胸膜腔内注入尿激酶对结核性胸膜肥厚的防治研究

Intrapleural injection of urokinase in prevention and treatment of loculated tuberculous pleural effusions and pleural thickening

目的 探讨胸膜腔内注入尿激酶 (UK)对结核性渗出性胸膜炎早期所致胸膜粘连肥厚的防治作用。方法 6 3例结核性渗出性胸膜炎伴胸膜粘连肥厚的初治患者 ,随机分为治疗组 (32例 )和对照组 (31例 ) ;治疗组抽液后注入UK 10 0 0 0 0IU ,共 3次 ;其余治疗方法两组相同。结果 治疗组注药后 ,第 1次和第 2次胸膜腔积液抽出量增多 ,两组比较差异有统计学意义 (P <0 .0 5 ) ,而第 3、4次胸膜腔积液抽出量两组比较差异无统计学意义 (P >0 .0 5 ) ,两组抽液总量差异亦无统计学意义 (P >0 .0 5 ) ;治疗组和对照组胸膜腔积液消失时间分别为 (2 5 .4± 8.7)天和 (30 .7± 8.2 )天 ,组间差异有统计学意义 (P <0 .0 5 ) ;随访 3个月时 ,治疗组胸膜粘连发生率为 15 .6 % ,对照组 38.7% ,组间差异有统计学意义 (P <0 .0 5 ) ;治疗组胸膜厚度为 (1.3± 0 .3)mm ,对照组为 (1.6± 0 .5 )mm ,组间差异有统计学意义 (P <0 .0 5 )。结论 胸膜腔注入UK可使胸膜腔积液“一过性”增高 ,胸膜粘连、肥厚减轻 ;对胸膜腔多房分隔的结核性渗出性胸膜炎也有一定疗效。

Objective To assess the efficacy of intrapleural injection of urokinase for the prevention and treatment of loculated pleural effusions and pleural thickening induced by tuberculosis. Methods Sixty-three patients with loculated tuberculous effusion were randomized to treatment group (32 patients) and control group(31 patients). The treatment group was injected with urokinase at dose of 100 000 IU, three times. The remaining treatment was the same in both groups. Results The amount of pleural effusion drained from the treatment group at the first and second time after the injection was increased, which showed a statistic significance with that of the control group(P< 0.05 ). While at the third and fourth time of drainage, the amount of pleural effusion was of no statistic significance between the two groups (P> 0.05 ). And the whole amount of pleural effusion drained was no significant (P> 0.05 ). The disappearance time of pleural effusion in the treatment and the control group was respectively ( 25.4 ± 8.7 ) d and ( 30.7 ± 8.2 ) d, showing statistic significance (P< 0.05 ). The incidence of pleural adhesion after three months′ follow-up was lower than that of the control group, respectively 15.16 % and 38.71 % (P< 0.05 ). The thickness of pleural membrane in the treatment and the control group was ( 1.3 ± 0.3 ) mm and ( 1.6 ± 0.5 ) mm, having difference(P< 0.05 ). Conclusion Intrapleural injection with urokinase can bring a transient increase of pleural effusion, but alleviate pleural adhesion and pleural thickening. And the therapy is also effective in some degree for loculated tuberculous pleurisy with effusion.