【摘要】 目的 观察温脾活血汤治疗结核性胸膜炎的作用及对胸膜肥厚、纤溶活性和腺苷脱氨酶（ADA）、单核细胞趋化蛋白-1（MCP-1）表达的影响。方法 选择2020年3月—2021年3月于河北省胸科医院治疗的120例结核性胸膜炎患者，以随机数字表法分组，60例患者为对照组，60例患者为研究组，对照组给予2HRZE/4HR抗结核方案及胸腔穿刺抽液治疗，研究组给予2HRZE/4HR抗结核方案、温脾活血汤及胸腔穿刺抽液治疗，治疗前、后检测两组患者γ-干扰素诱导蛋白10（IP-10）、干扰素-γ（IFN-γ）、白细胞介素-17（IL-17）、肿瘤坏死因子α（TNF-α）、转化生长因子β₁（TGF-β₁）、ADA、MCP-1、Ⅲ型前胶原（PCⅢ）、组织型纤溶酶原激活物（t-PA）、纤溶酶原激活剂抑制因子-1（PAI-1）、免疫球蛋白IgM、IgG、IgA水平，测量两组患者胸膜厚度，记录两组胸腔积液消失时间，给予两组患者中医证候积分，比较两组患者临床疗效，记录两组不良反应发生情况。结果 研究组IL-17、IP-10、IFN-γ、TNF-α水平低于对照组（P<0.05），研究组TGF-β₁、ADA、MCP-1水平低于对照组（P<0.05），研究组免疫球蛋白IgM、IgG、IgA水平高于对照组（P<0.05），研究组PCⅢ水平低于对照组（P<0.05），研究组t-PA/PAI-1水平高于对照组（P<0.05），研究组证候评分低于对照组（P<0.05），研究组胸膜薄于对照组（P<0.05），研究组胸腔积液消失时间短于对照组（P<0.05），研究组患者总有效率（96.67%）较对照组（85.00%）高（P<0.05），研究组不良反应发生率（8.33%）较对照组（33.33%）低（P<0.05）。结论 温脾活血汤治疗结核性胸膜炎患者，可抑制患者炎症，减低TGF-β₁、ADA、MCP-1水平，提升患者免疫力，增加胸腔积液纤溶活性，抑制胸膜肥厚，提升临床疗效，减少不良反应发生。更多还原

【Abstract】 Objective To observe the effect of Wenpi Huoxue Decoction（温脾活血汤） on tuberculous pleurisy,pleural hypertrophy,fibrinolytic activity and the expression of ADA and MCP-1 in pleural effusion.Methods 120 patients with tuberculous pleurisy who were treated in Hebei provincial thoracic hospital from March 2020 to March 2021 were selected,60 patients as the control group and 60 patients as the study group. The control group was treated with 2HRZE/4HR anti tuberculosis regimen and pleural puncture. The study group was treated with 2HRZE/4HR anti tuberculosis regimen,Wenpi Huoxue Decoction and pleural puncture the patients in both groups were treated for 3 months. Two groups of patients were detected after treatment γ-interferon inducible protein 10（IP-10）,interferon-γ（IFN-γ）,interleukin-17（IL-17）,tumor necrosis factor α（TNF-α）,transforming growth factor β₁（TGF-β₁）adenosine deaminase（ADA）,monocyte chemoattractant protein-1（MCP-1）,type Ⅲ procollagen（PC Ⅲ）,tissue plasminogen activator（t-PA）activity,plasminogen activator inhibitor-1（PAI-1）,immunoglobulin IgM,IgG and IgA levels,detected the pleural thickness of the two groups,record the disappearance time of pleural effusion in the two groups,given TCM syndrome scores to the two groups,compared the clinical efficacy of the two groups,and recorded the occurrence of adverse reactions in the two groups. Results The level of IL-17,IP-10,IFN-γ,TNF-α in the study group was lower control group（P<0.05）. The levels of TGF-γ,ADA and MCP-1 in the study group were lower control group（P<0.05）,the level of immunoglobulin IgM,IgG,IgA in the study group was higher control group（P<0.05）,the level of PC Ⅲ in the study group was lower than that in the control group（P<0.05）,the level of t-PA/PAI-1 in the study group was higher control group（P<0.05）,the score of symptom score in the study group was lower control group（P<0.05）,the study group’s pleura in was thinner control group（P<0.05）,the study group’s disappearance time of pleural effusion was shorter control group（P<0.05）,the total effective rate of patients study group（96.67%）was higher control group（85.00%）（P<0.05）,and the study group’s incidence of adverse reactions（8.33%）was lower the control group（33.33%）（P<0.05）. Conclusion Wenpi Huoxue Decoction can inhibit inflammation and reduce the levels of TGF-β₁,ADA and MCP-1,in patients with tuberculous pleurisy can improve patients’ immunity,increase the fibrinolytic activity of pleural effusion,inhibit pleural hypertrophy,improve clinical efficacy and reduce adverse reactions.更多还原