胸腔内尿激酶注射治疗结核性胸膜炎的疗效评价
|
摘要
目的评价胸腔内尿激酶注射治疗结核性胸膜炎的临床疗效。方法检索CBM、CNKI、维普、万方数据库自建库至2017年12月关于胸腔内尿激酶注射治疗结核性胸膜炎的临床研究,观察组予常规抗结核治疗+胸腔穿刺引流+胸腔内尿激酶注射,对照组予常规抗结核治疗和(或)胸腔穿刺引流和(或)胸腔内注射等量0.9%氯化钠注射液。采用Cochrane评估工具进行文献风险偏倚评估,使用Jadad评分量表进行文献质量评分,使用Rev Man 5.3软件对数据进行处理,效应性检验指标选用OR和95%可信区间(CI),异质性检验指标选用I~2和P,同时进行meta分析、亚组分析、敏感性分析、发表偏倚评估。结果本研究共纳入19篇文献,meta分析结果显示,与对照组比较,观察组胸膜粘连发生率明显降低[OR=4.93,95%CI(3.66,6.65),P<0.00001],胸腔积液吸收时间明显缩短[WMD=-0.80,95%CI(-0.95,-0.66),P<0.00001],胸膜厚度明显减小[WMD=-1.61,95%CI(-1.86,-1.36,P<0.00001]。文献敏感性分析显示结果稳定,但纳入研究的异质性较大,meta分析结果可靠性不确定。结论胸腔内尿激酶注射治疗结核性胸膜炎可降低胸膜粘连发生率,缩短胸腔积液吸收时间,减轻胸膜增厚。
Objective To evaluate the clinical effect of intrapleural injection of urokinase in the treatment of tuberculous pleurisy(TP). Methods The clinical data of intrapleural injection of urokinase in the treatment of TP were searched from CBM, CNKI, CQVIP, WAN-FANGDATA from the time of database etablishment to December 2017. The observation group was given conventional anti-tuberculosis treatment + thoracentesis drainage + intrapleural injection of urokinase. The control group was given conventional anti-tuberculosis treatment and(or) thoracentesis drainage and(or) intrapleural injection of the same amount of 0.9% sodium chloride. Bias risk was assessed using the Cochrane assessment tool. The Jadad scoring scale was used to score the quality of the literature. Rev Man 5.3 software was used to process the data. Inspection RR and 95% confidence interval(CI) were used as the indicator of effect. In addition, I~2 and P were selected to be heterogeneity test indicators. Meta analysis, subgroup analysis, sensitivity analysis and publication bias assessment were also performed in the meantime. Results A total of 19 articles were included in this study. Meta analysis results showed that as compared with the control group, the incidence of pleural adhesion was significantly reduced in the observation group [OR=4.93, 95%CI(3.66, 6.65), P<0.00001]. The absorption time of pleural effusion was obviously shortened [WMD=-0.80, 95%CI(-0.95,-0.66), P<0.00001]. The thickness of the pleura was decreased obviously [WMD=-1.61, 95%CI(-1.86,-1.36), P<0.00001]. Sensitivity analysis of the literature showed that the results were robust, but the heterogeneity of included studies was relatively large, and the reliability of Meta analysis results was uncertain. Conclusion Intrapleural injection of urokinase for the treatment of TP can reduce the incidence of pleural adhesion, shorten the absorption time of pleural effusion, and alleviate the thickening of the pleura.
