Treatment Of Tuberculous Pleurisy Research Articles

Urokinase in the treatment of tuberculous pleurisy: a systematic review and meta-analysis

ObjectiveTo evaluate the efficacy of urokinase (UK) treatment for tuberculous pleural effusion (TPE).MethodsWe searched Chinese biomedical literature database, WanFang data, CNKI, PubMed, EMbase, Web of Science and The Cochrane Library for the randomized controlled trials (RCTs) of urokinase treatment for tuberculous pleurisy from January 2000 to February 2023. Pleural tuberculosis, urokinase and randomized controlled trial were used as keywords. The eligible studies were meta-analyzed by using Revman 5.4.1: risk of bias was assessed, mean difference (MD) and 95% CI were used for continuous variables, pooled studies were conducted using random-effects or fixed-effects models, forest plots were drawn to analyze efficacy, and funnel plots were drawn to discuss publication bias.ResultsTwenty-nine RCTs were included. The meta-analyzed results showed that, on the basis of routine anti-tuberculosis, comparison between the treatment group treated with urokinase and the control group treated with antituberculosis alone, the time of pleural effusion absorption [MD-5.82, 95%CI (− 7.77, − 3.87); P<0.00001] and the residual pleural thickness [MD-1.31, 95%CI (− 1.70, − 0.91); P<0.00001], pleural effusion drainage volume [MD 822.81, 95%CI (666.46,977.96); P<0.00001], FVC%pred [MD 7.95, 95%CI (4.51,11.40); P<0.00001], FEV1%pred [MD 12.67, 95%CI (10.09,15.24); P<0.00001] were significantly different.ConclusionThe clinical effect of urokinase is better than that of antituberculous therapy alone: it can increase total pleural effusion, decrease residual pleural thickness, improve the pulmonary function, and shorten the time of pleural effusion absorption.

Morphological manifestation of tuberculous pleurisy in children under medical thoracoscope and diagnostic value.

Our study analyzed the main manifestations of tuberculous pleurisy (TBP) in children under medical thoracoscopy (MT). This article aimed to explore the clinical application value of MT in the diagnosis and treatment of TBP in children. In our study, we selected 23 TBP patients diagnosed in our hospital. We analyzed the clinical data and thoracoscopic morphology of these patients. At the same time, we also observed the pathological manifestations, acid-fast staining, and treatment effects of the patient's diseased tissue under MT. The MT clinical findings of TBP patients include pleural hyperemia and edema, miliary nodules, scattered or more white nodules, simple pleural adhesion, wrapped pleural effusion, massive cellulose exudation, yellow-white caseous necrosis, pleural hyperplasia and hyperplasia, and mixed pleural necrosis. The positive rate of pleural biopsy was 73.91% and that of acid-fast staining was 34.78%. The main pathologic types of these patients were tuberculous granulomatous lesions (16 cases), caseous necrosis (5 cases), and fibrinous exudative, multinucleated giant cell and other inflammatory cell infiltration lesions (13 cases). The average time of diagnosis of the 23 patients was 8.32 days (5.0-16.0 days), and they were transferred to specialized hospitals for treatment after diagnosis. The mean time of chest drainage was 3.0-5.0 days after treatment. The average time for their body temperature to return to normal was 3.31 days (2.0-5.0 days). Thoracoscopic lesions of TBP in children are varied. The use of MT is not only helpful for the early diagnosis and treatment of TBP. It also protects and improves lung function. Therefore, the use of MT has high clinical value.

Drug transdermal delivery by electrophonophoresis can increase the concentration of rifampicin in the pleural effusion of patients with tuberculous pleurisy but has no effect on the concentration of rifampicin in plasma.

