The Influence Of Glucocorticoid On Expression Levels Of Cytokines Including IL-6, IL-8, IL-18 And SIL-2R In Patients With Tuberculous Pleurisy

OBJECTIVE:To observe the effect of glucocorticoid by oral medication or intrathoracic injection on expression levels of cytokines including IL-6,IL-8,IL-18 and sIL-2R in blood serum and pleural fluid of patients with tuberculous pleurisy,and to provide experimental evidence on judging the clinical therapeutic effect and side effect of the two modalities on patients of tuberculous pleurisy.METHODS:40 cases of untreated patients with tuberculous pleurisy were randomly divided into two groups and the two groups were treated with glucocorticoid by oral medication(oral group) or by intrathoracic injection(injection group) separately. Enzyme linked immunosorbent assay(ELISA) was employed to detect expression levels of IL-6,IL-8,IL-18 and sIL-2R in blood serum and pleural fluid of these patients before treatment and at the 3^rd,6^th and 9^th day post-treatment.To examine the change of membrana pleuralis and pleural effusion of all patients,chest pictures were taken by Computed Tomography(CT) scan before treatment and after treatment for 1 month.RESULTS:After oral medication for 3,6 and 9 days,contents of IL-6 and IL-8 in blood serum decreased and were obviously lower than IL-6 and IL-8 contents in injection group(P<0.01).sIL-2R content increased and was significantly higher than that in injection group(P<0.01).After intrathoracic injection for 3,6 and 9 days, contents of IL-6 and IL-8 in pleural fluid decreased and sIL-2R content increased obviously.IL-6 and IL-8 contents were significantly lower and sIL-2R higher in injection group than in oral group(P<0.01).The difference between these two groups is significant(P<0.05).There was no significant change about content of IL-18 of the two groups before and after treatment(P>0.05).After 1 month of treatment,45% (9/20) cases of oral group showed complete absorption of pleural fluid and 40%(8/20) showed pachynsis pleurae.Compared with oral group,the data in injection group were 80%(16/20) and 10%(2/20) respectively.CONCLUSION:Compared with oral medication,intrathoracic injection of glucocorticoid displays increased therapeutic effect and decreased side effect on patients of tuberculous pleurisy.Intrathoracic injection of glucocorticoid exerts stronger suppression on the function of immunologic cell in cavum pleurae and weaker suppression on the general immune system than oral medication.This research provides indexes of molecular immunology to clinical doctors to judge therapeutic and side effects of the two kinds of medication and is helpful in selecting reasonable medication and instructing individualized treatment.