摘要目的 观察利奈唑胺对重症结核病患者炎性因子、T淋巴细胞水平的影响.方法 选择浙江金华广福医院2016年4月至2017年11月治疗的重症结核病患者60例为研究对象,根据治疗方案不同分为对照组(n=30)和观察组(n=30).对照组采用个性化抗结核方案治疗,观察组在对照组基础上联合利奈唑胺治疗,两组均连续治疗9个月.观察两组治疗前后白细胞介素1(IL-1)、肿瘤坏死因子α(TNF-α)、IL-6、IL-10及CD3+、CD4+、CD8+、CD4+/CD8+变化,比较两组肝功能受损、血小板减少、骨髓抑制、恶心呕吐、腹泻发生情况.结果 治疗前,两组IL-1、TNF-α、IL-6、IL-10及CD4+、CD8+、CD8+、CD4+/CD8+差异均无统计学意义(均P＞0.05).治疗后9个月,对照组IL-1、TNF-α、IL-6、IL-10分别为(10.94±1.31) ng/L、(3.03±0.49) ng/L、(183.43±13.24)ng/L、(134.93±34.51) ng/L,观察组分别为(6.89±1.29) ng/L、(2.49±0.45) ng/L、(129.48±10.74) ng/L、(189.35±43.27) ng/L,两组差异均有统计学意义(t=12.195、11.214、8.414、11.291,均P＜0.05);对照组CD3+、CD4+、CD8+、CD4+/CD8+分别为(47.61±7.16)％、(15.49±6.64)％、(20.58±5.61)％、(0.79±0.19),观察组分别为(65.46±8.31)％、(30.23±7.85)％、(34.59±7.41)％、(0.87±0.24),两组差异均有统计学意义(t=10.497、7.865、12.128、10.291,均P＜0.05).两组肝功能受损、血小板减少、骨髓抑制、恶心呕吐、腹泻发生率差异均无统计学意义(均P＞0.05).结论 利奈唑胺用于治疗重症结核病,有助于降低炎性因子水平,改善患者细胞免疫水平,不良反应发生率较低.

abstractsObjective To observe the effects of linezolid on the levels of inflammatory factors and T lymphocytes in patients with severe tuberculosis.Methods Sixty patients with severe tuberculosis treated in Jinhua Guangfu Hospital from April 2016 to November 2017 were selected and divided into control group(n =30) and observation group(n =30) according to different treatment options.The control group was treated with personalized anti-tuberculosis regimen.The observation group was treated with linezolid on the basis of the control group,and both two groups were treated for 9 months.The changes of interleukin-1 (IL-1),tumor necrosis factor alpha (TNF-α),IL-6,IL-10 and CD3+,CD4+,CD8+ and CD4+/CD8+ were observed before and after treatment.The incidence of liver injury,thrombocytopenia,myelosuppression,nausea and vomiting,diarrhea were observed.Results Before treatment,there were no statistically significant differences in IL-1,TNF-α,IL-6,IL-10,CD4+,CD8+,CD8+,CD4+/CD8+ between the two groups(all P＞0.05).At 9 months after treatment,the levels of IL-1,TNF-α,IL-6 and IL-10 in the control group were (10.94 ± 1.31) ng/L,(3.03 ± 0.49) ng/L,(183.43 ± 13.24) ng/L,(134.93 ± 34.51) ng/L,respectively,which in the observation group were (6.89 ± 1.29) ng/L,(2.49 ± 0.45) ng/L,(129.48 ± 10.74) ng/L,(189.35 ± 43.27)ng/L,respectively,the differences between the two groups were statistically significant(t =12.195,11.214,8.414,11.291,all P ＜ 0.05).The CD3+,CD4+,CD8+,CD4+/CD8+ in the control group were (47.61 ± 7.16) ％,(15.49 ± 6.64) ％,(20.58 ± 5.61) ％,(0.79 ± 0.19),respectively,which in the observation group were (65.46 ± 8.31) ％,(30.23 ± 7.85) ％,(34.59 ± 7.41) ％,(0.87 ± 0.24),respectively,the differences between the two groups were statistically significant (t =10.497,7.865,12.128,10.291,all P ＜ 0.05).There were no statistically significant differences in the incidence of liver function impairment,thrombocytopenia,myelosuppression,nausea and vomiting,and diarrhea between the two groups(all P ＞ 0.05).Conclusion Linezolid in the treatment of severe tuberculosis can reduce the level of inflammatory factors,improve the cellular immune level of patients,and has a lower incidence of adverse effects.