Electrophonophoresis (EP) has been widely used in various clinical fields. The purpose of this study was to evaluate the dermal permeability of rifampicin (RIF) in patients with tuberculous pleurisy assisted by EP and to verify the clinical application of this percutaneous drug delivery system in the treatment of tuberculous pleurisy, verify the system's influencing factors, and determine whether plasma drug concentration was increased. Patients were given oral isoniazid 0.3-0.4g, rifampicin 0.45-0.60g, pyrazinamide 1.0-1.5g and ethambutol 0.75g according to their body weight once a day. After 5days of anti-tuberculosis treatment, 3ml of rifampicin was delivered transdermally with EP. Pleural effusion and peripheral blood samples in patients were collected at and after dosing. The drug concentration in the samples was determined by high-performance liquid chromatography. The median plasma concentration (interquartile ranges) of RIF in 32 patients was 8.80 (6.65, 13.14) μg/ml before RIF transdermal injection plus EP and decreased to 8.09 (5.58, 11.82) μg/ml after 30min of RIF transdermal injection plus EP. The RIF concentration in pleural effusion was higher than that before RIF-transdermal plus EP. In patients who received RIF via EP transdermal administration, the concentration of the drug at the local site was statistically higher than the concentration at the local site prior to penetration. However, no such enhancement was observed in plasma after transdermal administration of RIF. EP can effectively increase the concentration of rifampicin in the pleural effusion of tuberculous pleurisy and has no effect on the circulating plasma concentration. The increased concentration of the drug in the lesion helps to destroy the bacteria.

Central Venous Catheter Based Closed Thoracic Drainage in the Treatment of Tuberculous Pleuritis.

Objective:To explore the clinical effect of central venous catheter closed thoracic drainage in the treatment of tuberculous pleurisy.Methods:One hundred and four patients with tuberculous pleurisy who were admitted to Binzhou People’s Hospital from August 2016 to August 2017 were divided into a control group and a treatment group according to random number table method, 52 each. The control group was treated with conventional pleural puncture and drainage, while the treatment group was treated with closed central venous catheter based thoracic drainage. The clinical efficacy, improvement time of clinical symptoms, total volume of drainage, pleural thickness, and improvement of quality of life and occurrence of adverse reactions were compared between the two groups.Results:Pleural effusion, fever and chest tightness of the treatment group disappeared earlier (P<0.05); the hospitalization time in the treatment group was less than that in the control group (P<0.05); the total amount of drainage in the treatment group was lower than that in the control group (P<0.05); the pleural thickness of the treatment group was higher than that in the control group (P<0.05); the quality of life score in the treatment group was significantly higher than that in the control group (P<0.05). The total effective rates of the treatment group and the control group were 93.5% and 85%, respectively, with a significant difference (P<0.05). The incidence of adverse reactions in the treatment group was significantly lower than that in the control group, with a significant difference (P<0.05).Conclusion:Central venous catheter based closed thoracic drainage is more effective than conventional thoracic puncture and drainage in the treatment of tuberculous pleurisy. It can accelerate the improvement of clinical symptoms, improve the quality of life of patients, and reduce the incidence of complications. It is worth popularizing and applying.

Efficacy of thoracic catheter combined with anti-tuberculosis drugs in the treatment of pleural effusion in patients with tuberculous

