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Objective To investigate the relationship between cellular immune response which is related with Th1/Th2 cells and the different severities of tuberculosis pleural effusion adhesion.Methods A total of 66 in-patients diagnosed with different severities of tuberculosis pleural effusion adhesion by internal thoracoscope were enrolled from August 2014 to December 2016.ELISA was used to determine levels of INF-γ,TNF-α,IL-2 and IL-4. The ratio of Th1 and Th2 cells was detected by flow cytometry. Results All the patients were divided into 3 groups:9 cases without pleural adhesion,32 cases with mild pleural adhesion,25 cases with severe pleural adhe-sion. The levels of 4 cytokines in pleural fluid were significantly higher than those in serum in each group(P <0.05,respectively).The concentrations of INF-γ and TNF-α were increased with the severity of tuberculosis pleu-ral effusion adhesion. The levels of INF-γ and TNF-α in the severe pleural adhesion group were markedly higher than those in the other two groups(P<0.05,respectively).The proportion of Th1 cells in the severe pleural adhe-sion group was significantly higher than that in the none pleural adhesion group and in the mild pleural adhesion group(P<0.05,respectively).Conclusions The proportion of Th1 cells and levels of INF-γ and TNF-α are pos-itively related with pleural adhesion severity. Cellular immune response which is related with Th1 cells contributes to pathological immune pleural damage and intensify the severity of pleural adhesions.
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Objective To evaluate the guiding values of different lung compressed forms in the choice of the treat?ment of spontaneous pneumothorax. Methods Based on lung compressed forms on anterior-posterior chest X-ray , a total of 219 spontaneous pneumothorax patients were divided into the periphery shape group (n=127) and irregular shape group (n=92). We observe the relationship between lung compressed form with the times of previous closed thoracic drainage,the cure rate of closed chest drain at the 7th day,length that closed thoracic drainage cure pneumothorax and the incidences of the surgical pleural adhesion. Results We found that the incidence of irregular lung compression in 0, 1 and 2 times of re?ceiving previous drainage were 11.71%(13/111), 57.89%(22/57) and 90.19%(46/51) respectively. Its incidence increased with the times of previous closed chest drain (χ2=96.339, P<0.01). In total, 94 patients (85 of which were cured until the 7th day) and 30 patients (11 of which were cured until the 7th day) were cured using close chest drain in peripheral shape and ir?regular shape group. And the 7th day cure rate is lower in irregular group than that in the peripheral shape. [36.7%(11/30) vs 90.4%(85/94),χ2=37.596, P<0.01]. What’s more, patients in irregular group need longer time to cure pneumothorax than patients in peripheral shape did [d:10.1±4.87 vs 4.00±2.07, t=9.806, P<0.01]. Among the 95 patients who underwent surgi?cal treatment in both groups, the incidence of pleural adhesion is higher in irregular shape group than that in peripheral shape group [91.9%(57/62)vs18.2%(6/33),χ2=52.445, P<0.01]. Conclusion The 7th day cure rate in patients with pe?ripheral shape lung compressed form is higher than patients in irregular lung compressed form using closed chest drain with fewer incidence of pleural adhesion and shorter cure time. Those with irregular lung compression is more appropriate for sur?gical treatment.
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@#ObjectiveTo investigate the corelation between fibrinogen in pleural effusion and pleural adhesion in tuberculosis exudative pleurisy.Methods234 cases of primary tuberculosis pleurisy were divided into 3 groups (A、B、C) according to their level of fibrinogen in pleural effusion from low to high. The incidence rates of pleural adhesion were assessed during the course of treatment and after treatment.ResultsThe incidence rate of pleural adhesion in the course of treatment were as those: group A 10.5%, group B 32.3%, group C 54.5%. After treatment, it was as those: group A 10.5%, group B 16.9%, group C 42.4%. Whenever, there was significant difference between group C and group A or B (P<0.05).ConclusionThe level of fibrinogen in pleural effusion may be associated with pleural adhesion, which hinder the recovery of patients.
