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Article(id=1322928166184026145, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.10.007, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340253634, onlineDateStr=2026-10-30, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340253634, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340253634, creator=13701087609, updateTime=1793340253634, updator=13701087609, issue=Issue{id=1322926740955341011, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='10', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1760025600000', pubDateStr='2025-10-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339913834, creator='13701087609', updateTime=1793340753123, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930261259846420, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930261259846421, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=37, endPage=40, ext={EN=ArticleExt(id=1322928166393741346, articleId=1322928166184026145, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Modified Baihe Gujin Decoction（加味百合固金汤）on CD+4 T Cell Subsets and Prognosis of Patients with Rifampicin-Sensitive Pulmonary Tuberculosis of Lung Yin Deficiency Syndrome, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the effect of Modified Baihe Gujin Decoction（加味百合固金汤）on CD+4 T cell subsets and prognosis of patients with rifampicin-sensitive pulmonary tuberculosis of lung Yin deficiency syndrome.

Methods

A total of 94 patients with rifampicin-sensitive pulmonary tuberculosis of lung Yin deficiency syndrome admitted to the Tuberculosis Department of Zhengzhou Sixth People＇s Hospital from September 2020 to September 2023 were selected as the study objects，and were divided into study group and control group by simple random number table with 47 cases in each group.The control group received 2HRZE/4HRE anti-tuberculosis regimen.On the basis of the control group，the study group was treated with Modified Baihe Gujin Decoction for 2 months.TCM symptoms integral，immune function indexes［serum immunoglobulin G（IgG），immunoglobulin A（IgA），immunoglobulin M（IgM）］and CD+4 T cell subsets were compared between the two groups before and after treatment.The lesion absorption，negative conversion rate and the occurrence of adverse reactions were compared during treatment.

Results

After treatment，the scores of hot flash，dry throat，phlegm and night sweat in both groups were significantly decreased，and the score of the study group was significantly lower than that of the control group（P<0.05）.After treatment，the levels of IgG，IgA，IgM and CD+4 T cell subsets were significantly increased in both groups，and those in the study group were significantly higher than those in the control group（P<0.05）.The lesion absorption rate and negative conversion rate of the study group were higher than those of the control group（P<0.05）.There was no significant difference in the incidence of adverse reactions between two groups（P>0.05）.

Conclusion

Modified Baihe Gujin Decoction is effective in the treatment of rifampicinsensitive pulmonary tuberculosis of lung Yin deficiency syndrome，which can significantly improve the immune function and prognosis of patients，and has high safety.

, authors=Hongzhi LI, Xian GAO, Xiaojiu CAO, Dandan LIU, Zhe LI, authorsList=Hongzhi LI, Xian GAO, Xiaojiu CAO, Dandan LIU, Zhe LI, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322928167618478121, articleId=1322928166184026145, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=加味百合固金汤对利福平敏感肺阴亏虚型肺结核CD4+ T细胞亚群及预后的影响分析, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

探讨加味百合固金汤对利福平敏感肺阴亏虚型肺结核患者CD+4 T细胞亚群及预后的影响。

方法

选择郑州市第六人民医院结核病科2020年9月—2023年9月收治的94例利福平敏感肺阴亏虚型肺结核患者作为研究对象，采用随机数字表通过简单随机方法将其分为研究组和对照组，每组47例。对照组接受2HRZE/4HRE抗结核方案，研究组在对照组基础上，使用加味百合固金汤，治疗2个月。比较治疗前后中医症状积分、免疫功能指标［血清免疫球蛋白G（Immunoglobulin G，IgG）、免疫球蛋白A（Immuno globulin A，IgA）、免疫球蛋白M（Immunoglobulin M，IgM）］水平、CD+4 T细胞亚群水平，比较两组病灶吸收情况、转阴率以及治疗期间不良反应发生情况。

结果

治疗后两组潮热、咽干、咳痰、盗汗积分均明显降低，研究组明显低于对照组（P<0.05）；治疗后两组IgG、IgA、IgM、CD+4 T细胞亚群水平均明显升高，研究组明显高于对照组（P<0.05）；研究组病灶吸收率及转阴率均高于对照组（P<0.05）；组间不良反应发生率差异无统计学意义（P>0.05）。

