.012）；中医证候积分的干咳乏力、潮热盗汗、手足心热、脉象细数评分均低于对照组［（0.65±0.16）分比（0.78±0.15）分、（0.58±0.13）分比（0.66±0.19）分、（0.59±0.17）分比（0.71±0.16）分、（0.58±0.18）分比（0.69±0.20）分］；FEV₁、FVC、PEF、PaO₂、OI水平均高于对照组［（1.23±0.26）L比（1.02±0.11）L、（2.06±0.28）L比（1.87±0.31）L、（1.29±0.22）L/s比（1.14±0.20）L/s、（63.28±5.88）mmHg（1 mmHg=0.133 kPa）比（60.17±6.24）mmHg、400.65±30.90比387.16±29.42］；CD3+、CD4+、CD4+/CD8+均高于对照组［（68.78±6.53）×10⁹/L比（65.01±6.41）×10⁹/L、（41.59±3.46）×10⁹/L比（38.97±3.51）×10⁹/L、1.58±0.22比1.36±0.19］；PaCO₂低于对照组［（45.02±4.47）mmHg比（47.79±4.16）mmHg］，差异均有统计学意义（均P<0.05）。研究组的不良反应发生率低于对照组［9.43%（5/53）比24.53%（13/53）］，差异有统计学意义（χ²=4.283，P=0.038）。结论　标准化疗方案治疗和百合地黄汤的联合使用，能显著提高老年肺结核患者的痰菌转阴率，并可能通过增强免疫功能中的CD4+T细胞水平发挥作用。

关键词:

肺结核, 老年, 百合地黄汤, 标准化疗方案, 痰菌转阴率, T淋巴细胞亚群