目的 比较分析化疗联合经支气管镜局部药物注射与单纯化疗对耐多药肺结核的治疗效果。方法 选择2014年1月-2016年12月铜川市人民医院的95例耐多药肺结核患者，随机分为两组。对照组给予2HPAZV/7~10DZV化疗方案，观察组在对照组基础上联合经支气管镜局部注入左氧氟沙星0.2 g，丁胺卡那0.2 g，异烟肼0.2 g。每周治疗1次，共治疗2个月。比较两组的痰菌涂片阴转率、免疫功能、血清白介素-4（IL-4）、干扰素-γ（INF-γ）水平和症状的消失率。结果 治疗后观察组的痰菌涂片阴转率明显高于对照组，差异有统计学意义（P<0.05）。两组治疗后的CD4⁺/CD8⁺以及CD4⁺均明显升高，CD8⁺明显降低，同组治疗前后比较差异有统计学意义（P<0.05）；且观察组明显优于对照组，差异有统计学意义（P<0.05）。两组治疗后的血清IL-4水平明显降低、INF-γ水平明显升高，同组治疗前后比较差异有统计学意义（P<0.05）；且观察组的血清IL-4、INF-γ水平明显优于对照组，差异有统计学意义（P<0.05）。观察组的咳嗽、发热、咳痰、呼吸困难和胸痛等症状的消失率明显高于对照组，差异有统计学意义（P<0.05）。结论 化疗联合经支气管镜局部注射对耐多药肺结核的治疗效果显著优于单纯化疗，不仅有助于患者症状的消失，还能改善患者的免疫状态，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.