结论

加味百合固金汤治疗利福平敏感肺阴亏虚型肺结核效果显著，可明显提升患者免疫功能，改善预后，且具有较高的安全性。

, authors=李洪智, 高娴, 曹小九, 刘丹丹, 李哲, authorsList=李洪智, 高娴, 曹小九, 刘丹丹, 李哲, authorCompany=null, correspAuthors=null, authorNote=

李洪智（1977-），女，河南巩义人，主任医师，硕士，研究方向：结核病诊断及治疗。

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李洪智（1977-），女，河南巩义人，主任医师，硕士，研究方向：结核病诊断及治疗。

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李洪智（1977-），女，河南巩义人，主任医师，硕士，研究方向：结核病诊断及治疗。

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中国中医药科技，2022，29（5）：876-878., articleTitle=百合固金汤加味辅助治疗复治肺结核的效果观察及对T细胞亚群的影响, refAbstract=null), Reference(id=1322928176149692532, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, doi=null, pmid=null, pmcid=null, year=2022, volume=42, issue=4, pageStart=118, pageEnd=119, url=null, language=null, rfNumber=［25］, rfOrder=24, authorNames=靳芳旭, journalName=哈尔滨医药, refType=null, unstructuredReference=靳芳旭. 百合固金汤加减联合穴位贴敷辅助2HRZE/4HR方案治疗继发性肺结核患者的临床疗效［J］. 哈尔滨医药，2022，42（4）：118-119., articleTitle=百合固金汤加减联合穴位贴敷辅助2HRZE/4HR方案治疗继发性肺结核患者的临床疗效, refAbstract=null), Reference(id=1322928176216801397, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, doi=null, pmid=null, pmcid=null, year=2022, volume=16, issue=1, pageStart=212, pageEnd=214, url=null, language=null, rfNumber=［26］, rfOrder=25, authorNames=靳秀春, journalName=中国现代药物应用, refType=null, unstructuredReference=靳秀春. 百合固金汤联合生脉散加减方治疗肺结核的疗效分析［J］. 中国现代药物应用，2022，16（1）：212-214., 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Hospital，Zhengzhou 450000，Henan，China), AuthorCompanyExt(id=1322928168360869932, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, companyId=1322928168344092714, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=郑州市第六人民医院，河南 郑州 450000)])], figs=[ArticleFig(id=1322928172081217618, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数潮热咽干咳痰盗汗
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
研究组472.88±0.321.84±0.26*△2.77±0.351.16±0.28*△2.85±0.411.22±0.23*△2.44±0.331.13±0.21*△
对照组472.86±0.352.11±0.31*2.76±0.371.88±0.35*2.83±0.451.82±0.27*2.46±0.311.78±0.26*
t值0.2894.5750.13511.0130.22511.5970.30313.333
P值0.773<0.0010.893<0.0010.822<0.0010.763<0.001
), ArticleFig(id=1322928172160909395, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, language=CN, label=表1, caption=

两组利福平敏感肺阴亏虚型肺结核患者治疗前后中医症状积分比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数潮热咽干咳痰盗汗
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
研究组472.88±0.321.84±0.26*△2.77±0.351.16±0.28*△2.85±0.411.22±0.23*△2.44±0.331.13±0.21*△
对照组472.86±0.352.11±0.31*2.76±0.371.88±0.35*2.83±0.451.82±0.27*2.46±0.311.78±0.26*
t值0.2894.5750.13511.0130.22511.5970.30313.333
P值0.773<0.0010.893<0.0010.822<0.0010.763<0.001
), ArticleFig(id=1322928172228018260, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数IgG/（g/L）IgA/（g/L）IgM/（g/L）CD+4 T细胞/（%）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
研究组4710.23±1.88 20.68±2.33*△2.93±0.793.74±0.23*△1.17±0.113.47±0.21*△32.58±4.4144.89±3.05*△
对照组4710.19±1.78 16.78±2.38*2.95±0.823.21±0.26*1.18±0.142.61±0.24*33.02±4.4339.98±3.11*
t值0.1068.0280.12010.4670.38518.4880.4837.728
P值0.916<0.0010.904<0.0010.701<0.0010.631<0.001
), ArticleFig(id=1322928172295127125, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, language=CN, label=表2, caption=