Objective To analyze the efficacy of the treatment of tuberculous pleurisy combined with pleural effusion in patients with pleural effusion. Methods Patients (n=130) with tuberculous pleural effusion in Department of Surgery, Jingmen Second People′s Hospital of Hubei Province, from March 2014 to December 2015 were retrospective study, and these patients were divided into observation group (n=65) and control group (n=65) by random number table. The control group was given traditional methods thoracentesis and observation group was taken the chest tube injection medicine combined therapy with anti-tuberculosis drugs, respectively. The treatment effect, adverse reaction and the recurrence rate, etc. were analyzed between groups. Measurement data were represented as ±s, and comparsion between groups was analyzed using the t test. Count data were evaluated by the percentage, and comparsion between groups was analyzed using the chi-square test. Results The effective rate (40%) and total effective rate (93.85%) of the patients in the observation group were significantly higher than those in the control group (P<0.05); In the observation group, the flow rate of pleural effusion (3 500±500) ml more than in the control group (P<0.05); the disappearing time (6.92±1.13) d were significantly shorter than in the control group (P<0.05); the value of pleural thickness change (1.67±0.35) mm of the patients in the observation group was significantly greater than that of the control group (P<0.05); the protein content of pleural effusion (14.78±2.16) g/L was significantly higher than that in the control group (P<0.05); the incidence of pleural thickening (1.54%), vomiting rate (1.54%), chest pain rate (4.62%) and fever incidence (1.54%) in the observation group were significantly lower than those in the control group (P<0.05); the total incidence of adverse reactions in the observation group (9.23%) was significantly lower than that of the control group (P< 0.05). After 6 months of follow-up, the recurrence rate of the patients in the observation group (0) was significantly lower than that of the control group (4.61%)(P<0.05). Conclusion Pleurisy pleural effusion in patients with tuberculous pleural catheter injection of anti-tuberculosis drugs can improve the therapeutic effect, reduce adverse reactions with application value. Key words: Tuberculosis, pleural; Antitubercular agents; Pleural effusion; Pleural catheterization

Clinical study on central venous catheter drainage and intrapleural injection of urokinase in the treatment of tuberculous pleurisy

Objective To observe the therapeutic effect of central venous catheter drainage and intrapleural injection of urokinase on tuberculous pleurisy patients. Methods 60 hospitalized patients with tuberculous pleurisy were selected, and they were divided into two groupsby simple random grouping method.Both two groups received 3HRZE/6HR anti-tuberculosis treatment.30 patients in the observation group were treated with central venous catheter drainage and intrapleural injection of urokinase.30 patients in the control group were treated with conventional pleurocentesis.The duration of pleural effussion drainage, incidence of pleural thickening, hospitalization time and expense, and the adverse reaction rate were observed during treatment. Results In the observation group, the curative effect at 1 week was 46.7%, the duration of pleural effussion drainage was (20.5±6.7)days, the incidence rate of pleural thickening was 26.7%, the hospitalization time was (9.4±2.7)days, the hospitalization expense was (6 675.4±1 818.4)RMB, the incidence rate of adverse reaction was 3.3%.In the control group, the curative effect at 1 week was 20.0%, the duration of pleural effussion drainage was (25.1±7.7)days, the incidence rate of pleural thickening was 46.7%, the hospitalization time was (10.3±2.8)days, the hospitalization expense was (7 508.9±1 692.1)RMB, the incidence rate of adverse reaction was 20.0%.There were statistically significant differences between the two groups in the curative effect at 1 week(χ2=4.800, P=0.028), duration of pleural effussion drainage (t=2.484, P=0.016), incidence of pleural thickening (t=4.444, P=0.035) and incidence rate of adverse reaction (χ2=4.043, P=0.044). No statistically significant differences were observed between the two groups in hospitalization time(t=1.270, P=0.209) and expense(t=1.838, P=0.071). Conclusion In comparison to conventional pleurocentesis, the treatment of central venous catheter drainage and intrapleural injection of urokinase for tuberculous pleurisy is markedly efective, it is safe and worthy of popularizing in clinical application. Key words: Pleurisy; Tuberculosis, pleural; Central venous catheter drainage; Urokinase

THE EFFICACY AND SAFETY OF ADJUNCTIVE CORTICOSTEROIDS IN THE TREATMENT OF TUBERCULOUS PLEURISY: A SYSTEMATIC REVIEW AND META‐ANALYSIS

RespirologyVolume 22, Issue S3 p. 214-214 APSR Poster Abstracts THE EFFICACY AND SAFETY OF ADJUNCTIVE CORTICOSTEROIDS IN THE TREATMENT OF TUBERCULOUS PLEURISY: A SYSTEMATIC REVIEW AND META-ANALYSIS First published: 23 November 2017 https://doi.org/10.1111/resp.13207_332Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume22, IssueS3Supplement: 22nd Congress of the Asian Pacific Society of Respirology, International Convention Centre, Sydney, Australia, 23–26 November 2017November 2017Pages 214-214 RelatedInformation

The efficacy and safety of adjunctive corticosteroids in the treatment of tuberculous pleurisy: a systematic review and meta-analysis.

