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中国防痨杂志 ›› 2020, Vol. 42 ›› Issue (10): 1036-1041.doi: 10.3969/j.issn.1000-6621.2020.10.006

• 论著 • 上一篇    下一篇

胸腔内注射尿激酶预防儿童结核性渗出性胸膜炎胸膜肥厚和粘连的价值

田瑶, 吴浩宇, 李然, 程漠鑫, 王晓丹, 陈禹()   

  1. 110044 沈阳市第十人民医院 沈阳市胸科医院儿童结核科
  • 收稿日期:2020-07-08 出版日期:2020-10-10 发布日期:2020-10-15
  • 通信作者: 陈禹 E-mail:yuchensyxk@163.com
  • 基金资助:
    辽宁省自然科学基金(2019-MS-289)

Study on intrapleural injection of urokinase to prevent pleural thickening and adhesive encapsulation in children with tuberculous pleurisy

TIAN Yao, WU Hao-yu, LI Ran, CHENG Mo-xin, WANG Xiao-dan, CHEN Yu()   

  1. Department of Pediatric Tuberculosis,Shenyang Tenth People’s Hospital,Shenyang 110044, China
  • Received:2020-07-08 Online:2020-10-10 Published:2020-10-15
  • Contact: CHEN Yu E-mail:yuchensyxk@163.com

摘要:

目的 观察胸腔内注射尿激酶预防儿童初治结核性渗出性胸膜炎胸膜肥厚和粘连的价值。方法 2019年1—12月沈阳市第十人民医院住院的初治结核性渗出性胸膜炎的儿童患者70例。采用数字表法随机分为两组(观察组和对照组),依据成组设计率的差异性检验样本含量估计,每组达到35例患儿即停止纳入,共纳入患者70例,男53例,女17例,4~14岁(27例),15~18岁(43例)。均在标准抗结核药品方案(2H-R-Z-E/10H-R-Z)治疗的基础上,对照组采用单纯置管胸腔积液引流方案,观察组采用置管胸腔积液引流联合胸腔内注射尿激酶方案。比较两组患者治疗12周时胸膜肥厚及粘连情况;比较两组住院时间、置管引流时间、胸腔积液消失时间、需进行手术情况,以及胸腔积液中纤溶酶原激活剂抑制因子-1(plasminogen activator inhibitor-1,PAI-1)、组织型纤溶酶原激活物(tissue-type plasminogen activator,t-PA)、Ⅲ型前胶原(procollagen type Ⅲ,PcⅢ)的变化水平。结果 治疗12周时,观察组胸膜肥厚,粘连或包裹性胸腔积液的发生率为28.6%(10/35),8.6%(3/35),明显低于对照组的62.9%(22/35)、31.4% (11/35),差异有统计学意义(χ2=8.289、5.714,P=0.004、0.017)。观察组住院时间[中位数(四分位数),M(Q1,Q3)]为21(14,32)d,置管引流时间[M(Q1,Q3)]为20(13,30)d,胸腔积液消失时间[M(Q1,Q3)]为19(12,29)d;均明显短于对照组的30(18,39)d,29(16,36)d,28(14,35)d,差异均有统计学意义(Z=2.475、2.382、2.164,P=0.013、0.017、0.030)。观察组需进行手术者占比为2.9%(1/35)明显低于对照组的22.9%(8/35),差异有统计学意义(χ2=4.590,P=0.032);观察组尿激酶干预后胸腔积液 t-PA/PAI-1的比值[M(Q1,Q3)]为0.43(0.38,0.53),明显高于对照组的0.22(0.19,0.32),差异具有统计学意义(Z=5.733,P=0.000);观察组尿激酶干预后胸腔积液PcⅢ浓度(35.09±6.26)μg/L低于对照组(51.73±10.27)μg/L,差异有统计学意义(t=8.188,P=0.000)。结论 胸腔置管引流联合胸腔内注射尿激酶能增高胸腔积液纤溶酶原活性、降低PcⅢ浓度,有助于预防儿童结核性渗出性胸膜炎引起的胸膜肥厚和粘连。

关键词: 儿童, 结核, 胸膜, 组织粘连, 预防和防护用药, 尿激酶型纤维蛋白酶原激活剂, 疗效比较研究

Abstract:

Objective To investigate the effect of early intrapleural injection of urokinase on pleural thickening and adhesive encapsulation in children with tuberculous exudative pleurisy. Methods Seventy children with tuberculous pleurisy diagnosed in Shenyang Tenth people’s Hospital from January 1, 2019 to December 31, 2019 were included in the study. According to the random number table, patients were randomly enrolled into treatment group or control group. It was estimated that the data will be discontinued when 35 patients per group were reached according to the variability of the cohort design rate. A total of 70 patients were included, 53 males and 17 females, aged 4-14 years (27 patients) and 15-18 years (43 patients).On the basis of standard anti-tuberculosis treatment (2H-R-Z-E/10H-R-Z) assisted by pleural catheterization, the control group was treated with simple pleural drainage. The treatment group was treated with intrapleural injection of urokinase and pleural drainage. Pleural thickening, adhesive encapsulation, and whether needed operation after treating for 12 weeks were compared between those two groups. At the same time, length of hospital stay, drainage time, disappearance time of pleural effusion, levels of plasminogen activator inhibitor-1 (PAI-1), tissue-plasminogen activator (t-PA) and procollagen type Ⅲ (PCⅢ) in pleural effusion before and after drainage were compared. Results The incidences of pleural thickening, adhesive encapsulation and operation (12 weeks) in the treatment group were 28.6% (10/35), 8.6% (3/35) and 2.9% (1/35) respectively, which were significantly lower than those in the control group (62.9% (22/35), 31.4% (11/35), 22.9% (8/35); χ2=8.289, 5.714, 4.590; P=0.004, 0.017, 0.032). Median (Q1,Q3) of hospital stay,the average drainage time and the disappearance time of pleural effusion in the treatment group were 21 (14,32) d,20 (13,30) d and 19 (12,29) d respectively, which were significantly shorter than those in the control group (30 (18,39) d, 29 (16,36) d, 28 (14,35) d respectively). The differences were statistically significant (Z values were 2.475, 2.382 and 2.164 respectively, P=0.013, 0.017, 0.030). The median (Q1,Q3) level of t-PA/PAI-1 (0.43 (0.38,0.53)) in pleural effusion after urokinase intervention in the treatment group was significantly higher than that in the control group (0.22 (0.19,0.32)), and the difference was statistically significant (Z=5.733,P=0.000). The concentration of PCⅢ ((35.09±6.26) μg/L) in pleural effusion after urokinase intervention in the treatment group was significantly lower than that in the control group ((51.73±10.27) μg/L), and the difference was statistically significant (t=8.188,P=0.000). Conclusion Early intrapleural injection of urokinase on the basis of thoracic drainage is helpful to prevent pleural thickening and adhesive encapsulation in children with tuberculous pleurisy.

Key words: Child, Tuberculosis, pleural, Tissue adhesions, Protective agents, Urokinase-type plasminogen activator, Comparative effectiveness research