两组利福平敏感肺阴亏虚型肺结核患者治疗前后免疫功能指标以及CD+4 T细胞亚群水平比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数IgG/（g/L）IgA/（g/L）IgM/（g/L）CD+4 T细胞/（%）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
研究组4710.23±1.88 20.68±2.33*△2.93±0.793.74±0.23*△1.17±0.113.47±0.21*△32.58±4.4144.89±3.05*△
对照组4710.19±1.78 16.78±2.38*2.95±0.823.21±0.26*1.18±0.142.61±0.24*33.02±4.4339.98±3.11*
t值0.1068.0280.12010.4670.38518.4880.4837.728
P值0.916<0.0010.904<0.0010.701<0.0010.631<0.001
), ArticleFig(id=1322928172366430294, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数病灶吸收情况转阴率
明显吸收吸收无变化恶化吸收率
研究组4728（59.57）15（31.91）4（8.51）0（0.00）43（91.49）40（85.11）
对照组4724（51.06）11（23.40）12（25.53）0（0.00）35（74.47）31（65.96）
χ2值4.8214.663
P值0.0280.031
), ArticleFig(id=1322928172454510679, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, language=CN, label=表3, caption=

两组利福平敏感肺阴亏虚型肺结核患者病灶吸收、转阴情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数病灶吸收情况转阴率
明显吸收吸收无变化恶化吸收率
研究组4728（59.57）15（31.91）4（8.51）0（0.00）43（91.49）40（85.11）
对照组4724（51.06）11（23.40）12（25.53）0（0.00）35（74.47）31（65.96）
χ2值4.8214.663
P值0.0280.031
), ArticleFig(id=1322928172525813848, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数恶心呕吐腹泻皮疹总发生
研究组472（4.26）1（2.13）2（4.26）5（10.64）10（21.28）
对照组471（2.13）1（2.13）2（4.26）1（2.13）5（10.64）
χ2值1.983
P值0.159
), ArticleFig(id=1322928172592922713, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928166184026145, language=CN, label=表4, caption=

两组利福平敏感肺阴亏虚型肺结核患者治疗期间不良反应情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数恶心呕吐腹泻皮疹总发生
研究组472（4.26）1（2.13）2（4.26）5（10.64）10（21.28）
对照组471（2.13）1（2.13）2（4.26）1（2.13）5（10.64）
χ2值1.983
P值0.159
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加味百合固金汤对利福平敏感肺阴亏虚型肺结核CD4+ T细胞亚群及预后的影响分析
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李洪智 , 高娴 , 曹小九 , 刘丹丹 , 李哲
中华中医药学刊 | 国家项目点击 2025,43(10): 37-40
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中华中医药学刊 |国家项目点击 2025 , 43 (10) : 37 -40
加味百合固金汤对利福平敏感肺阴亏虚型肺结核CD4+ T细胞亚群及预后的影响分析
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李洪智（1977-），女，河南巩义人，主任医师，硕士，研究方向：结核病诊断及治疗。

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李洪智（1977-），女，河南巩义人，主任医师，硕士，研究方向：结核病诊断及治疗。

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李洪智, 高娴, 曹小九, 刘丹丹, 李哲
作者信息
  • 郑州市第六人民医院，河南 郑州 450000
作者简介:

