| Objective:By conducting CBT sleep interventional research on PTB patients with sleep disorders,we will further understand the mechanism of sleep disorders on the cellular immune function of PTB patients;improve the treatment efficiency and optimize the treatment plan by improving the sleep conditions of PTB patients.Methods:On the basis of the inclusion and exclusion criteria,148 cases were determined and divided into intervention group(74 cases)and control group(74 cases)by randomized number method.Similarly all patients were given standardized anti tuberculosis treatment for 3 months according to the guidelines for tuberculosis diagnosis and treatment,while the intervention group was given cognitive behavior therapy and sleep intervention for 2 months.Collect patient general information,clinical symptoms,sleep disorders,PSQI score,imaging data,peripheral blood T cell subgroup indicators(CD3+,CD4+,CD8+T cell absolute count,CD4/CD8 value),and other laboratory results(WBC,LYM,TP,ABL,PA,sputum acid-fast bacillus smear,sputum Mycobacterium tuberculosis culture,etc.);and PSQI,sleep status,treatment effect(chest CT,anti-tuberculosis-related adverse reactions),T Cell subpopulation indicators.Use SPASS20.0 for statistical analysis:1.Observe and study the main manifestations,effects,and cognitive attitudes of sleep disorders in PTB patients with sleep disorders;2.Compare the peripheral blood T lymphocyte subsets of patients with different degrees of sleep disorders,and the analysis of the correlation between the severity of the disease and the sleep disorder classification;3.Compare the sleep,immunity and therapeutic effect between the two groups after 3 months of treatment;4.Comparison of T cell subsets and sleep in the intervention group before and after 3 months of treatment;5.Comparison of T cell subsets and sleep in the control group after 3 months of treatment.Result:1.In the 148 PTB patients with sleep disorders included in this study,sleep disorders are mainly manifested as frequent awakening,difficulty falling asleep,and early morning awakening;it has more impact on PTB patients,mainly manifested as fatigue,poor work spirit,and irritability.Anger,loss of appetite,etc.Generally,patients have a low level of understanding of sleep disorders,35.8%(53 cases)have no understanding of sleep disorders,and 75.7%of patients have a desire to improve sleep to varying degrees.2.Among the 148 study subjects included,mild sleep disorders were more common,with mild,moderate,and severe sleep disorders accounting for 43.9%(65 cases),36.5%(54 cases),and 19.6%(29 cases)respectively,of which 78 were males,78 females,62patients≥60 years old,86 patients<60 years old;2.1 Comparison of peripheral blood T lymphocyte subsets of PTB patients with light,moderate,and severe sleep disorders showed that there were differences between the groups.With the aggravation of sleep disorders,CD3+,CD4+T cell absolute counts,CD4+/CD8+values gradually decreased(P<0.05),the CD8+T cell count gradually increased(P>0.05);a pairwise comparison between the three groups,the CD3+T cell count was slightly compared with the severe,and the difference was statistically significant(P<0.017),CD4+,CD4+/There are significant differences between CD8+mild and moderate,mild and severe,and moderate and severe(P<0.017),and there is no statistically significant difference between CD8+T cells in each group;2.2 PTB patients’lung cavitation rate,positive rate of sputum acid-fast bacilli smears,and the number of lung lobes involved are related to the severity of sleep disorders.Further correlation analysis was performed.The rs values were 0.172,0.269,and 0.203(all P<0.05).It was found that the lung cavity rate,the positive rate of sputum acid-fast bacilli smears,and the cumulative number of lung lobes had no significant relationship with the severity of sleep disorders.3.After 3 months of treatment,the intervention group and the control group excluded those with incomplete data and failed follow-up.There were 70 cases in the intervention group and 67 cases in the control group:3.1 After treatment,there were significant differences in the total score of PSQ1 and the scores of each item between the two groups.No patients with severe sleep disorders were found in the two groups.Patients with no sleep disorder were more common in the intervention group,while those with mild sleep disorder were more common in the control group.And there existed a significant difference in sleep disorder classification between the two groups(χ~2=-3.96,P<0.05);3.2 After 3 months of treatment,the CD3+and CD4+T cell counts in the intervention group were 943.11±208.67,473.07±105.21,significantly higher than that in the control group 877.09±207.60,396.74±98.41(t=1.20,4.08,P<0.05),CD4+/CD8+intervention group was 1.30±0.12,higher than that in the group 1.16±0.19.The absolute count of CD8+T cells in the intervention group was lower than that in the dry control group(P>0.05);3.3 Comparison of treatment effects between the two groups after 3 months of treatment manifested that the absorption effective rate of chest CT lesions in the intervention group was 88.6%(62 cases),significantly higher than that in the control group which was 73.1%(49 cases),and the incidence of anti-tuberculosis treatment-related adverse reactions was 12.9%(9 cases)which were 26.9%(18 cases)less than the control group(t=5.31,4.21,P<0.05).4.Comparison of the immune indexes of the intervention group before and after treatment,CD3+,CD4+T cell count,CD4+/CD8+value after treatment 960.89±210.31,473.07±105.21,1.30±0.12,comparing with 765.03±196.59,299.18±99.37,0.89±0.23before,significantly increased(t=-4.95,-9.58,-12.77,P<0.01).After treatment,the sleep score and the other 7 item scores decreased(P<0.01),with significant difference;The effective rate of CTB sleep intervention treatment was 80.8%,and the effective rate of CBT combined with drug sleep intervention was 88.9%.There was no statistically significant difference between the two groups(χ~2=0.18,P>0.05).5.After treatment in the control group,the CD3+,CD4+T cell counts and CD4+/CD8+levels were higher than before,except that the CD8+T cell counts were slightly lower than before,with significant differences.Comparison of sleep conditions manifested that there was no statistically significant difference in the total score of PSQI and the scores of each sleep item except for sleep disorders and hypnotic drugs after 3months of treatment,while there were statistically significant differences in the rest items(P<0.05).Conclusion:1.Sleep disturbance can aggravate the impairment of cellular immune function in PTB patients,and with the aggravation of the degree of sleep disturbance,the impairment of cellular immune function in PTB patients increases.2.Cognitive behavioral therapy has a good effect on improving the sleep of PTB patients.The effective rate of CBT sleep intervention alone is 80.8%,and the effective rate of CBT combined drugs is 88.9%.3.Active and effective anti-tuberculosis treatment can improve the condition and sleep status of patients with sleep disorder PTB.Combined with cognitive behavioral therapy for sleep intervention therapy,it can significantly improve the patient’s sleep status,promote the recovery of cellular immune function,and reduce adverse reactions related to anti-tuberculosis treatment.And improve the effect of disease treatment. |
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