Objective To evaluate the clinical effect of intrapleural injection of urokinase in the treatment of tuberculous pleurisy(TP). Methods The clinical data of intrapleural injection of urokinase in the treatment of TP were searched from CBM, CNKI, CQVIP, WAN-FANGDATA from the time of database etablishment to December 2017. The observation group was given conventional anti-tuberculosis treatment + thoracentesis drainage + intrapleural injection of urokinase. The control group was given conventional anti-tuberculosis treatment and(or) thoracentesis drainage and(or) intrapleural injection of the same amount of 0.9% sodium chloride. Bias risk was assessed using the Cochrane assessment tool. The Jadad scoring scale was used to score the quality of the literature. Rev Man 5.3 software was used to process the data. Inspection RR and 95% confidence interval(CI) were used as the indicator of effect. In addition, I~2 and P were selected to be heterogeneity test indicators. Meta analysis, subgroup analysis, sensitivity analysis and publication bias assessment were also performed in the meantime. Results A total of 19 articles were included in this study. Meta analysis results showed that as compared with the control group, the incidence of pleural adhesion was significantly reduced in the observation group [OR=4.93, 95%CI(3.66, 6.65), P<0.00001]. The absorption time of pleural effusion was obviously shortened [WMD=-0.80, 95%CI(-0.95,-0.66), P<0.00001]. The thickness of the pleura was decreased obviously [WMD=-1.61, 95%CI(-1.86,-1.36), P<0.00001]. Sensitivity analysis of the literature showed that the results were robust, but the heterogeneity of included studies was relatively large, and the reliability of Meta analysis results was uncertain. Conclusion Intrapleural injection of urokinase for the treatment of TP can reduce the incidence of pleural adhesion, shorten the absorption time of pleural effusion, and alleviate the thickening of the pleura.
引文
[1]全国第五次结核病流行病学抽样调查技术指导组,全国第五次结核病流行病学抽样调查办公室.2010年全国第五次结核病流行病学抽样调查报告[J].中国防痨杂志,2012,34(8):485-508.
[2]丁玉平,陈继祥.结核性渗出性胸膜炎治疗的研究进展[J].临床肺科杂志,2009,14(3):361-362.
[3]高春荣,高卫红,张叶娜,等.胸腔内注射尿激酶治疗248例结核性胸膜炎胸膜粘连的疗效观察[J].实用预防医学,2005,12(4):766-767.
[4]陈永谦,张纯.胸腔内注射尿激酶治疗结核性胸膜炎[J].中国基层医药,2005,12(3):264-265.
[5]郑法德,刘斌.胸腔静脉导管留置注射尿激酶治疗结核性胸腔积液60例[J].临床肺科杂志,2008,13(10):1262-1263.
[6]范家亮,邹小凡.胸腔闭式引流联合尿激酶灌注治疗结核性胸膜炎的临床观察[J].井冈山学院学报(自然科学版),2008,29(5):73-74.
[7]杨凤,白云,胡建军,等.胸腔内注入尿激酶治疗结核性多房性胸腔积液疗效观察[J].河北医药,2008,30(9):1306-1307.
[8]钟少龙.胸腔闭式引流联合尿酶灌注治疗结核性胸膜炎95例[J].中国民族民间医药,2009,18(14):47.
[9]杨智,麦洪珍,蔡春葵,等.胸腔内注入尿激酶治疗结核性胸膜炎的临床疗效研究[J].中国医药导报,2010,7(13):73,76.
[10]李伟,黄礼年,刘超,等.胸膜腔注射尿激酶治疗结核性胸膜炎疗效观察[J].蚌埠医学院学报,2010,35(5):451-453.
[11]韩顺利,高文英.胸腔内注入尿激酶治疗结核性胸膜炎疗效观察[J].医学信息(中旬刊),2010,5(8):2017.
[12]王应平.胸膜腔内注入尿激酶治疗粘连包裹型结核性胸膜炎的疗效观察[J].南昌大学学报(医学版),2010,50(5):47-48.
[13]魏娇,李淑艳,邓国防.胸腔置管注入尿激酶治疗结核性胸膜炎的疗效观察[J].实用临床医学,2011,12(4):44-45.
[14]刘建春,杜敬华,王晓军,等.胸腔置管联合尿激酶治疗结核性胸膜炎的疗效观察[J].内科急危重症杂志,2014,20(5):338,346.
[15]李士英,李博.胸腔置管联合尿激酶治疗结核性胸膜炎的疗效观察[J].现代诊断与治疗,2014,25(22):5157-5158.
[16]李卓.尿激酶胸腔内注药治疗结核性胸膜炎包裹性积液的临床研究[J].中国医药指南,2015,13(30):104-105.
[17]蒋红球.胸腔注入尿激酶治疗结核性胸膜炎的疗效分析[J].大家健康(中旬版),2016,10(5):107-108.
[18]杨伏萍.胸腔内注射尿激酶治疗结核性胸膜炎及胸膜肥厚的疗效观察[C].珠海:国际数字医学会数字中医药分会成立大会暨首届数字中医药学术交流会,2016.
