Objective To compare the effects of heparin versus urokinase injection intrapleurally in the management of pleural thickening and adhesion due to tuberculous exudative pleurisy. Methods Sixty patients with tuberculous pleurisy were allocated into three groups randomly. Sodium heparin ( heparin group) , urokinase ( urokinase group) , and 0. 9% saline ( control group) were intrapleurally injected respectively. The concentrations of fibrinogen and D-dimer in pleural effusion were measured before and after the injection. The duration of absorption and the total drainage volume of pleural effusion were recorded. The pleural thickness and adhesion were observed two months after the injection. Results In 72 hours after the intrapleural injection, the concentration of fibrinogen( g/L) in the pleural effusion was significantly increased in the heparin group( 1. 13 ±0. 44 vs 0. 34 ±0. 19, P lt; 0. 001) , and significantly decreased in the urokinase group( 0. 25 ±0. 16 vs 0. 38 ±0. 15, P lt; 0. 05) when compared with baseline. Concentrations of D-dimer in the pleural effusions were significantly higher than those at baseline in both the heparin group and the urokinase group( 57. 0 ±17. 6 vs 40. 0 ±15. 4, P lt; 0. 05; 74. 5 ±16. 4 vs 43. 8 ±14. 9, P lt; 0. 001) . There were no significant differences in the absorption duration of pleural effusion among the three groups( P gt;0. 05) . The total drainage volume of pleural effusion was higher in the heparin group and the urokinase group compared to the control group( P lt;0. 01) . And the total volume of pleural effusion was significantly higher in the heparin group and the urokinase group than that in the control group( 2863 mL and 2465 mL vs 1828 mL,P lt;0. 01) . Two months after the intervention, the pleura were thinner[ ( 1. 37 ±0. 82) mm and ( 1. 33 ±0. 85) mmvs ( 3. 06 ±1. 20) mm, P lt; 0. 01] and the incidence of pleural adhesion was significantly lower[ 15% and 20% vs 50% , P lt; 0. 05] in the heparin and the urokinase groups than those in the control group.Conclusion Intrapleural heparin has similar effects with urokinase for prevention pleural thickness andadhesion in tuberculous pleurisy with good availability and safety.
ObjectiveTo investigate the overall accuracy of interleukin-12 (IL-12) for diagnosis of tuberculous pleurisy. MethodsWe searched in PubMed, Embase, Web of Science, China National Knowledge Infrastructure databases, WanFang Data, and VIP Information for qualified studies that reported diagnostic accuracy of IL-12 for tuberculous pleurisy up to February 2014. The methodological quality of each study was evaluated by Quality assessment of diagnostic accuracy studies. Statistical analyses were performed by Meta-Disc 1.4 software and the pooled sensitivity, specificity and other diagnostic indexes. Meta-analysis of the reported accuracy of each study and summary receiver operating characteristic (SROC) curve were also performed. ResultsEight studies met the inclusion criteria for the analysis. The summary estimates for IL-12 in the diagnosis of tuberculous pleurisy were:sensitivity 0.80 [95% CI (0.76, 0.84)], specificity 0.76 [95% CI (0.71, 0.81)], positive likelihood ratio 3.23 [95% CI (2.26, 4.60)], negative likelihood ratio 0.30 [95% CI (0.20, 0.45)], diagnostic odds ratio 13.57 [95% CI (6.66, 27.64)], and the area under the curve of SROC was 0.86. ConclusionIL-12 plays a valuable role in the diagnosis of tuberculous pleurisy, and IL-12 may be a useful diagnostic marker for tuberculous pleurisy.