逐饮活血方剂联合西药治疗结核性胸膜炎的临床研究

Clinical study of Fluid-Eliminating and Blood-Activating Prescription combined with western medicine in the treatment of tuberculous pleurisy

目的 探讨逐饮活血方剂联合常规抗结核方案（2HREZ/10HR）治疗结核性胸膜炎的临床效果。方法 选取2014年1月~2015年6月上海市浦东新区肺科医院收治的128例结核性胸膜炎患者,依据随机数字表法将其分为对照组和研究组,每组64例。对照组按照2HREZ/10HR方案进行抗结核治疗,研究组在2HREZ/10HR方案抗结核治疗的同时给予逐饮活血方剂。治疗前及治疗第3、6、9天采用酶联免疫吸附法检测两组患者胸腔积液中肿瘤坏死因子α（TNF-α）以及纤维蛋白原（FIB）水平,治疗前及治疗后2个月检测胸膜厚度、呼吸功能并评价临床疗效。结果 两组治疗前胸腔积液TNF-α及FIB水平、胸膜厚度、用力肺活量（FVC）、第1秒用力呼气容积（FEV1）及FEV1/FVC比较,差异无统计学意义（P〉0.05）;治疗第3、6、9天研究组胸腔积液TNF-α及FIB水平均低于对照组,差异有统计学意义（P〈0.05）;治疗2个月后研究组胸膜厚度低于对照组,差异有统计学意义（P〈0.05）;研究组治疗后FVC、FEV1及FEV1/FVC高于对照组,差异有统计学意义（P〈0.05）;研究组临床有效率（96.9%）高于对照组（87.5%）,差异有统计学意义（P〈0.05）。结论 逐饮活血方剂联合西药治疗结核性胸膜炎能够减轻患者炎性反应,抑制FIB渗出,缓解胸膜反应,改善肺功能,提高临床疗效。

Objective To investigate the clinical curative effect of Fluid-Eliminating and Blood-Activating Prescription combined with common anti-tuberculosis program （2HREZ/10HR） in the treatment of tuberculous pleurisy. Methods One hundred and twenty eight cases of patients with tuberculous pleurisy admitted to Pulmonary Hospital of Pudong New District in Shanghai City from January 2014 to June 2015 were selected and divided into control group and study group according to random number table method, with 64 cases in each group. The control group was treated with anti- tuberculosis program （2HREZ/10HR）, while the study group was given Fluid-Eliminating and Blood-Activating Pre- scription in addition. The levels of tumor necrosis factor α （TNF-α） and fibrinogen （FIB） in hydrothorax of the two groups were detected by enzyme linked immunosorbent assays before treatment and after treatment for 3, 6, 9 days, the pleural thickness and lung function were detected before treatment and after treatment for 2 months, and the clinical curative effect was contrasted. Results The levels of TNF-c~ and FIB in hydrothorax, pleural thickness, forced vital ca- pacity （FVC）, forced expiratory volume in one second （FEV~） and FEV~/FVC of the two groups before treatment had no statistically significant differences （P 〉 0.05）; the levels of TNF-c~ and FIB in hydrothorax of study group after treatment for 3, 6, 9 days were lower than those of control group, the differences were statistically significant （P 〈 0.05）; the pleural thickness of study group after treatment for 2 months was less than that of control group, the difference was statistically significant （P 〈 0.05）; the levels of FVC, FEV~ and FEVI/FVC of study group were higher than those of control group, the differences were statistically significant （P 〈 0.05）; the clinical effective rate of study group （96.9%） was high- er than that of control group （87.5%）, the difference was statistically significant （P 〈 0.05）. Conclusion Fluid-Eliminating and Blood-Activating Prescription combined with western medicine can alleviate inflammatory reactions of patients with tuberculous pleurisy, restrain FIB exudation, reduce pleural reactions, improve lung function and curative effect.