口服及胸腔注射糖皮质激素对结核性胸膜炎患者血清和胸腔积液中IL-6、IL-8和sIL-2R表达水平的影响

目的 观察口服和胸腔注射糖皮质激素对结核性胸膜炎患者血清和胸腔积液中IL-6、IL-8和sIL-2R表达水平的影响.方法 应用ELISA法检测口服用药组和胸腔注射组各20例患者用药前及用药后第3,6、9天外周血和胸腔积液中IL-6、IL-8和sIL-2R水平.结果 口服用药组用药后第3、6、9天血清中IL-6、IL-8明显降低并显著低于胸腔注射组(P＜0.01),sIL-2R明显升高并显著高于胸腔注射组(P＜0.01).胸腔注射组用药后第3、6、9天胸腔积液中IL-6、IL-8明显下降并显著低于口服用药组(P＜0.01),sIL-2R明显上升并显著高于口服用药组(P＜0.01).用药1个月后,口服用药组胸腔积液完全吸收率45%(9/20),胸膜肥厚率40%(8/20),胸腔注射组分别为80%(16/20)、10%(2/20).两组比较差异有统计学意义(P＜0.05).结论 与口服糖皮质激素比较,胸腔内注射糖皮质激素对胸膜腔局部的细胞免疫功能具有更强的抑制作用,而对整个机体免疫功能的抑制显著减弱;胸腔内注射糖皮质激素对结核性胸膜炎患者具有更显著的疗效.

Effect of glucocorticoid by oral medication or intrathoracic injection on the expression of IL-6,IL-8 and sIL-2R in serum and pleural fluid in patients of tuberculous pleurisy

Objective To observe the effect of gheocorticoid by oral medication or intrathoracic iniection on the expression of IL-6,IL-8 and sIL-2R in gerum and pleural fluid in patients of tuberculous pleurisy.Methods Twenty tuberculous pleurisy patients were treated with ghcocortieoid by oral medication (oral group)and 20 cases by intrathoracic injection(injection group).ELISA wag employed to detect the levels of IL-6,IL-8 and sIL-2R in serum and pleural fluid before treatment and 3,6 and 9 days after treatment.Results The levels of serum IL-6 and IL-8 decreased and sIL-2R increased obviously in injection group at 3,6 and 9 days after treatment(P＜0.01).Meanwhile the levels of IL-6 and IL-8 in pleural fluid decreased and sIL-2R increased obviously(P＜0.01).The levels of IL-6 and IL-8 were significantly lower and the levels of aIL-2R were significantly higher in injection group than those in oral group(P＜0.01).One month after treatment,the rate of complete absorpion of pleural fluid was higher in injection group(80%)than thatin oral group(45%),the rate of pachynsis pleurae was lower in injection group(10%)than that in oral group(40%),P＜0.05.Conclusions Intrathoracic injection of ghcocorticoid shows stronger suppression of cellular immune function in cavum pleurae and weaker suppression of the general immune sysmm than oral medication.Intrathoracic injection of glucocorticoid can increase the therapeutic effect and decrease side effect in tuberculous pleurisy.