口服及胸腔注射糖皮质激素对结核性胸膜炎患者血清和胸腔积液中γ干扰素、肿瘤坏死因子-α表达水平的影响

Effect of Glucocorticoid by Oral Medication or Intrathoracic Injection on Expression Levels of IFN-γ and TNF-α in Serum and Pleural Fluid in Patients with Tuberculous Pleurisy

目的对比研究口服和胸腔注射糖皮质激素对结核性胸膜炎患者的血清和胸腔积液中γ干扰素(IFN-γ)、肿瘤坏死因子-α(TNF-α)表达水平的影响,及两种用药方式的疗效。方法应用酶联免疫吸附法(ELISA)检测口服用药组和胸腔注射组各30例患者用药前及用药后第3、6、9天外周血和胸腔积液中IFN-γ和TNF-α水平。并在用药前及用药后1个月行胸部CT扫描,检测胸膜肥厚和胸腔积液吸收情况。结果胸腔注射组注射后第3、6、9天胸腔积液中IFN-γ、TNF-α表达水平明显下降并低于口服用药组,差异有统计学意义(P<0.001)。口服用药组用药后第3、6、9天血清中IFN-γ、TNF-α表达水平明显降低并低于胸腔注射组,差异有统计学意义(P<0.001)。用药1个月后,口服用药组胸腔积液完全吸收率为43.3%,胸膜肥厚率为40.0%,胸腔注射组分别为83.3%和16.7%,两组患者胸腔积液完全吸收率、胸膜肥厚率比较差异均有统计学意义(P<0.05)。结论胸腔内注射糖皮质激素比口服用药具有更强的疗效和更少的副作用,可显著降低胸腔局部的免疫因子IFN-γ和TNF-α的表达,而对整个机体的免疫功能的抑制显著减弱。

Objective To compare the effects of glucocorticoid by oral medication or intrathoracic injection on expression levels of IFN - γ and TNF - α in blood serum and pleural fluid in patients with tuberculous pleurisy and therapeutic effects of these two kinds of medication. Methods The tuberculous pleurisy patients were treated respectively with glucocorticoid by oral medication （oral group） and intrathoracic injection （injection group）, 30 in each group. The enzyme linked immunosorbent as say （ELISA） was employed to detect contents of IFN -γ and TNF-α in serum and pleural fluid of the patients before treatment and 3, 6, 9 days after treatment. CT scanning on thoracic part of each patient was performed to detect the conditions of pachyonysis pleurae and pleural fluid before medication and 1 month after medication. Results After treatment for 3, 6, 9 days, the contents of IFN - γ and TNF - α in pleural fluid decreased and were obviously lower in the injection group than in the oral group （P 〈 0. 001 ）. After oral medication for 3, 6, 9 days, the contents of IFN - γ and TNF - α in serum decreased and were obviously lower in the oral group than in injection group （P 〈 0. 001 ）. One month after treatment, the rates of complete absorption of pleural fluid and pachyonysis pleurae were respectively 43.3% and 40. 0% in the oral group, and 83.3% and 16.7% in the injection group, the differences between the two groups were significant （ P 〈 0. 05 ）. Conclusion Compared with oral medication, the intrathoracic injection of glucocorticoid is of stronger effects and less side effects in tuberculous pleurisy patients. It can remarkably decrease expression levels of IFN - γ and TNF - α in the local thorax, however its inhibition to general immunity is obviously weaker.