内科胸腔镜联合尿激酶治疗结核性包裹性胸腔积液的疗效

Therapeutic effects of internal medicine thoracoscope combined with urokinase on tuberculous encapsulated hydrothorax

目的探讨内科胸腔镜联合尿激酶治疗结核性包裹性胸腔积液临床疗效及其对CA-125、ADA以及Th1/Th2细胞因子的影响。方法 120例结核性包裹性胸腔积液患者随机分为治疗组和对照组,每组60例。2组均给予抗结核药物治疗,对照组给予超声引导下胸膜腔注入尿激酶,治疗组给予内科胸腔镜联合尿激酶治疗,观察2组临床治疗效果及治疗前后胸腔积液CA-125、ADA和Th1/Th2细胞因子水平变化情况。结果治疗组在抽液总量,FEV1和FVC水平明显高于对照组,而引流天数和胸膜厚度明显低于对照组,治疗组胸腔积液CA-125、ADA、IL-12、IL-18、IL-4和IL-10水平明显低于对照组,IFN-γ高于对照组,差异均有统计学意义(P<0.05)。结论内科胸腔镜联合尿激酶治疗结核性包裹性胸腔积能有效改善患者临床症状,缓解免疫因子紊乱。

Objective To investigate the therapeutic effects of internal medicine thoracoscope combined with urokinase on tuberculous encapsulated hydrothorax,and to explore its effects on relevant cytokines including cancer antigen 125（ CA-125）,adenosine deaminase（ ADA） and Th1/Th2. Methods A total of 120 patients with tuberculous encapsulated hydrothorax were randomly divided into treatment group and control group,with 60 patients in each group. The patients in both groups were treated by antituberculosis drugs,on this basis,the patients in control group were treated by ultrasound-guided infusion of urokinase into pleural cavity,however,the patients in treatment group were treated by thoracoscope combined urokinase. The clinical curative effects,and the changes of levels of CA-125,ADA and Th1/Th2 in pleural effusion before and after treatment were observed and compared between two groups. Results The total volume of fluid drainage,the levels of FEV1,FVC and IFN-γ in treatment group were obviously higher than those in control group,however,the days of drainage and pleura thickness in treatment group were significantly lower than those in control group,moreover,the levels of CA-125,ADA,IL-12,IL-18,IL-4 and IL-10 in pleural effusion in treatment group were significantly lower than those in control group,but the levels of IFN-γ in treatment group were significantly higher than those in control group（ P〈0. 05）. Conclusion The internal medicine thoracoscope combined with urokinase in treatment of tuberculous encapsulated hydrothorax can effectively improve the clinical symptoms of patients and can relieve immune factor disorder.