泼尼松对结核性胸膜炎ADA及细胞因子IL-6和IFN-y的影响

目的：观察泼尼松对结核性胸膜炎患者胸腔积液腺苷脱氢酶（ADA）及细胞因子IL-6和IFN-1表达水平及疗效的影响。方法：随机将40例结核性胸膜炎患者分为激素治疗组和常规治疗组，两组均接受常规抗结核化学治疗。激素治疗组加用泼尼松30mg／d，连用7d。分别于治疗前和治疗7、14d采用ELISA法测定患者胸腔积液中IL-6和IFN-y表达水平，酶比色法测定ADA水平。结果：40例患者经治疗后胸腔积液ADA、IL-6和IFN-y水平均有不同程度的降低，激素组降低程度均大于常规组（P〈0．05）。治疗6个月后．激素组完全有效13例、部分有效5例、无效2例；常规组完全有效10例、部分有效7例、无效3例；激素组疗效好于常规组（P〈0．05）。常规组胸膜厚度为（1．43±0．20）mm，粘连7例；激素组胸膜厚度为（1．09±0．13）mm，粘连2例；两组比较，差异有统计学意义（P〈0．05）。结论：早期增加激素治疗能有效降低结核性胸膜炎患者IL-6、IFN-y、ADA水平，治疗效果满意。

Effects of corticosteroids on adenosine deaminase,interlukin-6 and interferon- in patients with tuberculous pleurisy

Objective ： To determine the effects of prednisone on adenosine deaminase （ ADA）, interleukin- 6 （IL-6） and intefferon-y （IFN-y） expression and the association with the efficacy of oral corticosteroids in patients with tuberculous pleurisy. Methods ： We randomly allocated 40 patients with tuberculous pleurisy to, on the basis of usual anti-tuberculous therapy, receive nil additional therapy （ usual treatment group） or the addition of prednisone 30rag once daily for 7 days （eorticosteroids group）. Enzyme-linked imnmnosorbent assay （ELISA） was employed to detect the levels of IL-6 and IFN-y, and enzymatic chromatography was applied to assay the level of ADA prior to the treatment and at days 7 and 14. Results： Corticosteroids group yielded a more pronounced decrease in the levels of ADA, IL-6 and IFN-＇y （ all P 〈 0.05）. Corticosteroid group was associated with preferable therapeutic outcomes compared with control group following the 6-month therapy, as evidenced by an increased number of patients in whom treatment was completely effective （ 13 vs. 10 cases） , partially effective （5 vs. 7 cases） and ineffective （2 vs. 3 cases） （P 〈0.05）. Corticosteroid group had a reduced thiekuess of pleura[ （ 1.09 ± 0.13 ）mm vs. （ 1.43 ± 0.20） ram, P 〈 0.05 ] and number of patients with pleural adhesion （2 vs. 7 cases, P 〈0.05）. Conclusion： The corticosteroids therapy, when administered in an early fashion, may effectively reduce the levels of IL-6, IFN-y and ADA in patients with tuberculous pleurisy compared with conventiona] treatment.