Analysis of the efficacy and attenuation effect of bedaquiline combined with Ganshuang Granules in the treatment of multi-drug resistant tuberculosis

MA Qingyan; DANG Ping; HOU Lili; LIU Xiaofei; KANG Guannan

doi:10.3969/j.issn.1007-8134.2024.03.007

Abstract：Objective To investigate the therapeutic effects of bedaquinoline on multidrug resistant tuberculosis (MDR-TB) and its impact on interferon-induced protein 10 (IP-10) and suppressors of cytokine signaling 1 (SOCS1). Methods Using a 1:1 propensity matching principle,144 patients with MDR-TB admitted to the Tuberculosis Department Ⅳ of our hospital from January to October 2022 were divided into 3 groups,each with 48 patients. All 3 groups received conventional treatment,Control group 1 received Ganshuang Granules,control group 2 received bedaquiline,and the combination group received both. The sputum negative conversion rate and median negative conversion time were compared among the 3 groups at 4,8,12,24,36 and 48 weeks. Changes in lesion absorption and cavity were compared among the three groups after 48 weeks of treatment. Changes in serum inflammatory factors (IFN-γ,IL-4,IL-17,TNF-α,IP-10,and SOCS1) and adverse reactions were compared among the three groups before treatment and at 8,24 and 48 weeks post-treatment. Results Sputum bacteria in control group 2 and the combination group at weeks 4,8,12,24,36,and 48 were higher than those in control group 1 (P<0.05). Median conversion times in the control group 2 and the combined group was earlier than in the control group 1 (P<0.05). Lesion absorption rates in tcontrol group 2 and the combination group were 93.75％ and 95.83％,respectively,both higher than in the control group 1 (56.25％) (P<0.05). Cavity improvement rates in control group 2 and the combined group were 95.83％ and 95.83％,higher than in control group 1 (62.50％) (P<0.05). At weeks 8,24,and 48,the levels of IL-17,TNF-α,and IL-4 in the combination group were lower than in control group 2 and higher than in control group 1 (P<0.05). Levels of IP-10 and SOCS1 in the combination group at weeks 8,24,and 48 were lower than in control group 2,and these were lower than in control group 1 (P<0.05). Rates of electrocardiogram abnormality in control 2 group and the combination group were 16.67％ and 12.50％,respectively,higher than in control group 1 by 0 (P<0.05). Rates of liver injury and gastrointestinal adverse reactions in the combination group were 0,lower than that in control group 2 by 12.50％ and 16.67％,and control group 1 by 14.58％ and 14.58％,respectively (P<0.05). Conclusions The bedaquiline-containing regimen improves lesion absorption,cavity closure,and sputum conversion rates in MDR-TB,while inhibiting inflammatory response. Although combining with Ganshuang Granules did not enhance efficacy,it further improved the inflammatory response and reduced liver injury and gastrointestinal adverse reactions,potentially increasing patient tolerance and compliance with bedaquiline therapy.