李洪智（1977-），女，河南巩义人，主任医师，硕士，研究方向：结核病诊断及治疗。

Effect of Modified Baihe Gujin Decoction（加味百合固金汤）on CD+4 T Cell Subsets and Prognosis of Patients with Rifampicin-Sensitive Pulmonary Tuberculosis of Lung Yin Deficiency Syndrome
Hongzhi LI, Xian GAO, Xiaojiu CAO, Dandan LIU, Zhe LI
Affiliations
  • Zhengzhou Sixth People＇s Hospital，Zhengzhou 450000，Henan，China
出版时间: 2025-10-10 doi: 10.13193/j.issn.1673-7717.2025.10.007
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摘要
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目的

探讨加味百合固金汤对利福平敏感肺阴亏虚型肺结核患者CD+4 T细胞亚群及预后的影响。

方法

选择郑州市第六人民医院结核病科2020年9月—2023年9月收治的94例利福平敏感肺阴亏虚型肺结核患者作为研究对象，采用随机数字表通过简单随机方法将其分为研究组和对照组，每组47例。对照组接受2HRZE/4HRE抗结核方案，研究组在对照组基础上，使用加味百合固金汤，治疗2个月。比较治疗前后中医症状积分、免疫功能指标［血清免疫球蛋白G（Immunoglobulin G，IgG）、免疫球蛋白A（Immuno globulin A，IgA）、免疫球蛋白M（Immunoglobulin M，IgM）］水平、CD+4 T细胞亚群水平，比较两组病灶吸收情况、转阴率以及治疗期间不良反应发生情况。

结果

治疗后两组潮热、咽干、咳痰、盗汗积分均明显降低，研究组明显低于对照组（P<0.05）；治疗后两组IgG、IgA、IgM、CD+4 T细胞亚群水平均明显升高，研究组明显高于对照组（P<0.05）；研究组病灶吸收率及转阴率均高于对照组（P<0.05）；组间不良反应发生率差异无统计学意义（P>0.05）。

结论

加味百合固金汤治疗利福平敏感肺阴亏虚型肺结核效果显著，可明显提升患者免疫功能，改善预后，且具有较高的安全性。

百合固金汤  /  利福平  /  肺阴亏虚  /  肺结核  /  CD+4 T细胞亚群  /  转阴率
Objective

To investigate the effect of Modified Baihe Gujin Decoction（加味百合固金汤）on CD+4 T cell subsets and prognosis of patients with rifampicin-sensitive pulmonary tuberculosis of lung Yin deficiency syndrome.

Methods

A total of 94 patients with rifampicin-sensitive pulmonary tuberculosis of lung Yin deficiency syndrome admitted to the Tuberculosis Department of Zhengzhou Sixth People＇s Hospital from September 2020 to September 2023 were selected as the study objects，and were divided into study group and control group by simple random number table with 47 cases in each group.The control group received 2HRZE/4HRE anti-tuberculosis regimen.On the basis of the control group，the study group was treated with Modified Baihe Gujin Decoction for 2 months.TCM symptoms integral，immune function indexes［serum immunoglobulin G（IgG），immunoglobulin A（IgA），immunoglobulin M（IgM）］and CD+4 T cell subsets were compared between the two groups before and after treatment.The lesion absorption，negative conversion rate and the occurrence of adverse reactions were compared during treatment.

Results

After treatment，the scores of hot flash，dry throat，phlegm and night sweat in both groups were significantly decreased，and the score of the study group was significantly lower than that of the control group（P<0.05）.After treatment，the levels of IgG，IgA，IgM and CD+4 T cell subsets were significantly increased in both groups，and those in the study group were significantly higher than those in the control group（P<0.05）.The lesion absorption rate and negative conversion rate of the study group were higher than those of the control group（P<0.05）.There was no significant difference in the incidence of adverse reactions between two groups（P>0.05）.

Conclusion

Modified Baihe Gujin Decoction is effective in the treatment of rifampicinsensitive pulmonary tuberculosis of lung Yin deficiency syndrome，which can significantly improve the immune function and prognosis of patients，and has high safety.