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Aim To establish an animal model of inflammatory pleural adhesion and to investigate the role of low-molecular-weight heparin(LMWH) in preventing encapsulation of pleural effusion.Methods Thirty New-Zealand rabbits were randomly divided into three groups:the model and the treatment group received injection of tetracycline(35 mg?kg~(-1)) in the right chest cavity,the control animals received injection of normal saline.LMWH (55 U?kg~(-1)) was injected into the right chest cavity of rabbits in the treatment group.The animals were killed on 14 d.Result In the model group,pleural effusion appeared at 2 h and reached maximum within 2～3 days.In the effusion,leukocytes accumulated and procoagulant activity increased at the same time.Fibrosis and pleural adhesion,encapsulation appeared on the fourteenth day.In the treatment group pleural effusion and procoagulant activity were reduced.No pleural adhesion was observed.Conclusion Tetracycline was successfully used to establish an animal model of pleural adhesion in rabbits.LMWH was effective in reducing pleural effusion and preventing pleural fibrosis and encapsulation.
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BACKGROUND: The routine application of the combined regimen of corticosteroid-antituberculosis therapy to the tuberculous pleurisy remains controversial. Steroid therapy to tuberculous pleurisy could be effective on the acceleration of absorption of pleural effusion and symptom improvement, but there has been debate about the effect of prednisolone on the prevention of pleural adhesion. So we studied the efficacy of combined regimen of prednisolone-antituberculosis therapy on the absorption of pleural effusion and prevention of pleural adhesion. METHODS: A prospective, randomized study was performed in 82 patients, 50 patients(non-steroid group) were treated with only antituberculosis regimen for 6 months and in 32 patients(steroid group) prednisolone(30mg/day) were administered in addition to antituberculosis regimen for one months and tapered for another month. The amount of pleural effusion was compared at the beginning of treatment, 2nd month, 6th month and final visit with chest X-ray findings which were graded from grade 0(complete absorption) to grade 6(near total haziness). RESULTS: The amount of pleural effusion of steroid group at 2nd month, 6th month and final visit was lesser than that of non-steroid group (P<0.05). The incidence of the complete absorption of the pleural effusion was 3/32(9.4%) in steroid group, 1/50(2%) in non-steroid group at 2nd month after treatment; and 12/32(37.5%) in steroid group, 6/50(12%) in non-steroid group at 6th month after treatment (P<0.05). At final observation, the incidence of residual pleural thickening was 15/32(47%) in steroid group and 37/50(74%) in non-steroid group (P<0.05). No serious side effects were noted during the treatment with prednis olone. CONCLUSION: The administration of prednisolone in conjunction with antituberculosis chemotherapy improved the absorption of pleural effusion and decreased the residual pleural thickening.
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Humanos , Absorción , Aceleración , Quimioterapia , Incidencia , Derrame Pleural , Prednisolona , Estudios Prospectivos , Tórax , Tuberculosis PleuralRESUMEN
BACKGROUND: The routine application of the combined regimen of corticosteroid-antituberculosis therapy to the tuberculous pleurisy remains controversial. Steroid therapy to tuberculous pleurisy could be effective on the acceleration of absorption of pleural effusion and symptom improvement, but there has been debate about the effect of prednisolone on the prevention of pleural adhesion. So we studied the efficacy of combined regimen of prednisolone-antituberculosis therapy on the absorption of pleural effusion and prevention of pleural adhesion. METHODS: A prospective, randomized study was performed in 82 patients, 50 patients(non-steroid group) were treated with only antituberculosis regimen for 6 months and in 32 patients(steroid group) prednisolone(30mg/day) were administered in addition to antituberculosis regimen for one months and tapered for another month. The amount of pleural effusion was compared at the beginning of treatment, 2nd month, 6th month and final visit with chest X-ray findings which were graded from grade 0(complete absorption) to grade 6(near total haziness). RESULTS: The amount of pleural effusion of steroid group at 2nd month, 6th month and final visit was lesser than that of non-steroid group (P<0.05). The incidence of the complete absorption of the pleural effusion was 3/32(9.4%) in steroid group, 1/50(2%) in non-steroid group at 2nd month after treatment; and 12/32(37.5%) in steroid group, 6/50(12%) in non-steroid group at 6th month after treatment (P<0.05). At final observation, the incidence of residual pleural thickening was 15/32(47%) in steroid group and 37/50(74%) in non-steroid group (P<0.05). No serious side effects were noted during the treatment with prednis olone. CONCLUSION: The administration of prednisolone in conjunction with antituberculosis chemotherapy improved the absorption of pleural effusion and decreased the residual pleural thickening.