目的 觀察補肺活血膠囊聯(lián)合2HRZE/4HR方案治療初治老年肺結(jié)核（肺陰虧虛兼血瘀證）的臨床療效及對外周血T細胞亞群的影響。方法 選取符合標(biāo)準(zhǔn)的206例初治老年肺結(jié)核患者（肺陰虧虛兼血瘀證）為研究對象，隨機分為對照組和觀察組，每組103例。對照組采用2HRZE/4HR方案治療，觀察組在對照組的基礎(chǔ)上聯(lián)合補肺活血膠囊治療，兩組持續(xù)治療6個月，在療程結(jié)束時比較兩組的總有效率，并對比兩組痰菌轉(zhuǎn)陰率、病灶吸收有效率、中醫(yī)證候評分以及治療前后外周血T淋巴細胞亞群（CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺）水平變化及不良反應(yīng)發(fā)生情況。結(jié)果 治療過程中脫落22例（兩組各11例）。觀察組的治療總有效率為93.48%，高于對照組的83.69%，差異有統(tǒng)計學(xué)意義（P＜0.05）。治療后，兩組痰菌轉(zhuǎn)陰率無統(tǒng)計學(xué)差異（P＞0.05）；觀察組病灶吸收有效率為90.22%，對照組為75.00%，兩組比較差異有統(tǒng)計學(xué)意義（P＜0.05）治療后，兩組中醫(yī)證候評分均較治療前降低（P＜0.05），且觀察組中醫(yī)證候評分低于對照組（P＜0.05）。治療后，兩組CD3⁺、CD4⁺、CD4⁺/CD8⁺水平均較治療前升高，CD8⁺水平較治療前降低（P＜0.05），且觀察組CD3⁺、CD4⁺、CD4⁺/CD8⁺水平均高于對照組，CD8⁺水平低于對照組（P＜0.05）；兩組不良反應(yīng)發(fā)生率比較，差異無統(tǒng)計學(xué)意義。結(jié)論 補肺活血膠囊聯(lián)合2HRZE/4HR方案治療初治老年肺結(jié)核患者的效果優(yōu)于單純2HRZE/4HR方案治療，可改善患者臨床癥狀，促進肺部病灶吸收，提高患者免疫力和臨床療效，證實中西醫(yī)結(jié)合治療肺結(jié)核效果顯著。

Objective To observe the clinical efficacy of Bufei Huoxue Capsule (補肺活血膠囊) combined with the 2HRZE/4HR regimen in treating elderly patients with newly diagnosed pulmonary tuberculosis (PTB) presenting with deficiency of lung-yin and blood stasis syndrome, and to assess its impact on peripheral blood T-cell subsets. Methods A total of 206 eligible elderly patients with newly diagnosed PTB (deficiency of lung-yin and blood stasis syndrome) were enrolled and randomly divided into the control group (n = 103) and the observation group (n = 103). The control group received the standard 2HRZE/4HR anti-tuberculosis regimen, while the observation group received Bufei Huoxue Capsule plus the 2HRZE/4HR regimen. Both groups were treated continuously for six months. At the end of the treatment course, the following outcomes were compared: total effective rate, sputum smear conversion rate, lesion absorption effective rate, traditional Chinese medicine (TCM) symptom scores, changes in peripheral blood T-lymphocyte subsets (CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺ ratio) before and after treatment, and incidence of adverse reactions. Results A total of 22 patients discontinued the study (11 per group). The observation group exhibited a significantly higher overall response rate (93.48% vs 83.69%, P < 0.05). After treatment, sputum smear conversion rates showed no significant difference between groups (P > 0.05). The lesion absorption effective rate of the observation group was significantly higher in the observation group (90.22% vs 75.00%, P < 0.05). Both groups showed reduced TCM symptom scores post-treatment (P < 0.05), with lower scores in the observation group (P < 0.05). After treatment, the levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in both groups increased compared with those before treatment, and the level of CD8⁺ decreased compared with that before treatment (P < 0.05). Moreover, the levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in the observation group were higher than those in the control group, and the level of CD8⁺ was lower than that in the control group (P < 0.05). No significant difference in adverse reaction incidence was observed between groups. Conclusion The efficacy of Bufei Huoxue Capsule combined with the 2HRZE/4HR regimen demonstrates superior efficacy over the 2HRZE/4HR regimen alone in treating elderly patients with newly diagnosed PTB. The integrated approach alleviates clinical symptoms, promotes lesion absorption, enhances immune function, and improves overall clinical outcomes, supporting the significant therapeutic value of combining traditional Chinese and Western medicine for PTB management.

R285.64

河南省醫(yī)學(xué)科技攻關(guān)項目（LHGJ20230113）