内科

目的探讨四联抗结核治疗方案联合纤维支气管镜下异烟肼和地塞米松磷酸钠治疗气管支气管结核（TBTB）的临床效果。方法选取200例TBTB患者为研究对象，将其随机分为对照组和研究组各100例。对照组行四联抗结核药（异烟肼、利福平、吡嗪酰胺和乙胺丁醇）治疗，研究组在对照组的基础上行纤维支气管镜下局部给药（异烟肼和地塞米松磷酸钠注射液）治疗，两组患者均治疗6个月。比较两组患者的治疗总有效率、治疗前和治疗结束后1个月内血清CD4+、CD8+、腺苷脱氨酶(ADA)水平，CD4+/CD8+，γ-干扰素体外释放试验（IGRA）阳性率，症状缓解时间，痰菌转阴率，以及治疗结束后随访6个月内的肺不张发生率。结果治疗结束后1个月，研究组患者治疗总有效率为97.0%，高于对照组的87.0%。治疗前，两组患者血清CD4+、CD8+、ADA 水平，CD4+/CD8+和IGRA阳性率比较，差异均无统计治疗意义（均P＞0.05）；治疗结束后1个月内，研究组血清CD4+水平和CD4+/CD8+均高于对照组，血清CD8+、ADA水平和IGRA阳性率均低于对照组（均P＜0.05）。研究组患者症状缓解时间短于对照组，痰菌转阴率（97.0%）高于对照组（82.0%）（均P＜0.05）。治疗结束后随访6个月内，观察组肺不张发生率为3.0%，低于对照组的19.0%（P＜0.05）。结论四联抗结核用药+纤维支气管镜下使用异烟肼和地塞米松磷酸钠注射液局部给药，能有效地缓解TBTB患者临床症状，提高免疫功能，改善病情，保护肺功能，值得临床运用推广。

ObjectiveTo investigate the clinical effect of quadruple anti-tuberculosis regimen combined with isoniazid and dexamethasone sodium phosphate under fiber bronchoscope in the treatment of tracheobronchial tuberculosis (TBTB). MethodsA total of 200 TBTB patients were selected as the research objects, and they were randomly divided into control group and research group, with 100 cases in each group. The control group was treated with quadruple anti-tuberculosis drugs (isoniazid, rifampin, pyrazinamide, and ethambutol), while the research group was treated with topical administration (isoniazid and dexamethasone sodium phosphate injections) under fiber bronchoscope based on the control group. Patients in both groups were treated for 6 months. The total effective rate of treatment, serum CD4+, CD8+, adenosine deaminase (ADA) levels, CD4+/CD8+, and interferon-γ release assay (IGRA) positive rates before treatment and within 1 month after treatment, symptom relief time, and the sputum negative conversion rate, as well as the incidence of atelectasis within 6 months of follow-up after treatment were compared in the two groups. ResultsOne month after the end of treatment, the total effective rate of patients in the research group was 97.0%, which was higher than the 87.0% in the control group. Before treatment, there were no statistically significant differences in serum CD4+, CD8+, and ADA levels, CD4+/CD8+, as well as the IGRA positive rate between the two groups (all P＞0.05). Within 1 month after the end of treatment, the serum CD4+ level and CD4+/CD8+ in the research group were higher than those in the control group, while the serum CD8+, ADA levels and IGRA positive rate were lower than those in the control group (all P＜0.05). The symptom relief time of the research group was shorter than that of the control group, and the sputum negative conversion rate (97.0%) was higher than that of the control group (82.0%) (all P＜0.05). Within 6 months of follow-up after treatment, the incidence of atelectasis in the observation group was 3%, which was lower than the 19% in the control group (P＜0.05). ConclusionQuadruple anti-tuberculosis drugs combined with topical administration of isoniazid and dexamethasone sodium phosphate injections under fiber bronchoscope can effectively relieve clinical symptoms of TBTB patients, improve immune function and disease condition, and protect lung function, which is worthy of clinical application promotion.