[19]王卫华.尿激酶治疗多房性胸腔积液32例临床观察[J].中国民族民间医药,2016,25(2):66.
[20]郑春晓,甘艳.中心静脉导管胸腔闭式引流联合尿激酶胸腔内注射治疗结核性胸膜炎[J].河北医药,2016,38(5):751-752.
[21]李阳.胸腔内注入尿激酶治疗结核性胸膜炎88例的临床疗效观察[J].当代医学,2017,23(8):88-89.
[22]Jadad A R,Moore R A,Carroll D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary[J].Control Clin Trials,1996,17(1):1-12.
[2]丁玉平,陈继祥.结核性渗出性胸膜炎治疗的研究进展[J].临床肺科杂志,2009,14(3):361-362.
[3]高春荣,高卫红,张叶娜,等.胸腔内注射尿激酶治疗248例结核性胸膜炎胸膜粘连的疗效观察[J].实用预防医学,2005,12(4):766-767.
[4]陈永谦,张纯.胸腔内注射尿激酶治疗结核性胸膜炎[J].中国基层医药,2005,12(3):264-265.
[5]郑法德,刘斌.胸腔静脉导管留置注射尿激酶治疗结核性胸腔积液60例[J].临床肺科杂志,2008,13(10):1262-1263.
[6]范家亮,邹小凡.胸腔闭式引流联合尿激酶灌注治疗结核性胸膜炎的临床观察[J].井冈山学院学报(自然科学版),2008,29(5):73-74.
[7]杨凤,白云,胡建军,等.胸腔内注入尿激酶治疗结核性多房性胸腔积液疗效观察[J].河北医药,2008,30(9):1306-1307.
[8]钟少龙.胸腔闭式引流联合尿酶灌注治疗结核性胸膜炎95例[J].中国民族民间医药,2009,18(14):47.
[9]杨智,麦洪珍,蔡春葵,等.胸腔内注入尿激酶治疗结核性胸膜炎的临床疗效研究[J].中国医药导报,2010,7(13):73,76.
[10]李伟,黄礼年,刘超,等.胸膜腔注射尿激酶治疗结核性胸膜炎疗效观察[J].蚌埠医学院学报,2010,35(5):451-453.
[11]韩顺利,高文英.胸腔内注入尿激酶治疗结核性胸膜炎疗效观察[J].医学信息(中旬刊),2010,5(8):2017.
[12]王应平.胸膜腔内注入尿激酶治疗粘连包裹型结核性胸膜炎的疗效观察[J].南昌大学学报(医学版),2010,50(5):47-48.
[13]魏娇,李淑艳,邓国防.胸腔置管注入尿激酶治疗结核性胸膜炎的疗效观察[J].实用临床医学,2011,12(4):44-45.
[14]刘建春,杜敬华,王晓军,等.胸腔置管联合尿激酶治疗结核性胸膜炎的疗效观察[J].内科急危重症杂志,2014,20(5):338,346.
[15]李士英,李博.胸腔置管联合尿激酶治疗结核性胸膜炎的疗效观察[J].现代诊断与治疗,2014,25(22):5157-5158.
[16]李卓.尿激酶胸腔内注药治疗结核性胸膜炎包裹性积液的临床研究[J].中国医药指南,2015,13(30):104-105.
[17]蒋红球.胸腔注入尿激酶治疗结核性胸膜炎的疗效分析[J].大家健康(中旬版),2016,10(5):107-108.
[18]杨伏萍.胸腔内注射尿激酶治疗结核性胸膜炎及胸膜肥厚的疗效观察[C].珠海:国际数字医学会数字中医药分会成立大会暨首届数字中医药学术交流会,2016.
[19]王卫华.尿激酶治疗多房性胸腔积液32例临床观察[J].中国民族民间医药,2016,25(2):66.
[20]郑春晓,甘艳.中心静脉导管胸腔闭式引流联合尿激酶胸腔内注射治疗结核性胸膜炎[J].河北医药,2016,38(5):751-752.
[21]李阳.胸腔内注入尿激酶治疗结核性胸膜炎88例的临床疗效观察[J].当代医学,2017,23(8):88-89.
[22]Jadad A R,Moore R A,Carroll D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary[J].Control Clin Trials,1996,17(1):1-12.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |