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