结核性渗出性胸膜炎激素治疗的探讨

Clinical curative effect of glucocorticoids treatment on patients with tuberculous exudative pleurisy

目的评价激素在治疗结核性渗出性胸膜炎的临床疗效。方法随机将56例结核性渗出性胸膜炎患者分为激素治疗组(25例)和非激素治疗组(31例)。两组均采用统一的抗结核化疗加胸穿抽液或引流方案治疗,激素治疗组在上述方案的基础上加用强的松口服。观察两组病例发热改善时间,胸液吸收时间,治疗初始及2月、4月、6月后胸膜粘连肥厚的情况。结果激素治疗组及非激素治疗组退热时间分别为(1.86±1.25)天,(3.81±2.30)天,差异有统计学意义(P<0.001);胸水吸收时间分别为(7.24±4.60)天,(8.50±5.78)天,两者比较差异无统计学意义(P>0.05);胸膜增厚的例数分别为23及27例,增厚厚度为(19.79±11.92)mm,(17.56±11.73)mm,差异均无统计学意义(P>0.05);两组2月、4月及6月胸膜肥厚例数分别为18例、7例、3例及24例、10例、4例,两者比较均无统计学意义(P>0.05)。结论激素能缓解患者发热等结核中毒症状,但对于加快胸液吸收、减少胸膜增厚的发生率和治疗并无明显效果。

Objective To evaluate clinical curative effect of glucocorticoids treatment on patients with tuberculous exudative pleurisy. Methods 56 patients with tuberculosis exudative pleurisy were divided into two groups randomly, glucocorti- coids therapy group （25 cases） and control group （31 cases）. All patients were treated with same anti-tuberculosis chemotherapy plus thoracentesis （or drainage） in two groups, and patients in glucocorticoids therapy group were combined with oral predni- sone. The time for abatement of fever and absorption of pleural fluid, and pleural thickening and adhesion at 0, 2 , 4, 6 monthes after treatment, were compared between two groups. Results There was significant difference in the time for abate- ment of fever （ 1.86 ＋ 1.25 days vs 3.81 _＋ 2. 30 days） between two groups （ P 〈 0. 00l ）. There were no significant differences in the time for absorption of pleural fluid （7.24 ± 4. 60 days vs 8.50 ± 5.78 days） , case number of pleural thickening （23 cases vs 27 cases） , pleural thickening （ 19.79 ± 11.92mm vs 17.56 ± 11.73mm） and case number of pleural thickening at 2, 4, 6 monthes after treatment （ 18, 7, 3 cases vs 24, 10, 4 cases, respectively） between two groups （all of P 〉 0. 05 ）. Con- clusion Glucoeorticoids treatment can relieve toxic symptoms of tuberculosis, such as fever. But it cannot quicken absorption of pleural fluid and reduce incidence of pleural thickening, and it has no obvious therapeutic effect on pleural thickening.