PurposeTo evaluate the efficacy and safety of adjunctive corticosteroids in the treatment of patients with tuberculous pleurisy.MethodsThe PubMed, Cochrane, Medline, Embase, Web of Science and Chinese National Knowledge Infrastructure were searched. Clinical trials of corticosteroids compared with control were eligible for inclusion.ResultsTen studies (6 randomized controlled trials [RCTs] and 4 non-RCTs) with 957 participants met the inclusion criteria. Compared to the controls (placebos or non-steroids), adjunctive corticosteroid use reduced the risk of residual pleural fluid after 4 weeks and the number of days to symptom improvement; however, there was no convincing evidence to support the positive effects of corticosteroids over the long term (8 weeks) on residual pleural fluid, pleural thickening, or pleural adhesions, and there was no statistical difference between the corticosteroid group and control group with respect to 7-days relief of the clinical symptoms or death from any cause. In addition, more adverse events were observed in patients who received corticosteroids than in those in the control group.ConclusionsOur results suggest that adjunctive corticosteroid use did not improve long-term efficacy and might induce more adverse events, although the risk of residual pleural fluid at 4 weeks and the number of days to symptom improvement were reduced.

DIAGNOSIS AND TREATMENT OF TUBERCULOUS PLEURISY

Tuberculous pleurisy as well as malignant pleuritis is a representative disease presenting pleural effusion. The diagnosis of tuberculous pleurisy is made from examination of pleural effusion, but the sensitivity of smear or culture of Mycobacterium tuberculosis from pleural fluid is generally low. Although the pleural fluid concentration of adenosine deaminase (ADA) is useful in terms of sensitivity or specificity, the value could be high in empyema or rheumatoid pleuritis. Thoracoscopic biopsy of pleura is more sensitive rather than conventional percutaneous needle biopsy, but is more invasive. Tuberculous pleural effusion is caused by delayed allergy which macrophage and T-helper 1 cells mainly relate and the stimuli of bacterial body consecutively induces T-helper 1 cytokines. Pleural fluid interferon-gamma (INF-gamma) is important not only in pathogenesis but also in diagnosis. We demonstrated that INF-gamma is a more sensitive and specific indicator for tuberculous pleurisy than ADA using receiver operating characteristics (ROC) analysis. Cytometric bead array (CBA) is a tool to simultaneously measure abundance of various cytokines and is expected to be a very useful method to provide informations for understanding a feedback mechanism of cytokine network. It is needed to clear the immunity in pleural fluid and to establish the less invasive and more useful method to diagnose tuberculous pleurisy.

A Case of Pseudochylothorax Developed from Chronic Pleural Effusion after Treatment of Tuberculous Pleurisy

A pseudochylothorax, a chyliform pleural effusion, is a rare disease of pleural effusion that contains cholesterol crystals or high lipid content that is not the result of a disrupted thoracic duct. Most of the cases were found in patients with long-standing pleural effusion due to chronic inflammatory disease, such as old tuberculous pleurisy or chronic rheumatoid pleurisy. We experienced a case of pseudochylothorax in a 74-year-old man, who was being treated for pulmonary tuberculosis and pleurisy 10 years ago. The diagnosis was confirmed on pathological study of the pleural effusion, which contained cholesterol crystals having a diagnostic rhomboid appearance.

