血府逐瘀汤联合西医常规疗法治疗结核性胸膜炎胸膜增厚临床研究

Clinical Study on Tuberculous Pleurisy and Pleura Thickness by Xuefu Zhuyu Decoction Combined with Conventional Western Medicine

目的观察血府逐瘀汤联合西医常规疗法治疗结核性胸膜炎(TBP)胸膜增厚的临床疗效,探讨可能的作用机制。方法采用随机数字表法将150例TBP胸膜增厚患者分为试验组和对照组各75例,共脱落11例,最终试验组71例,对照组68例。对照组予常规短程强化抗结核化疗方案+胸腔穿刺抽中-大量积液,试验组在对照组治疗基础上予血府逐瘀汤,每次150m L,每日3次口服。2组均连续治疗2个月。观察2组中医症状评分、胸水引流量、胸膜厚度、胸水消失时间、胸水指标及临床疗效。结果试验组胸水引流量、胸膜厚度、胸水消失时间均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后发热、咳嗽、气促、胸胁痛评分明显改善(P<0.05);试验组治疗后发热、咳嗽、气促、胸胁痛评分低于对照组(P<0.05)。与本组治疗前比较,2组治疗后胸水肿瘤坏死因子-α(TNF-α)、纤维蛋白原(FIB)、转化生长因子-β1(TGF-β1)、腺苷脱氨酶(ADA)水平下降(P<0.05);试验组治疗后胸水TNF-α、FIB、TGF-β1、ADA水平低于对照组(P<0.05)。试验组总有效率为97.2%(69/71),对照组为88.2%(60/68),2组比较差异有统计学意义(P<0.05)。结论血府逐瘀汤联合西医常规疗法可有效缓解TBP胸膜增厚患者的临床症状,提高临床疗效,其机制可能与降低胸腔积液中TNF-α、FIB、TGF-β1水平相关。

Objective To observe the clinical efficacy of Xuefu Zhuyu Decoction combined with conventional Western medicine for tuberculous pleurisy (TBP) and pleura thickness;To explore the possible mechanism. Methods Totally 150 cases of TBP and pleura thickness were divided into the experiment group and control group according to random number table method, with 75 cases in each group. 11 cases were lost. In the end, 71 cases were treated in the experiment group and 68 cases in the control group. The control group received conventional short-course intensive anti-tuberculosis chemotherapy + thoracentesis medium to large amount of effusion, while the experiment group was given Xuefu Zhuyu Decoction on the basis of the control group, 150 mL each time, three times a day, orally. The treatment for both groups lasted for two months. TCM syndrome scores, pleural drainage volume, pleural thickness, pleural effusion duration, pleural effusion index and clinical efficacy of the two groups were observed. Results The pleural drainage volume, pleural thickness and pleural effusion duration in the experiment group were lower than those in the control group (P<0.05). Compared with before treatment, the scores of fevers, cough, shortness of breath and thoracicgia were significantly improved after treatment in the two groups (P<0.05);The scores of fevers, cough, shortness of breath and thoracicgia in the experiment group were lower than those in the control group (P<0.05). Compared with before treatment, the levels of pleural effusion tumor necrosis factor-α(TNF-α), fibrinogen (FIB), transforming growth factor-β1 (TGF-β1) and adenosine deaminase (ADA) decreased after treatment in both groups (P<0.05);The levels of TNF-α, FIB, TGF-β1 and ADA in the pleural effusion of the experiment group were lower than those of the control group (P<0.05). The total effective rate was 97.2%(69/71) in the experiment group and 88.2%(60/68) in the control group, with statistical significance (P<0.05). Conclusion Xuefu Zhuyu Decoction combined with conventional Western medicine can effectively alleviate the clinical symptoms of patients with TBP and pleural thickness and improve clinical efficacy. The mechanism may be related to reducing the levels of TNF-α, FIB and TGF-β1 in pleural effusion of patients.