Abstract: Objective　To investigate the clinical effect of conventional antitubercular agents combined with bronchoscopic cryotherapy on endobronchial tuberculosis（EBTB）,and to analyze the changes in patients’ immune function before and after treatment.Methods　50 patients who were diagnosed with EBTB in the Fifth Hospital of Shijiazhuang from 2013 to 2015 were selected as research objects.Patients were conventionally given anti-tuberculosis scheme of 2HRZE（S）/10HRE;tracheal secretions were cleared under bronchofiberscopy,0.3 g isoniazide was locally injected in region of lesion,freezing probe was applied to freeze lesions with a freezing time of about 60 s each time,and self-melting of 1 minute,and each lesions repeated for 3 to 5 times.Bronchoscope was reexamined after 1 week,and frozen and necrotic tissue were cleaned.According to the situation of patient tolerance and severity of lesions,cryotherapy could be performed for many times.Occurrence of adverse reactions was recorded during treatment;the clinical effect was evaluated 2 months after treatment,and T-lymphocyte subsets and immune globulin levels were detected before and 2 months after treatment.Results　Patients received cryotherapy of 3 to 11 times with an average time of（4.0±2.5）.2 months after treatment,there were 41 cases（82.0%） with remarkable effects,8 cases（16.0%） with effects,1 case（2.0%） with no effects,and the total effective rate was 98.0%（49/50）.Cough occurred in 5 patients,slight bleeding in 3 patients,without other serious adverse reactions and complications.The proportion of CD+3 T cells,CD+4 T cells and CD+4 /CD+8 after treatment were higher than those before the treatment,and proportion of CD+8 T cells was lower than that before treatment（P<0.05）.There were no significant difference in immunoglobulin IgA,IgG,IgM levels before and after treatment（P>0.05）.Conclusion　Conventional antitubercular agents combined with bronchoscopic cryotherapy can obtain good treatment effects on EBTB,and improve the disordered status of T-lymphocyte subsets of patients.

Key words: Tuberculosis, pulmonary, Antitubercular agents, Cryotherapy, Bronchoscopes, Treatment outcome, T-lymphocyte subsets

摘要： 目的　探讨常规抗结核药物联合经支气管镜冷冻治疗支气管结核（EBTB）的临床疗效，分析治疗前后患者免疫功能的变化。方法　选取2013—2015年于石家庄市第五医院确诊为EBTB患者50例为研究对象。患者常规给予2HRZE（S）/10HRE抗结核方案治疗；支气管镜下清理支气管分泌物，在病变部位给予异烟肼0.3 g局部注射，冷冻探头冷冻病灶，冷冻时间约60 s/次，自行解融1 min，每个病灶反复3～5次。1周后复查支气管镜，清理冷冻坏死组织。根据患者耐受情况及病变严重程度，可多次进行冷冻治疗。记录治疗期间不良反应发生情况，治疗2个月后评价临床疗效，并于治疗前及治疗2个月后检测血清T淋巴细胞亚群和免疫球蛋白水平。结果　患者接受冷冻治疗3～11次，平均（4.0±2.5）次。治疗2个月后，显效41例（82.0%），有效8例（16.0%），无效1例（2.0%），总有效率为98.0%（49/50）。5例患者出现咳嗽，3例患者出现轻微出血，未出现其他严重不良反应及并发症。治疗后CD+3T细胞比例、CD+4T细胞比例、CD+4T细胞及CD+8T细胞比值高于治疗前,CD+8T细胞比例低于治疗前（P<0.05）。治疗前后免疫球蛋白IgA、IgG、IgM水平比较，差异均无统计学意义（P>0.05）。结论　常规抗结核药物联合经支气管镜冷冻治疗EBTB可取得良好效果，可改善患者T淋巴细胞亚群紊乱。

关键词: 结核, 肺, 抗结核药, 冷冻疗法, 支气管镜, 治疗结果, T淋巴细胞亚群