摘要
目的观察糖皮质激素治疗对结核性胸膜炎患者的腺苷脱氨酶(ADA)、Th1/Th2细胞因子及炎症因子的影响。方法选取于2014年5月至2015年7月确诊为结核性胸膜炎的患者80例,将患者按照随机数表法分为胸腔给药组和口服给药组。在常规抗结核治疗的基础上,胸腔给药组给予胸腔内地塞米松3 mg注射治疗,口服给药组给予口服糖皮质激素治疗。测定治疗前和治疗9 d后两组患者的胸腔积液中ADA、Th1/Th2细胞因子以及炎症因子白细胞介素6和白细胞介素8(IL-6、IL-8)水平,并于治疗30 d后评价两组患者的临床疗效。结果治疗9 d后,两组患者胸腔积液中ADA、Th1/Th2细胞因子(IFN-γ、IL-2、IL-4)以及炎症因子IL-6、IL-8水平均有下降,且胸腔给药组(25.62±9.74 IU/L、25.23±12.21 pg/ml、19.31±12.03 pg/ml、14.23±8.6 pg/ml、78.33±17.64 pg/ml、163.65±46.25 pg/ml)明显低于口服给药组(34.96±10.45 IU/L、36.78±13.80 pg/ml、26.28±13.47 pg/ml、23.82±10.01 pg/ml、286.78±75.41 pg/ml、550.23±78.92 pg/ml),胸腔给药组患者的IL-10水平(39.12±14.46 pg/ml)明显高于口服给药组(28.13±23.11 pg/ml),差异有统计学意义(P<0.05);治疗30 d后胸腔给药组的治疗总有效率(95.0%)显著高于口服给药组(67.5%),差异有统计学意义(P<0.05)。结论应用糖皮质激素治疗可以有效抑制结核性胸膜炎病程中炎症因子的释放,减少炎症因子的表达、抑制局部免疫细胞,减轻局部炎症反应,能显著提高结核性胸膜炎的临床疗效。胸腔给药疗效优于口服给药。
Objective To observe the effect of ADA, Th1 / Th2 and inflammatory factors of glucocorticoid treatment to tuberculosis pleurisy patients. Methods Select 80 tuberculosis pleurisy patients in our hospital diagnosed from May 2014 to July 2015. All these patients were divided the patients into pleural administration group and the oral administration group according to the random number table method. On the basis of the conventional anti - tuberculosis treatment, pleural group was injected of dexamethasone 3 mg in pleural. Oral administration group was given oral corticosteroids. Measured the ADA, Th1/Th2 and inflammatory cytokine interleukin - 6 and interleukin - 8 （ IL - 6 , IL - 8 ） levels of pleural effusion before treatment and 9 d after treatment. And evaluated the clinical efficacy of the two groups of patients after treatment 30 d. Results After 9 d treatment, the pleural effusion ADA, Th1/Th2 cytokines （IFN - 7 , IL - 2 , IL - 4 ） and inflammatory cytokines IL - 6 , IL - 8 levels of the two groups of patients decreased. And the pleural administration group （25. 62 ± 9.74 IU/L, 25. 23 ± 12. 21 pg/ml, 19.31 ±12.03 pg/ml, 14. 23 ± 8.6 pg/ml, 78.33 ± 17. 64 pg/ml, 163. 65 ±46. 25 pg/ml） was significantly lower than the oral administration group （34. 96 ± 10. 45 IU/L, 36.78 ±13.80 pg/ml, 26.28 ±13.47 pg/ml, 23.82±10.01 pg/ml, 286.78 ±75.41 pg/ml, 550.23 ±78.92 pg/ml）.The IL_10 of pleural administration group （39. 12 ± 14. 46 pg/ml） was significantly higher than the oral administration group （28. 13 ±23. 11 pg/m）. The difference was statistically significant （ P 〈0. 0 5） . 30 d after treatment, treatment of pleural administration group total efficiency （95% ） was significantly higher than oral administration group （67. 5% ）. The difference was statistically significant （ P 〈 0 .0 5 ） . Conclusion Glucocorticoid therapy can effectively inhibit the release of inflammatory factors in tuberculosis course, reduce the expression of inflammatory factors and suppress local immune cells, reduce local inflammation. Therefore, this method can significantly improve the clinical efficacy of treatment to tuberculosis pleurisy, worthy widely used. Intrathoracic administration more effective than oral administration.
出处
《临床和实验医学杂志》
2016年第19期1918-1921,共4页
Journal of Clinical and Experimental Medicine
