CAJ | 학술논문

目的：比较中医整体观辨治和对症治疗耐多药肺结核（ MDR-TB ）化疗过程胃肠道反应的近期疗效和复发率以及对MDR-TB疗效的影响。方法将2000年1月-2009年12月在门诊化疗过程出现胃肠道反应的MDR-TB患者96例，分为中医辨治组（观察组）和对症治疗组（对照组）。中医辨治组经辨证分为2型，分别用参苓白术散加减和补天大造丸合理中汤加减治疗，对症治疗组用奥美拉唑、盐酸甲氧氯普胺治疗；观察比较两组治疗前后胃肠道反应症状积分、全疗程胃肠道反应复发率、全疗程因胃肠道反应干预失败而中断口服化疗率、24个月内达治愈标准率。结果中医辨治组治疗后胃肠道反应症状与治疗前相比，有非常显著改善（ P＜0.01）；与对照组治疗后相比，症状明显轻微（ P＜0.05）；对症治疗组治疗后除了便秘或腹泻症状较治疗前无明显改善（P＞0.05）；其余症状也显著改善（P＞0.05）；中医辨治组全疗程胃肠道反应复发率、全疗程因胃肠道反应干预失败而中断口服化疗率均明显低于对症治疗组，差异有非常显著性意义（ P＜0.01）；中医辨治组24个月内达治愈标准率高于对症治疗组，但差异无显著性意义（P＞0.05）。结论中医整体观辨治MDR-TB化疗过程胃肠道反应的近期疗效好，复发率低，因胃肠道反应干预失败而中断口服化疗率低。
목적：비교중의정체관변치화대증치료내다약폐결핵（ MDR-TB ）화료과정위장도반응적근기료효화복발솔이급대MDR-TB료효적영향。방법장2000년1월-2009년12월재문진화료과정출현위장도반응적MDR-TB환자96례，분위중의변치조（관찰조）화대증치료조（대조조）。중의변치조경변증분위2형，분별용삼령백술산가감화보천대조환합리중탕가감치료，대증치료조용오미랍서、염산갑양록보알치료；관찰비교량조치료전후위장도반응증상적분、전료정위장도반응복발솔、전료정인위장도반응간예실패이중단구복화료솔、24개월내체치유표준솔。결과중의변치조치료후위장도반응증상여치료전상비，유비상현저개선（ P＜0.01）；여대조조치료후상비，증상명현경미（ P＜0.05）；대증치료조치료후제료편비혹복사증상교치료전무명현개선（P＞0.05）；기여증상야현저개선（P＞0.05）；중의변치조전료정위장도반응복발솔、전료정인위장도반응간예실패이중단구복화료솔균명현저우대증치료조，차이유비상현저성의의（ P＜0.01）；중의변치조24개월내체치유표준솔고우대증치료조，단차이무현저성의의（P＞0.05）。결론중의정체관변치MDR-TB화료과정위장도반응적근기료효호，복발솔저，인위장도반응간예실패이중단구복화료솔저。
Objective To study and compare syndrome differentiation and treatment of Traditional Chinese Medicine's holism and symptomatic treatment of gastrointestinal reaction for multidrug-resistant tuberculosis ( MDR-TB) patients during chemotherapy .Short-term effect and recurrence rate as well as the impact of MDR-TB chemotherapy were also studied .Methods From January 2000 to December 2009, cases of MDR-TB patients with gastrointestinal reactions during chemotherapy were studied , 96 cases were divided into Traditional Chinese Medicine (TCM) syndrome differentiation and treatment group (observationgroup) and the symptomatic group(control group).The observationgroup also divided into two sub-groups, treated with shenlingbaishusan and butiandazaowan with lizhongtang respectively , the symptomatic group was treated with omeprazole , metoclopramide .Observed and compared before and after treatment of gastrointestinal tract symptom score ,the rate of the gastrointestinal tract recurrence during the whole course , the rate of peroral chemotherapy discontinuation due to gastrointestinal intervention failure during the whole course , the rate of up to the cure standard rate within 24 months of the two group . Results After Treatment,gastrointestinal symptom of the observationgroup were very significantly improved (P<0.01);compared with the control group , symptoms were mild ( P <0.05 ); the control group after treatment , except constipation or diarrhea symptoms was no significantly improved (P>0.05);other symptoms were significantly improvement (P<0.05); for the observationgroup, the rate of the gastrointestinal tract recurrence during whole course , the rate of peroral chemotherapy discontinuation due to gastrointestinal Intervention failure during whole course was significantly lower than the control group , the difference was very statistically significant ( P<0.01);up to the cure standard rate within 24 months of the observationgroup is higher than the control group , but the difference was not statistically significant ( P >0.05 ) .Conclusion The TCM syndrome differentiation and treatment of Gastrointestinal reactions during MDR-TB chemotherapy has good short-term effect, low recurrence rate, also has low rate of peroral chemotherapy treatment interruption due to gastrointestinal intervention failure .