Baihe Gujin Decoction（百合固金汤）  /  rifampin  /  lung Yin deficiency  /  tuberculosis  /  CD+4 T cell subpopulation  /  negative conversion rate
李洪智, 高娴, 曹小九, 刘丹丹, 李哲. 加味百合固金汤对利福平敏感肺阴亏虚型肺结核CD4+ T细胞亚群及预后的影响分析. 中华中医药学刊, 2025 , 43 (10) : 37 -40 . DOI: 10.13193/j.issn.1673-7717.2025.10.007
Hongzhi LI, Xian GAO, Xiaojiu CAO, Dandan LIU, Zhe LI. Effect of Modified Baihe Gujin Decoction（加味百合固金汤）on CD+4 T Cell Subsets and Prognosis of Patients with Rifampicin-Sensitive Pulmonary Tuberculosis of Lung Yin Deficiency Syndrome[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (10) : 37 -40 . DOI: 10.13193/j.issn.1673-7717.2025.10.007
正文
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作为常见的一种呼吸系统疾病，肺结核的相关流行病学特征、病原学特征已经有了较为深入全面的研究。该病主要因感染结核分枝杆菌引起，相关调查显示[1]，全球肺结核发病率已经达到了14.3%，显然已经成为一个较为严重的公共卫生问题。中医将“肺痨”作为肺结核的解释，病因在于病原菌侵袭肺部，劳损之位在于肺，属传染病范畴。对于不能及时就诊的患者，疾病不断发展，对肺部功能造成严重影响，肺阴亏虚，甚至对患者的生命造成威胁[2-3]。临床上在近年来针对中医、西医治疗肺结核的研究较多，也取得了一定的成效。其中西医治疗主要采用利福平、异烟肼、吡嗪酰胺等，治疗效果方面尚满意，但是涉及到多种药物的应用很容易影响胃肠道的功能，不良反应较多[4-5]。而中医治疗肺部疾病具有较为完善的理念，采用中药汤剂治疗肺结核，可有效稳定脏腑的阴阳平衡，达到止咳润肺的作用，并可有效抑制病原菌对肺部的损伤。鉴于此，本研究针对近3年收治的利福平敏感肺阴亏虚型肺结核患者进行研究，在西医治疗的基础上，采用加味百合固金汤辅助治疗，观察效果，报道如下。
1　资料与方法
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1.1　一般资料
选择郑州市第六人民医院结核病科2020年9月—2023年9月收治的94例利福平敏感肺阴亏虚型肺结核患者作为研究对象，纳入标准：（1）临床表现、血常规、结核菌素实验等辅助检查，符合西医结核病诊断标准；（2）中医主症包括气短、咳嗽、咯血、盗汗、脉弱、腹胀、舌红苔薄、五心烦热表现；（3）参加本研究前未规范接受抗结核治疗；（4）患者以及家属对本研究知情，自愿加入。排除标准：（1）肺外结核；（2）加入研究近半年有手术史；（3）合并自身免疫性疾病；（4）治疗依从性差，无法完成治疗方案。采用随机数字表对患者进行编号，通过简单随机方法将其分为研究组和对照组，每组47例。研究组男26例，女21例，年龄25～75岁，平均（55.66±4.18）岁，病程1～6年，平均（3.33±0.98）年，病灶个数1～4个，平均（3.15±0.55）个；对照组男25例，女22例，年龄24～77岁，平均（55.89±4.38）岁，病程1～7年，平均（3.41±0.88）年，病灶个数1～5个，平均（3.21±0.58）个。两组一般资料差异无统计学意义（P>0.05），组间可进行比较。本研究经医院伦理委员会批准。
1.2　治疗方法
