关键词: 结核, 胸膜, 超声透入疗法, 化学疗法, 辅助, 疗效比较研究, 数据说明, 统计

Abstract:

Objective To explore the clinical value of triple-drug adjuvant therapy for tuberculous pleurisy (TBP) via chest wall ultrasound. Methods A total of 76 eligible TBP patients admitted to Hainan General Hospital from January 2016 to December 2018 were collected and randomly divided into the observation group and the control group according to the order of admission, with 38 cases in each group. Both groups were treated with 2H-R-Z-E/10H-R systemic chemotherapy+thoracentesis and drainage. On this basis, the observation group was supplemented with a triple-drug treatment of isoniazid+rifampicin+urokinase via transthoracic ultrasound, and the control group was given the same triple-drug treatment applied to the skin of the chest wall. The therapeutic efficacy of patients was compared between the two groups. The count data were represented by $\bar{x}$±s and analyzed using t test; and the measurement data were represented by rate (%) and analyzed using χ² test. P<0.05 was considered statistically significant. Results The total effective rates of the observation and the control groups were 94.74% (36/38) and 78.95% (30/38), respectively, with the statistically significant difference (χ ²=4.146, P=0.042). The thickness of the parietal pleura in the observation and the control groups was (5.29±0.21) mm and (5.98±0.25) mm at 2 months of treatment, respectively; (3.25±0.39) mm and (3.75±0.41) mm at 6 months of treatment, respectively; and (2.15±0.25) mm and (2.62±0.34) mm at 6 months after treatment, respectively; with the statistically significant differences (t=13.028, 29.669 and 47.132, P=0.000, 0.000, and 0.000, respectively). The ratios of the complete absorption of pleural effusion in the observation and the control groups were 65.79% (25/38) and 42.11% (16/38) at 6 months of treatment, respectively; and 94.74%(36/38) and 78.95% (30/38) at the end of 6 months, with the statistically significant differences (χ ²=4.290 and 4.146, P=0.038 and 0.042, respectively). The forced vital capacity (FVC) of the observation group and the control group was (3.86±0.68) L and (3.51±0.61) L at 2 months of treatment; (4.28±0.90) L and (3.74±0.84) L at 6 months of treatment; and (4.68±0.75) L and (3.98±0.79) L at the end of 6 months of treatment, respectively; with the statistically significant difference between the two groups (t=5.578, 4.894, and 35.307, P=0.021, 0.000, and 0.000, respectively). The 1s forced expiratory volumes (FEV₁) of the observation group and the control group were (3.54±0.67) L and (3.38±0.69) L at 2 months of treatment, respectively; (3.89±0.72) L and (3.38±0.69) L at 6 months of treatment, respectively; (4.23±0.75) L and (3.54±0.71) L at the end of 6 months of treatment, respectively, with the statistically significant difference (t=4.541, 3.153, 16.962, P=0.036, 0.000, 0.000, respectively). The inspiratory capacity (IC) of the observation group and the control group was (2.76±0.42) L and (2.30±0.38) L at 6 months of treatment, respectively; (2.98±0.45) L and (2.49±0.43) L at the end of 6 months of treatment, respectively; with the statistically significant difference (t=5.007 and 23.551, P=0.000 and 0.000, respectively). Conclusion The triple-drug treatment of isoniazid+rifampicin+urokinase via chest wall ultrasound can further improve the clinical efficacy of tuberculous pleurisy, significantly reduce the thickness of the pleura, accelerate the absorption of pleural effusion and improve lung function.

Key words: Tuberculosis, pleural, Ultrasound penetration therapy, Chemotherapy, adjuvant, Comparative effectiveness research, Data description, Statistics