泼尼松联合标准四联抗结核疗法对结核性胸膜炎临床指标及炎症因子的影响

The effect of prednisone combined with standard four-drug anti-tuberculosis therapy on clinical indicators and inflammatory factors in tuberculous pleuritis

摘要:

目的 探究泼尼松联合标准四联抗结核疗法（以下简称HRZE）对结核性胸膜炎（TBP）临床指标及炎症因子的影响。方法 选取2018年3月—2024年3月绵阳四〇四医院258例TBP患者为研究对象，按照信封抽签法随机分为HRZE组与联合组，每组129例。HRZE组给予HRZE治疗，联合组给予HRZE联合泼尼松治疗。比较两组治疗后的临床疗效及临床指标；比较两组治疗前后免疫功能和炎症因子水平；统计两组治疗后不良反应情况。结果 治疗后联合组的临床疗效总有效率高于HRZE组（P <0.05）。联合组临床症状改善时间、胸腔积液吸收时间、住院时间均短于HRZE组（P <0.05），胸膜肥厚度小于HRZE组（P <0.05）。联合组治疗前后白细胞、中性粒细胞、CD3⁺、CD4⁺的差值均高于HRZE组（P <0.05）。联合组治疗前后C反应蛋白、白细胞介素-17、白细胞介素-8的差值均高于HRZE组（P <0.05）。两组的不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 泼尼松联合HRZE对TBP临床指标及炎症因子的影响较为显著。

Abstract:

Objective To investigate the effect of prednisone combined with standard four-drug anti-tuberculosis therapy (HRZE) on clinical indicators and inflammatory factors in tuberculous pleuritis (TBP).Methods A total of 258 TBP patients admitted to Mianyang 404 Hospital from March 2018 to March 2024 were selected as the study subjects. They were randomly divided into the HRZE group and the combination group by the envelope method (129 cases each). The HRZE group received HRZE treatment, while the combination group received HRZE combined with prednisone. The clinical efficacy and indicators, immune function, inflammatory factor levels, and adverse reactions were compared between the two groups before and after treatment.Results After treatment, the total effective rate of clinical efficacy in the combination group was higher than that in the HRZE group (P < 0.05). The combination group showed shorter symptom improvement time, pleural effusion absorption time, and hospitalization duration, as well as less pleural thickening compared to the HRZE group (P < 0.05). The differences in white blood cell count, neutrophil count, CD3⁺ T cells, and CD4⁺ T cells before and after treatment in the combination group were greater than those in the HRZE group (P < 0.05). Similarly, the differences in C-reactive protein (CRP), interleukin-17 (IL-17), and interleukin-8 (IL-8) levels before and after treatment in the combination group were greater than those in the HRZE group (P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P > 0.05).Conclusion Prednisone combined with HRZE significantly improves clinical indicators and modulates inflammatory factors in TBP.