和解通利法治疗结核性包裹性胸腔积液的临床研究  

The clinical research on treating encapsulated tuberculous pleural effusion with the method of reconciliation and diuresis

作　　者：李同霞 韩彤亮[2] 薛卫林 胡海波 邓凯 苏海涛 

机构地区：[1]青岛市胸科医院结核科,266043 [2]青岛市市立医院东院区B超室 [3]青岛市海慈医疗集团呼吸科 [4]青岛市胸科医院影像科,266043

出　　处：《中国防痨杂志》2013年第8期592-596,共5页Chinese Journal of Antituberculosis

基　　金：青岛市科技支撑计划课题(07-2-1-19-nsh)

摘　　要：目的探讨和解通利法治疗结核性包裹性胸腔积液的疗效。方法采用随机数字表法将120例结核性包裹性胸腔积液患者随机分为治疗组60例(2例退出,实际为58例)和对照组60例。观察两组治疗前后胸腔积液中肿瘤坏死因子α(TNF-α)浓度的变化情况,治疗后1个月末、3个月末、9个月末患者的胸膜厚度变化情况,以及治疗后3个月末、9个月末患者的综合疗效情况。结果胸腔积液中TNF-α浓度治疗组治疗后[(35.35±17.46)pg/L]及对照组治疗后[(47.16±18.89)pg/L]比较,差异有统计学意义(t=-3.114,P<0.01)。治疗1、3、9个月末CT扫描显示的胸膜厚度治疗组[分别为(0.42±0.27)cm、(0.31±0.26)cm、(0.25±0.21)cm]小于对照组[分别为(0.54±0.30)cm、(0.42±0.32)cm、(0.37±0.28)cm],差异均有统计学意义(F=42.727,P=0.000)。两组综合疗效相比,治疗3个月末、9个月末治疗组显效率[分别为70.69%(41/58)、89.66%(52/58)]均优于对照组[分别为45.00%(27/60)、65.00%(39/60)],差异均有统计学意义(Z=-2.856、-3.192,P值均<0.05)。结论采用和解通利法用药联合抗结核西药治疗结核性包裹性胸腔积液与单纯应用西药抗结核治疗比较,显效率更高;可减少胸膜肥厚粘连;降低胸腔积液中TNF-α水平。Objective To investigated the clinical efficacy with the method of reconciliation and diuresis on encapsulated tuberculous pleural effusion.Methods We randomly divided 120 participants,which were diagnosed as encapsulated tuberculous pleural effusion,into 2 groups（the treatment group and the control）.Before and after treatments,we observed the levels of TNF-α in pleural effusion.The pleural thickness was measured before and at the end of the first,the third and the ninth months after treatments.The comprehensive curative effect was evaluated at the third and the ninth months after treatment.Results There was significant difference in the levels of TNF-α in pleural effusion between 2 groups（t=-3.114,P0.01）,which were（35.35±17.46） pg/L and（47.16±18.89） pg/L in treatment group and the control,respectively.The pleural thickness measured on CT between 2 groups was statistically significant difference at the different month after treatment（F=42.727,P=0.000）,which were（0.42±0.27） cm、（0.31±0.26） cm、（0.25±0.21） cm at the first,third and ninth months after treatments in treatment group,respectively and were（0.54±0.30） cm、（0.42±0.32） cm、（0.37±0.28） cm at the same months after treatments in control group,respectively.While compared comprehensively efficacy between 2 groups,comprehensive improvement was more significant in the treatment group（70.69%,41/58;89.66%,52/58） at the the third and ninth months after the treatments（Z=-2.856 and-3.192 respectively,both of P0.05）,than that of in the control group（45.00%,27/60;65.00%,39/60）.Conclusion The method of reconciliation and diuresis combined with antituberculosis drugs to treat encapsulated tuberculous pleural effusion is better than the method with antituberculosis drugs only.It can reduce pleural adhesion and the levels of TNF-α in pleural effusion.

关 键 词：结核 胸膜 中医疗法 胸腔积液 肿瘤坏死因子Α 

分 类 号：R521.7[医药卫生—内科学]