给予对照组患者2HRZE/4HRE治疗方案，给予盐酸乙胺丁醇（国药准字H21020434，东北制药）0.75 g，1次/d，异烟肼（国药准字H62020833，酒泉大得利制药）0.3 g、1次/d，吡嗪酰胺（国药准字H44020580，广州白云山）0.5 g、3次/d，利福平胶囊（国药准字H41021154，郑州民众制药）0.6 g，1次/d。研究组在对照组基础上，给予加味百合固金汤治疗，药用如下：熟地黄10 g，百合10 g，生地黄10 g，白芍10 g，麦冬15 g，桔梗15 g，玄参10 g，川贝母5 g，当归5 g，甘草6 g，桑叶10 g，枇杷叶10 g，黄芩10 g。水煎取汁400 mL，1剂/d，分早晚2次温服。
1.3　观察指标
（1）中医症状积分：自拟症状评分表，对患者咽干、潮热、咳痰、盗汗进行评分，采用0～3分标准，分数越高则越严重。（2）免疫功能指标以及CD4+ T细胞亚群水平：采用放射免疫法测定血清免疫球蛋白G（Immunoglobulin G，IgG）、免疫球蛋白A（Immuno globulin A，IgA）、免疫球蛋白M（Immunoglobulin M，IgM）水平、采用美国BD流式细胞仪测定CD4+ T细胞亚群水平。（3）病灶吸收、转阴情况：按照中医内科学相关标准，①明显吸收：症状完全消失，病灶直径减小50%以上，空洞体积明显减小，痰液培养为阴性；②吸收：症状改善，病灶直径减小1/3～1/2，痰液转阴；③无变化：病灶无改变；④恶化：出现新的病灶或原有病灶增大。（4）不良反应：观察并记录治疗期间不良反应发生情况。
1.4　统计学方法
本研究采用SPSS 24.0对数据进行处理，计量资料采用表示，组内治疗前后比较采用配对样本t检验，组间采用独立样本t检验，计数资料以百分比（%）表示，以χ2检验进行比较，若P<0.05，则差异具有统计学意义。
2　结果
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2.1　中医症状积分比较
治疗后两组潮热、咽干、咳痰、盗汗积分均明显降低（P<0.05），研究组明显低于对照组（P<0.05）。见表1。
2.2　免疫功能指标以及CD4+ T细胞亚群水平比较
治疗后两组IgG、IgA、IgM、CD4+ T细胞亚群水平均明显升高（P<0.05），研究组明显高于对照组（P<0.05）。见表2。
2.3　病灶吸收、转阴情况比较
研究组病灶吸收率及转阴率均高于对照组（P<0.05）。见表3。
2.4　不良反应
组间不良反应差异无统计学意义（P>0.05）。见表4。
3　讨论
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中医学认为肺结核的发生原因包含两个方面，即内因与外因，其中结核分枝杆菌感染属外因，而肾虚亏损属内因[6-7]。当机体功能亏虚，正气不足，则易造成痨虫侵袭，损伤肺腑，引起咳嗽、咯血等表现，当邪气与热气共同聚集于肺腑之地，肺部则明显阴气不足，产生亏虚改变，对津液输布产生抑制效应，肾脏功能受损，疾病累及至肾。肾内阴气受损，虚火升高，临床上常常表现为骨蒸潮热，在具体表现方面，男女患者存在一定差异，其中男性主要表现为遗精、多梦，而女性则表现为闭经[8-9]。在肺阴亏虚型肺结核中，其肝火过旺，虚火上行至肺部，肺阴受到损耗，患者表现出烦躁、盗汗，且合并预后胸部不适。长时间处于肺阴亏虚状态，损伤进一步影响到肝脾等脏器，患者逐渐产生气短、乏力表现[10-11]。因此中医治疗的着手点在于清肺养阴，补充亏虚。
百合固金汤最早出现于清代的《医方集解》中，书中表明：百合固金汤为手太阴、足少阴之药[12]。金无生水，水干火炎，故本方的主药为生、熟二地黄，其可以发挥退热功效，并且可促进肾脏生水，保肾而养肺；百合的功效为保肺安神，在此基础上，加味麦冬，发挥养肺阴之功效；玄参辅助二地，发挥生水、降虚火、滋肾阴之功，作为臣药；贝母具有散肺郁、止咳化痰之功效，芍药、当归则具有和营养血，并兼具平肝功效，作为佐药；桔梗、甘草组成桔甘汤，可达到畅喉利咽的效果，并具有清金化痰之功效，作为使药[13-15]，上述诸药共用，全方均培元清本。现代医学相关研究也认为，百合固金汤对于提升机体的免疫功能具有显著效果，对提升患者的免疫功能指标、实现抗炎效果、镇咳平喘等具有显著作用。本研究显示，治疗后两组潮热、咽干、咳痰、盗汗积分均明显降低，研究组明显低于对照组，表明百合固金汤在改善患者症状方面具有显著效果。但潘静洁等[16]研究发现，其在改善咳痰、气短、乏力效果不够理想，与本研究有一定出入，分析原因，可能与病例的选择差异有关，例如疾病程度、结核分枝杆菌耐药程度、机体免疫能力等对治疗效果的影响，还需要下一步深入研究。
