Plit M L, Anderson R, Van Rensburg C E, Page-Shipp L, Blott J A, Fresen J L, Feldman C
Dept of Immunology, Institute for Pathology, University of Pretoria, South Africa.
Eur Respir J. 1998 Aug;12(2):351-6. doi: 10.1183/09031936.98.12020351.
Patients who have completed a treatment for severe pulmonary tuberculosis (TB) are often left with severe respiratory disability. There have been few prospective studies assessing the effect of treatment on lung function in such patients. The influence of antimicrobial chemotherapy on lung function was investigated over a six month period in patients with newly diagnosed pulmonary TB to test the hypothesis that treatment improves lung function, as well as to identify factors that may influence lung function outcome. Seventy-six patients were recruited into the study, of whom 74 completed the treatment programme. Forty-two were current smokers and 13 seropositive for the human immunodeficiency virus. Improvement in lung function occurred in 54% of patients, but residual airflow limitation or a restrictive pattern was evident in 28% and 24% of patients, respectively. The extent of lung infiltration (radiographic score) both at the outset and after chemotherapy was significantly and negatively related to forced expiratory volume in one second (FEV1) (% pred) (r=-0.41, and r=-0.46, respectively). The post-treatment serum C-reactive protein and alpha1-protease inhibitor levels were negatively associated with FEV1 (% pred) (r=-0.30 and r=-0.35, respectively). These findings demonstrate that, while antimicrobial chemotherapy may lead to improved lung function in patients with pulmonary tuberculosis, a large proportion of patients has residual impairment. The most significant factor influencing post-treatment lung function status, as measured by forced expiratory volume in one second (% predicted), is the pretreatment and post-treatment radiographic score, which acts as a marker of the extent of pulmonary parenchymal involvement in tuberculosis.
完成重症肺结核治疗的患者往往会留下严重的呼吸功能残疾。很少有前瞻性研究评估此类患者治疗对肺功能的影响。在新诊断的肺结核患者中，对其进行了为期六个月的抗微生物化疗对肺功能影响的调查，以检验治疗可改善肺功能这一假设，并确定可能影响肺功能结果的因素。76名患者被纳入研究，其中74名完成了治疗方案。42名是当前吸烟者，13名人类免疫缺陷病毒血清学呈阳性。54%的患者肺功能得到改善，但分别有28%和24%的患者存在残余气流受限或限制性模式。化疗开始时和化疗后的肺部浸润程度（影像学评分）与一秒用力呼气量（FEV1）（预测值百分比）均呈显著负相关（分别为r = -0.41和r = -0.46）。治疗后血清C反应蛋白和α1-蛋白酶抑制剂水平与FEV1（预测值百分比）呈负相关（分别为r = -0.30和r = -0.35）。这些发现表明，虽然抗微生物化疗可能会使肺结核患者的肺功能得到改善，但很大一部分患者仍有残余损害。通过一秒用力呼气量（预测值百分比）衡量，影响治疗后肺功能状态的最显著因素是治疗前和治疗后的影像学评分，它可作为肺结核中肺实质受累程度的一个指标。