Intrapleural injection of urokinase in the treatment of tuberculous pleurisy with effusion

目的 观察胸腔注射尿激酶减少结核性渗出性胸膜炎胸膜粘连的效果.方法收治渗出性胸膜炎74例,随机分为治疗组与对照组各37例.治疗组第1、2、3次抽液后注射尿激酶10万IU+生理盐水20ml,对照组注射生理盐水20 ml,化疗方案等其他治疗方法相同.结果胸腔积液吸收时间:治疗组(15.3±6.6)d,对照组(28.7±9.8)d(P＜0.05).抽液总量:治疗组(3738.2±613.4)ml,对照组(3114.5±498.8)ml(P＜0.05).抽液次数:治疗组(3.1±1.2)次,对照组(5.7±1.8)次(P＜0.05).形成纤维分隔、多房积液:治疗组2例,对照组9例(P＜0.01).3个月后B超查胸膜厚度:治疗组(0.6±0.1)mm,对照组(1.1±0.2)mm(P＜0.05).肺功能FEV1%:治疗组(82.6%±2.6%),对照组(75.8%±1.9%)(P＜0.05);FVC%治疗组(84.2%±1.2%),对照组(77.1%±2.1%)(P＜0.05).结论胸腔注射尿激酶能减少胸腔分隔、多房的形成,减轻胸膜增厚,改善肺功能。

Tuberculous Pleurisy Is More Common in AIDS Than in Non-AIDS Patients With Tuberculosis

To investigate the incidence, clinical features, and treatment of tuberculous pleurisy in AIDS patients. We reviewed all cases of pleural tuberculosis in AIDS patients in South Carolina from 1988 through 1994. Clinical findings, test results, treatment, and outcome were analyzed. Twenty-two (11%) of the 202 AIDS patients with tuberculosis had pleural involvement compared to 6% (169/2,817) pleural involvement in non-AIDS patients (p=0.01). Associated features of AIDS tuberculous pleurisy included substantial weight loss (7.65+/-1.35 kg) and lower lobe infiltrates (12/22; 55%). No difference in pleural fluid characteristics was found when comparing AIDS patients with a serum CD4 count > or =200/microL to patients with CD4 count <200/microL. Two (9%) of the 22 patients died of tuberculosis. Chest radiograph follow-up of 20 patients showed complete resolution in 7, improvement in 10, and no improvement in 3. In South Carolina, pleural involvement is more common in AIDS patients than in non-AIDS patients with tuberculosis. Tuberculous pleurisy has several atypical features in AIDS patients such as substantial weight loss and lower lobe infiltrates. The outcome of treatment is good for most patients.

Corticosteroids in the Treatment of Tuberculous Pleurisy: A Double-blind, Placebo-controlled, Randomized Study

A prospective, double-blind, randomized study of the role of corticosteroids in the treatment of tuberculous pleurisy was performed in 40 patients. All patients received adequate antituberculosis chemotherapy (isoniazid, 300 mg/day; rifampin, 450 mg/day; ethambutol, 20 mg/kg/day) for more than nine months. They were randomly assigned to take prednisolone 0.75 mg/kg/day orally or placebo for the initial treatment, which was tapered gradually for the next two to three months. Twenty-one were treated with steroids and 19 were given a placebo. The two groups were identical with regard to age, sex, duration from onset of symptoms to diagnosis, and initial amount of pleural effusion. The mean duration from symptoms (fever, chest pain, dyspnea) to relief was 2.4 days in the steroid-treated group, and 9.2 days in the placebo group (p less than 0.05). Complete reabsorption of pleural effusion occurred an average of 54.5 days in the steroid-treated group and 123.2 days in the placebo group (p less than 0.01). The development of residual pleural thickening was not influenced by the administration of corticosteroids. No serious side effects were noted during the treatment in either group. We conclude that the administration of corticosteroids, in conjunction with antituberculosis chemotherapy, will resolve the clinical symptoms more quickly and hasten the absorption of pleural effusion in patients with tuberculous pleurisy.

The treatment of tuberculous pleurisy.

The treatment of tuberculous pleurisy.