泼尼松联合标准四联抗结核疗法治疗结核性胸膜炎的疗效及安全性研究

Efficacy and safety of prednisone combined with standard quadruple antituberculosis therapy in the treatment of tuberculous pleurisy

目的研究泼尼松联合标准四联抗结核疗法(HRZE)治疗结核性胸膜炎(TBP)的疗效及安全性。方法选取陕西省结核病防治院2021年2月至2023年2月收治的TBP患者120例进行前瞻性研究。将其以电脑编号随机法分为研究组及参考组,每组60例。参考组予以HRZE治疗,研究组则于参考组的基础上联合泼尼松治疗。对比两组疗效、各项临床指标、不良反应、血清炎症因子水平。结果研究组治疗总有效率[93.33%(56/60)]显著高于参考组[78.33%(47/60)](χ^(2)=5.55,P<0.05)。研究组临床症状改善时间[(10.34±1.65)d]、胸腔积液吸收时间[(21.37±4.16)d]、胸膜肥厚度[(2.15±0.35)mm]及住院天数[(23.19±4.56)d]均显著短于、小于参考组[(13.27±2.30)d、(27.25±4.95)d、(2.62±0.40)mm、(28.42±5.60)d](t=8.02、7.04、6.85、5.61,均P<0.05)。两组不良反应发生率差异无统计学意义(χ^(2)=2.91,P>0.05)。治疗后8周两组各项血清炎症因子均较治疗前改善,且研究组白细胞介素6(IL-6)[(90.37±12.05)ng/L]、IL-18[(270.94±14.58)ng/L]均显著低于参考组[(110.59±16.90)ng/L、(296.10±25.29)ng/L](t=7.55、6.68,均P<0.05),而IL-10[(78.91±8.25)ng/L]、可溶性白细胞介素2受体(sIL-2R)[(1875.82±359.23)pg/L]均显著高于参考组[(70.40±7.16)ng/L、(1566.87±311.02)pg/L](t=-6.03、-5.04,均P<0.05)。结论泼尼松联合HRZE治疗TBP的疗效较佳,安全性好,有利于炎症因子的改善。

Objective To investigate the efficacy and safety of prednisone combined with standard quadruple antituberculosis therapy(HRZE)in the treatment of tuberculous pleurisy.MethodsA prospective study was conducted involving 120 patients with tuberculous pleurisy who were admitted to the Shaanxi Provincial Tuberculosis Prevention and Control Hospital from February 2021 to February 2023.The patients were randomly assigned to a study group and a control group,with 60 patients in each group,using a computer-generated randomization method.The control group received HRZE alone,while the study group received prednisone therapy and HRZE.The efficacy,clinical indicators,adverse reactions,and serum inflammatory factor levels were compared between the two groups.ResultsThe total response rate in the study group was significantly higher than that in the control group[93.33%(56/60)vs.78.33%(47/60),χ^(2)=5.55,P<0.05].In the study group,the time for clinical symptom improvement was(10.34±1.65)days,the time for pleural effusion absorption was(21.37±4.16)days,the pleural thickness measured(2.15±0.35)mm,and the duration of hospitalization was(23.19±4.56)days.They were significantly shorter or smaller than those in the control group[(13.27±2.30)days,(27.25±4.95)days,(2.62±0.40)mm,(28.42±5.60)days,t=8.02,7.04,6.85,5.61,all P<0.05].There was no significant difference in the incidence of adverse reactions between the two groups(χ^(2)=2.91,P>0.05).After 8 weeks of treatment,all serum inflammatory factors improved in both groups compared with baseline levels.In the study group,levels of interleukin-6[(90.37±12.05)ng/L]and interleukin-18[(270.94±14.58)ng/L]were significantly lower than those in the control group[(110.59±16.90)ng/L,(296.10±25.29)ng/L,t=7.55,6.68,both P<0.05].Levels of interleukin-10[(78.91±8.25)ng/L]and soluble interleukin-2 receptor[(1875.82±359.23)pg/L]in the study group were significantly higher than those in the control group[(70.40±7.16)ng/L,(1566.87±311.02)pg/L,t=-6.03,-5.04,both P<0.05].ConclusionThe combination of prednisone and HRZE demonstrates good efficacy and safety,and it is beneficial for improving inflammatory factors.