加味升降散对饮停胸胁型结核性胸膜炎的疗效及对患者胸腔积液ADA,免疫功能,T淋巴细胞及炎症因子水平的影响

Efficacy of Modified Shengjiangsan in Treatment of Chest and Hypochondrium Fluid-retention Type Tuberculous Pleurisy and Effect on Pleural effusion,Immune Function,T-lymphocytes and Inflammatory Factors

目的：探讨饮停胸胁型结核性胸膜炎（TBP）患者应用加味升降散对其胸腔积液腺苷脱氨酶（adenosine deaminase,ADA）,免疫功能,T淋巴细胞及炎症因子水平的影响。方法：选取河北大学附属医院2014年3月—2016年3月收治的结核性胸膜炎患者120例,按随机数字表法分为两组。两组均予以胸腔穿刺抽液＋抗结核药物常规治疗;观察组在此基础上,给予加味升降散治疗。记录并比较两组连续治疗2个月时胸腔积液ADA免疫功能及炎症因子指标,同时对比中医证候积分及临床疗效。结果：治疗2个月后,观察组总有效率为91.11%,较对照组总有效率73.33%明显升高（P〈0.05）;两组治疗2个月时胸腔积液ADA水平明显低于治疗前（P〈0.05）;与对照组比较,观察组治疗2个月时胸腔积液ADA水平明显降低（P〈0.05）;治疗2个月后,两组免疫球蛋白（IgA,IgG,IgM）和T淋巴细胞（CD3^＋,CD4^＋）较治疗前升高,转化生长因子-β1（transforming growth factor-β,TGF-β1）,白细胞介素-6（interleukin-6,IL-6）,白细胞介素-8（interleukin-8,IL-8）及肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）含量较治疗前明显降低（P〈0.05）;两组患者发热、胸胁痛、气促、咳嗽中医证候评分明显降低（P〈0.05）;与对照组比较,观察组治疗后免疫球蛋白（IgA,IgG,IgM）和T淋巴细胞（CD3^＋,CD4^＋）明显升高,TGF-β1,IL-6,IL-8,TNF-α含量降低,发热、胸胁痛、气促、咳嗽中医证候评分降低（P〈0.05）;观察组胸水引流量、胸水消失时间、住院时间及胸膜厚度均低于对照组（P〈0.05）;所有患者均获得随访,无病例脱落现象,两组间不良反应发生率比较差异无统计学意义。结论：加味升降散治疗饮停胸胁型结核性胸膜炎疗效确切,降低胸腔积液ADA水平及炎症因子水平,提高免疫功能。

Objective： To investigate the effect of modified Shengjiangsan on pleural effusion adenosine deaminase（ ADA）,immune function,T lymphocytes and inflammatory factors in the treatment of chest and hypochondrium fluid-retention type tuberculous pleurisy. Method： The 120 patients with tuberculous pleurisy from our hospital in March 2014 to March 2016 were selected and randomly divided into 2 groups. The control group received thoracic cavity drainage ＋ anti-tuberculosis routine drug treatment,and observation group received received modified Shengjiangsan based on the treatment in control group. Pleural effusion,inflammatory factors,immune index,Chinese medicine syndrome scores and clinical curative effect were compared after the treatment for 2 months. Result： After treatment for 2 months, the total effective rate was 91. 11% in observation group,significantly higher than 73. 33% in control group（ P〈0. 05）; pleural effusion ADA levels were significantly lower than the levels before treatment in both groups（ P〈0. 05）,and the level in observation group was significantly lower than that in control group after treatment（ P〈0. 05）. After treatment for 2 months,the immunoglobulin（ IgA,IgG,IgM） and T lymphocytes（ CD3＋,CD4^＋） were increased,while the levels of TGF-β1,IL-6,IL-8 and TNF-α were decreased,and the symptom scores of fever,chest pain,shortness of breath and cough were decreased in both groups（ P〈0. 05）; as compared with control group,the levels of immunoglobulin（ IgA,IgG,IgM） and T lymphocytes（ CD3^＋,CD4^＋） in observation group were higher,while the levels of TGF-β1,IL-6,IL-8 and TNF-αwere lower,and the symptom scores of fever,chest pain,shortness of breath and cough were lower（ P〈0. 05）.Pleural effusion drainage, pleural effusion disappearing time, hospitalization time and pleural thickness in observation group were lower than those in control group（ P〈0. 05）. All the patients were followed up,no cases of falling, with no statistically significant difference in adverse reactions incidence between two groups.Conclusion： With clear effect in the treatment of tuberculous pleurisy,modified Shengjiangsan can significantly reduce the thickness and inflammatory factors of the pleura,and improve immune function.