Abstract:

Objective To investigate the dynamic changes of pulmonary function in patients with tuberculous pleurisy after chemotherapy with glucocorticoid. Methods All of 172 patients with tuberculous pleurisy admitted to Beijing Chest Hospital affiliated to Capital Medical University from May 2015 to May 2018 were retrospectively analyzed. The pulmonary ventilation, volume, diffusion function and respiratory muscle mechanics indexes of patients were tested for 4 times: before treatment, at the end of the 1st, 6th and 12th months of treatment. On the basis of anti-tuberculosis drug treatment regimen, patients were divided into two groups: 60 patients in the plus group (prednisone acetate +2H-R-Z-E/10H-R-E) and 112 patients in the non-plus group (2H-R-Z-E/10H-R-E).Pulmonary ventilation function of patients were tested with percentage of forced vital capacity values over the expected value (expected value of pulmonary function factory default value formula), percentage of forced expiratory volume in 1 second readings over the expected value, percentage of forced expiratory volume in 1 second readings versus a forced vital capacity values, percentage of forcibly exhale 75% total lung moment expiratory flow values over the expected value (FEF₇₅% pred), percentage of the maximum values of the expected minute ventilation (MVV% pred);The measurement index of lung volume function were percentage of residual volume detected value over the estimated value, percentage of total lung detected value over the estimated value, and percentage of residual volume/total lung ratio over the estimated value.The measurement index of dispersion function were percentage of the detected lung dispersion amount over the predicted value and percentage of the detected lung dispersion rate in the corrected alveolar volume over the predicted value.The measurement indexes of respiratory muscle mechanics were percentage of airway resistance detected, percentage of peak expiratory flow detected and the measured value of peak inspiratory flow. Results (1)Before chemotherapy, patients with tuberculous pleurisy were mainly affected by restricted ventilation dysfunction (FVC (62.1±13.4) %, FEV₁ (64.4±15.5) %, FEV₁/FVC (87.0±11.1) %, MVV (65.7±21.1) %, FEF₇₅ (61.6 (41.6,83.0) %, RV (111.3 (89.8,131.4) %, TLC (77.0±16.9) %, RV/TLC (146.9±35.9) %,D_LCO (62.6±18.3) %, D_LCO/VA (92.3±16.6) %, PEF (64.1±18.13) %, PIF (3.2 (2.3,4.1) %, Rtot 96.0 (69.3,118.9) %).(2) During the course of treatment, 80.2% (138/172), 75.0% (129/172), and 0.0% (0/0) of patients were tested as having FVC <80% at the end of 1st, 6th, and 12th months. At the end of the 6th month of treatment, up to 44.2% (76/172) of patients had D_LCO <80%. (3) FEF₇₅ for glucocorticoid plus group and non plus group patients before treatment, at 1, 6, 12 months of treatment were (68.7 (49.8,84.1)% and 60.7 (39.4, 80.7) %;87.1 (70.5, 94.4) % and 73.1 (51.9, 87.0) %; 80.1 (66.5, 111.9) % and 66.8 (59.9, 87.2) %;90.4 (55.3, 102.9) % and 78.4 (54.6,87.3) % respectively, improvements after treatment were not significant (Z values were -1.091, -0.111, -1.609, -1.171, all P values were >0.05). MVV% pred were (65.8±19.4) % and (65.5±18.6) %; (86.9±18.6) % and (79.5±18.7) %; (90.3±16.0) % and (86.3±16.0) %;(96.8±11.1) % and (87.3±19.8) %) respectively, the improvement were not significant too(t values were 1.043, 0.444, 0.708, 1.113, all P values were >0.05). Conclusion Patients with tuberculous pleurisy showed restrictive ventilation dysfunction and diffusion function decline before treatment and at the end of the first month of treatment. At the end of 6 months’ treatment, only ventilation function returned to normal. Dispersion function returned to normal at the end of 12 months’ treatment. Early adjuvant treatment of glucocorticoid had no significant effect on pulmonary function in patients with tuberculous pleurisy.

Key words: Tuberculosis,pleural, Antitubercular agents, Glucocorticoids, Drug therapy,combination, Respiratory function tests, Comparative effectiveness research