结核性胸膜炎患者异烟肼胸腔积液浓度测定及胸膜透过性

Determination of isoniazide concentration in pleural effusion and its pleural permeability in patients with tuberculous pleurisy

目的采用高效液相色谱法(HPLC)测量结核性胸膜炎患者胸腔积液和血浆中异烟肼浓度,并评价异烟肼从血液经胸膜的透过性。方法收集15名结核性胸膜炎患者第1天晨服300 mg异烟肼后2 h的胸腔积液,并采集第3天服药后2 h的血样和胸腔积液,建立HPLC方法进行样品检测,并计算异烟肼的胸膜透过率。结果第1天异烟肼在胸腔积液中的平均浓度是(1.156±1.190)μg/ml;第3天异烟肼在胸腔积液中的平均浓度是(1.920±1.294)μg/ml,在血浆中的平均浓度是(2.445±1.463)μg/ml;异烟肼从血浆进入胸腔积液的平均透过率是86.0%。结论大多数初治患者异烟肼的胸腔积液透过性较高,连续口服异烟肼可以达到有效治疗浓度,对于非耐药结核性胸膜炎不需要胸腔内单独注射异烟肼。

Objective To establish a high-performance liquid chromatography（HPLC）-based method for determining isoniazide concentration in pleural effusion and plasma of patients with tuberculous pleurisy,and evaluate the permeability of isoniazide from blood into pleural effusion.Methods We collected pleural effusion from 15 patients with tuberculous pleurisy 2 h after administration 300 mg isoniazide in the morning of day 1.Pleural effusion and plasma were obtained 2 h after isoniazide administration on day 3.Isoniazide concentration was measured using HPLC,and the penetration rate of isoniazide in pleural effusion was calculated.Results Isoniazide concentration in the pleural effusion averaged 1.156±1.190 μg/ml in the 15 patients at 2 h after isoniazide administration on day 1.On day 3,isoniazide concentration was 1.920±1.294 μg/ml in the pleural effusion and 2.445±1.463 μg/ml in the plasma,and the mean penetration rate of isoniazide from blood into the pleural effusion was 86.0%.Conclusion As isoniazide has a high penetration rate into the pleural effusion in most patients,continuous oral administration of isoniazid has been sufficient to achieve an effective treatment concentration,and intrapleural injection of isoniazide may seem unnecessary for non-drug-resistant tuberculosis pleurisy.