目的 比較分析化療聯(lián)合經(jīng)支氣管鏡局部藥物注射與單純化療對耐多藥肺結核的治療效果。方法 選擇2014年1月-2016年12月銅川市人民醫(yī)院的95例耐多藥肺結核患者，隨機分為兩組。對照組給予2HPAZV/7~10DZV化療方案，觀察組在對照組基礎上聯(lián)合經(jīng)支氣管鏡局部注入左氧氟沙星0.2 g，丁胺卡那0.2 g，異煙肼0.2 g。每周治療1次，共治療2個月。比較兩組的痰菌涂片陰轉率、免疫功能、血清白介素-4（IL-4）、干擾素-γ（INF-γ）水平和癥狀的消失率。結果 治療后觀察組的痰菌涂片陰轉率明顯高于對照組，差異有統(tǒng)計學意義（P<0.05）。兩組治療后的CD4⁺/CD8⁺以及CD4⁺均明顯升高，CD8⁺明顯降低，同組治療前后比較差異有統(tǒng)計學意義（P<0.05）；且觀察組明顯優(yōu)于對照組，差異有統(tǒng)計學意義（P<0.05）。兩組治療后的血清IL-4水平明顯降低、INF-γ水平明顯升高，同組治療前后比較差異有統(tǒng)計學意義（P<0.05）；且觀察組的血清IL-4、INF-γ水平明顯優(yōu)于對照組，差異有統(tǒng)計學意義（P<0.05）。觀察組的咳嗽、發(fā)熱、咳痰、呼吸困難和胸痛等癥狀的消失率明顯高于對照組，差異有統(tǒng)計學意義（P<0.05）。結論 化療聯(lián)合經(jīng)支氣管鏡局部注射對耐多藥肺結核的治療效果顯著優(yōu)于單純化療，不僅有助于患者癥狀的消失，還能改善患者的免疫狀態(tài)，降低炎性因子水平。

Objective To investigate the clinical effect of chemotherapy combined with local drug injection and simple chemotherapy on multi drug resistant pulmonary tuberculosis. Methods Selected 95 cases of patients with multi drug resistant pulmonary tuberculosis who were treated in our hospital from January 2014 to December 2016, divided into two groups randomly. The control group was treated with chemotherapy alone, and the observation group combined with the local drug injection by bronchoscopy. The negative rate of sputum smear, immune function, the level of serum IL-4, INF-α gamma and the rate of disappearance of symptoms were compared between the two groups. Results The negative rate of sputum smear in the observation group was significantly higher than control group (P<0.05). After treatment, CD4⁺/CD8⁺ and CD4⁺ were significantly increased (P<0.05), CD8⁺ decreased significantly (P<0.05), and the observation group was significantly better than the control group (P<0.05). The levels of serum IL-4 and INF-γ in the two groups were significantly decreased (P<0.05), and the level of serum IL-4 and INF-γ in the observation group was significantly lower than control group (P<0.05). The rate of disappearance of cough, fever, expectoration, dyspnea and chest pain in the observation group was significantly lower than control group (P<0.05). Conclusion Chemotherapy combined with local drug injection through bronchoscopy is better than chemotherapy alone in the treatment of multidrug-resistant pulmonary tuberculosis, which not only contributes to the disappearance of symptoms, but also improves the immune status and reduces the level of inflammatory factors.