口服结合胸腔注射糖皮质激素治疗结核性胸膜炎的疗效及其对hs-CRP和ADA的影响

目的探讨口服结合胸腔注射糖皮质激素治疗结核性胸膜炎的疗效及其对高敏C反应蛋白(hs-CRP)和腺苷脱氨酶(ADA)的影响。方法结核性胸膜炎患者135例,按照给药方法的不同分为观察组和对照组,观察组57例予以口服和胸腔注射糖皮质激素,对照组78例予以口服糖皮质激素。观察两组的疗效、症状和体征、胸膜的厚度、胸穿次数、胸腔积液中的hs-CRP和ADA水平。结果观察组的总有效率为87.72%,优于对照组的71.79%(P<0.05)。观察组的胸水消失时间、发热消退时间、胸痛消退时间和盗汗消退时间均较对照组明显缩短,差异有统计学意义(P<0.01)。观察组的胸穿<3次的比例明显高于对照组(P<0.01),而胸膜增厚的比例明显低于对照组(P<0.05)。两组治疗后胸水中hs-CRP和ADA水平均较治疗前明显降低,用药3d和用药后7d,观察组的胸水中hs-CRP和ADA水平较对照组降低更为明显,差异有统计学意义(P均<0.05)。结论口服结合胸腔注射糖皮质激素治疗结核性胸膜炎具有较好的疗效,可显著降低胸腔局部的hs-CRP和ADA表达。

Efficacy of oral medication and intrathoracic injection of glucocorticoid in patients with tuberculous pleurisy and the effect on the expression levels of hs-CRP and ADA in pleural fluid

Objective To evaluate the effect of glucocorticoid by oral medication and intrathoracic injection on expression levels of hs-CRP and the impact of ADA in pleural fluid in patients with tuberculous pleurisy. Methods According to the administration methods, 135 tuberculous pleurisy patients in our hospital were divided into observation group and control group. In the observation group, 57 cases were treated with glucocorticoid by oral medication and intrathoracic injection; in the control group, 78 cases were gave oral glucocorticoid. The effect, symptoms and signs, pleural thickness, numbers of puncture, the high-sensitivity C-reactive protein (hs-CRP) and adenosine deaminase (ADA) in pleural effusion were observed. Results The total effective rate of the observation group was 87.72% and was higher than that (71.79%) of the control group (P<0.05). The disappearance time of pleural effusion, fever, chest pain and night sweats in observation group were significantly shorter than those in the control group (P<0.01). The rates of thoracentesis (<3 times) in observation group were significantly higher than that of control group (P<0.01), and the pleural thickening of observation group was significantly lower than that of control group (P<0.05). After treatment, the levels of hs-CRP and pleural fluid ADA were significantly lower than those before treatment. The levels of hs-CRP and ADA in pleural fluid after medication day 3 and 7 in observation group decreased more significantly than those in control group (P <0.05 or <0.01). Conclusion Oral medication and intrathoracic injection of glucocorticoid in patients with tuberculous pleurisy has a better effect. Glucocorticoid can significantly reduce the expression of hs-CRP and ADA in local chest.