糖皮质激素治疗结核性腹膜炎的临床体会

Our experience with glucocorticoid treatment of tuberculous peritonitis

目的:探讨糖皮质激素应用于渗出型结核性腹膜炎(tuberculous peritonitis,TBP)的适应证和方法以期达到最佳疗效.方法:以同期30例渗出型TBP为研究对象,抗结核治疗2 wk后加用糖皮质激素治疗.依疗效将患者分为A组(显效和有效)和B组(无效或恶化),对比分析2组病例的基本情况、临床表现、合并症、辅助检查、治疗效果和预后.结果:A组18例,B组12例,两组平均年龄(29.1岁±10.2岁vs 48.5岁±20.8岁,P<0.05).A、B两组合并症如下:黏连型T B P,肠结核,结核性胸膜炎,卵巢结核(2/18 vs 9/12,1/18 vs2/12,12/18 vs 2/12,1/18 vs 2/12,P<0.05).A组高热12例,中度发热5例;B组中度发热5例,低热7例.A组结核菌素试验强阳性10例,阳性8例;B组阳性5例,弱阳性7例.A组10例血沉>100 mm/h,4例血沉50-100 mm/h,1例血沉≥20 mm/h且<50 mm/h;B组2例血沉50-60mm/h,10例血沉≥20 mm/h且<50 mm/h.A组中大量腹水8例,中量腹水10例;B组中量腹水3例,少量腹水9例.A组14例显效,尿量增加300-500 mL/d,腹胀明显减轻;4例有效,尿量增加200-350 m L/d,腹胀减轻.使用激素4wk后复查提示少量腹水,6-8 wk后腹水消失.B组12例无效,腹水无明显减少,腹胀未好转.5-8 wk后腹水消失.随访6 mo,所有病例未发现疾病进展,未出现相关并发症,恢复良好.结论:糖皮质激素主要适用于变态反应强烈的渗出型TBP.在规律抗结核治疗2 wk后遵循短期、小量、顿服、递减的原则应用糖皮质激素是安全有效的.

AIM：To investigate the indications and methods for the application of glucocorticoid treatment in exudative tuberculous peritonitis（TBP） in order to achieve the best treatment effect.METHODS：Thirty patients with exudative TBP hospitalized in the same period were chosen as subjects and given glucocorticoid 2 wk after anti-tuberculosis treatment.According to the result of glucocorticoid treatment,the patients were divided into either group A（excellent and effective;n- 18） or group B（invalid or deteriorated;n- 12）.The basic conditions,clinical manifestations,complications,auxiliary examination,treatment effect and prognosis were compared for the two groups.RESULTS：Patients in groups A and B had different average age（29.1 years ± 29.1 years vs48.5 years ± 20.8 years,P 〈0.05）.Complications in groups A and B were as follows：adhesive type TBP（2/18 vs 9/12）,intestinal tuberculosis（1/18 vs 2/12）,tuberculous pleurisy（12/18 vs2/12）,and ovarian tuberculosis（1/18 vs 2/12）（P 〈0.05 for all）.In group A,12 cases had high fever,and 5 cases had moderate fever;in group B,5 cases had moderate fever,and 7 cases had low grade fever.PPD test was strongly positive in 10 cases and positive in 8 cases in group A,and positive in 5 cases and weakly positive in 7cases in group B.In group A,ESR was greater than 100 mm/h in 10 cases,50-100 mm/h in 4cases,and 20-50 mm/h in 1 case;in group B,ESR was 50-60 mm/h in 2 cases and 20-50 mm/h in10 cases.In group A,8 cases had massive ascites,and 10 cases had moderate ascites;in group B,3 cases had moderate ascites,and 9 cases had mild ascites.In group A,14 cases had an excellent response,their urine volume increased300-500 mL/d,and abdominal distention was greatly relieved;4 cases had effective results,their urine volume increased 200-350 mL/d,and distension was alleviated.Only a small amount of ascites was detected by ultrasound after four weeks of glucocorticoid treatment and ascites disappeared after 6-8 wk.In contrast,no significant improvement was observed in all the12 cases of group B.Ascites was not reduced and distension was not improved after the glucocorticoid treatment.Ascites disappeared after 5-8 wk.In a follow-up period of 6 mo,all patients had neither disease progression nor related complications and recovered well.CONCLUSION：Glucocorticoid is mainly suitable for exudative TBP patients who had strong allergic reaction.After 2 wk of regular anti-tuberculosis treatment,the application of glucocorticoid following the principle of short period,small quantity,draught,and decrement is safe and effective.