Efficacy Evaluation of Intrapleural Injection of Urokinase in the Treatment of Tuberculous Pleurisy

XIA Xin-tian; ZHANG Wei; LI Li-na; CHEN Wen-jia

doi:10.3969/j.issn.1002-3429.2019.03.007

Abstract：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, I2 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.