另外本研究结果显示，治疗后两组IgG、IgA、IgM、CD+4 T细胞亚群水平均明显升高，研究组明显高于对照组。IgG、IgA、IgM是反映患者体液免疫功能的重要指标，在组织以及血浆中可检出上述抗体，其属于一种动物蛋白，具有抗体活性，在自然被动免疫中发挥重要的作用[17-18]。IgG的合成场所主要为脾脏、淋巴结等，在自然被动免疫中具有重要的作用。IgA主要组成机体的黏膜防御系统，IgM是应对机体感染的“先头部队”，在初次免疫应答中发挥重要的作用。CD+4 T细胞亚群在调节其他T细胞免疫应答方面具有重要的作用，反映了机体免疫功能水平。从本研究结果可以看出，百合固金汤可明显改善利福平敏感肺结核患者的免疫功能。现代药理研究表明[19-22]，百合固金汤在提升患者免疫功能方面具有积极的作用，具有显著的润肺生津、养血柔润功效，这对改善患者机体状态，促进免疫功能恢复具有积极的作用。另外在预后方面，本研究显示，研究组病灶吸收率及转阴率均高于对照组。利福平作为临床一线治疗药物，在利福平敏感肺结核的治疗过程中，常常需要联合治疗方案，可发挥显著效果，是临床治疗肺结核一线药物，临床上主要与异烟肼、盐酸乙胺丁醇和吡嗪酰胺联合应用。百合固金汤方剂中诸药合用，可发挥阴液渐充之功效，同时肾阴得到滋养，显著缓解肺肾阴亏、咳嗽、吐血等证[23-24]。分析组间差异，可能和加味百合固金汤中的桔梗、甘草等止咳润肺、清热化痰功效相关，其可显著改善咳痰、咳嗽症状，促进疗效的提升，通过与西药的联合，发挥出协同作用，在促进痰菌转阴、病灶吸收方面效果进一步提升。在不良反应方面，研究组发生率虽高于对照组，但组间差异无统计学意义，可见百合固金汤的应用具有较高的安全性。同时，但在下步研究中，在中西医结合治疗方案制定方面，可进一步探讨在应用中药汤剂的情况下，酌情调整西药的治疗方案，从而降低对患者肝功能的损害，减少并发症的发生，使安全性方面得到进一步提高[25-26]。由于本研究样本量较小，且未开展远期随访，研究结果可能存在一定偏差，还需要下步深入研究，进一步论证结论，为中西医结合治疗结核病提供有力参考依据。
综上所述，加味百合固金汤治疗利福平敏感肺阴亏虚型肺结核效果显著，可明显提升患者免疫功能，改善预后，且具有较高的安全性。
基金
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  • 国家中医药管理局第五批全国中医临床优秀人才研修项目(国中医药人教函〔2022〕1号)
  • 河南省中医药科学研究专项(2024ZY2171)
文献
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2025年第43卷第10期
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doi: 10.13193/j.issn.1673-7717.2025.10.007
  • 首发时间：2026-10-30
  • 出版时间：2025-10-10
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基金
国家中医药管理局第五批全国中医临床优秀人才研修项目(国中医药人教函〔2022〕1号)
河南省中医药科学研究专项(2024ZY2171)
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    郑州市第六人民医院，河南 郑州 450000
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https://castjournals.cast.org.cn/joweb/zhzyyxk/CN/10.13193/j.issn.1673-7717.2025.10.007
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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