尿激酶胸腔注射联合四联抗结核疗法治疗结核性胸膜炎临床研究

Clinical Study of Chest Cavity Injection of Urokinase Combined with Quadruple Anti-Tuberculosis Therapy in the Treatment of Tuberculous Pleurisy

目的探讨尿激酶胸腔注射联合四联抗结核疗法治疗结核性胸膜炎的临床疗效。方法选取河北省衡水市第三人民医院2019年1月至2021年9月收治的结核性胸膜炎患者82例,按随机数字表法分为观察组和对照组,各41例。两组患者均予四联抗结核疗法,观察组患者加用尿激酶胸腔注射液。结果观察组治疗总有效率为95.12%,明显高于对照组的80.49%(P<0.05)。与对照组比较,观察组患者治疗4周和8周时的胸膜厚度均明显更薄(P<0.05);观察组患者胸腔积液的引流时间明显更短(P<0.05),引流总量明显更多(P<0.05);观察组患者治疗后的用力肺活量(FVC)和第1秒用力呼气容积(FEV1)均明显更高(P<0.05);观察组患者治疗后的炎性因子[白细胞介素17(IL-17)和γ干扰素(INF-γ)]水平均明显更低(P<0.05)。观察组和对照组患者治疗期间的药品不良反应及引流异常的发生率均相当(14.63%比4.88%,7.32%比12.20%,P>0.05)。结论尿激酶胸腔注射联合四联抗结核疗法治疗结核性胸膜炎的临床疗效较好,能有效促进胸腔积液排出,降低胸膜厚度,改善炎性因子水平和肺功能,且安全性良好。

Objective To investigate the clinical efficacy of chest cavity injection of urokinase combined with quadruple anti-tuberculosis therapy in the treatment of tuberculous pleurisy.MethodsA total of 82 patients with tuberculous pleurisy admitted to the Third People′s Hospital of Hengshui from January 2019 to September 2021 were selected and divided into the observation group and the control group by the random number table method,with 41 cases in each group.Patients in the two groups were given the quadruple anti-tuberculosis therapy,on this basis,the patients in the observation group were given the chest cavity injection of urokinase.ResultsThe total effective rate in the observation group was 95.12%,which was significantly higher than80.49%in the control group(P<0.05).Compared with that in the control group,the pleural thickness in the observation group was significantly thinner at the fourth and eighth weeks after treatment(P<0.05).Compared with those in the control group,the drainage time of pleural effusion in the observation group was significantly shorter(P<0.05),and the total drainage volume of pleural effusion in the observation group was significantly more(P<0.05).Compared with those in the control group,the forced vital capacity(FVC)and forced expiratory volume in one second(FEV1)in the observation group were significantly higher after treatment(P<0.05).Compared with those in the control group,the levels of inflammatory factors[interleukin-17(IL-17)and interferon-γ(INF-γ)]in the observation group were significantly lower after treatment(P<0.05).The incidence of adverse drug reactions and abnormal drainage in the observation group was similar to that in the control group during treatment(14.63%vs.4.88%,7.32%vs.12.20%,P>0.05).ConclusionChest cavity injection of urokinase combined with quadruple anti-tuberculosis therapy is effective and safe in the treatment of tuberculous pleurisy,which can promote the drainage of pleural effusion,reduce the pleural thickness,improve the inflammatory factor levels and lung function of patients.