A Clinical Comparative Study on Intrapleural Heparin Versus Urokinase in the Management of Tuberculous Pleurisy_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HUANG Yanming ¹ , XIE Canmao ² , ZUO Wanli. ¹

Department of Respiratory Medicine, Jiangmen Central Hospital. Jiangmen, Guangdong, 529070, China;

Corresponding author：

Keywords：

Heparin; Urokinase; Fibrinogen; D-dime; Tuberculous pleurisy; Pleural effusion

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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.

Citation： HUANG Yanming,XIE Canmao,ZUO Wanli.. A Clinical Comparative Study on Intrapleural Heparin Versus Urokinase in the Management of Tuberculous Pleurisy. Chinese Journal of Respiratory and Critical Care Medicine, 2009, 09(3): 247-250. doi: Copy

1.	Laisaar T, Puttsepp E, Laisaar V, et al. Early administration of intrapleural streptokinase in the treatment of multiloculated pleaural effusions and pleural empyemas. Thorac Cardiovasc Surg, 1996, 44 :252-256.
2.	吕友堤, 陈平, 徐敏. 测定胸液中D-二聚体含量的临床意义. 湖南医科大学学报, 2000, 25: 71-72.
3.	Cochran JB, Tecklenburg FW, Turner RB. Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema. Pediatr Crit Care Med, 2003, 4: 39-43.
4.	Basile A, Boullosa-Seoane E, Dominguez Viguera L, et al.Intrapleural fibrinolysis in the management of empyemas and haemothoraces. Our experience. Radiol Med, 2003, 105: 12-16.
5.	姜轶飞, 程海英, 姚杨伟. 胸腔内注射肝素防治包裹性胸腔积液. 临床医学, 2007, 27: 57.
6.	Park CS, Chung WM, Lim MK, et al. Transcatheter instillation of urokinase into loculated pleural effusion: analysis of treatment effect. Am J Roentgenol, 1996, 167: 649-652.
7.	Kornecki A, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg, 1997, 32: 1473 -1475.
8.	Kwak SM, Park CS, Cho JH, et al. The effects of urokinase instillation therapy via percutaneous transthoracic catheter inloculated tuberculous pleural effusion: a randomized prospective study. Yonsei Med J, 2004, 45: 822-828.
9.	黄秀云. 肝素钠胸腔内注入治疗结核性渗出性胸膜炎的临床观察. 临床荟萃, 2006, 21: 1041-1042.
10.	Strange C, Baumann MH, Sahn SA, et al. Effects of intrapleural heparin or urokinase on the extent of tetracycline-induced pleural disease. Am J Respir Crit Care Med, 1995, 151: 508-515.
11.	李家增, 贺石林, 王鸿利, 主编. 血栓病学. 北京: 科学出版社,1998, 53-64, 439-455.
12.	Lantz M, Thysell E, Nilsson E, et al. On the binding of tumor necrosis factor( TNF) to heparin and the release in vivo of the TNFbinding protein 1 by heparin. J Clin Invest, 1991, 88: 2026-2031.
13.	Dikensoy O, Zhu Z, Na MJ, et al. Intrapleural heparin or heparin combined with human recombinant DNase is not effective in the treatment of empyema in a rabbit model. Respirology, 2006, 11: 755-760.
14.	Ray RL, Berkenbosh JW, Russo P, et al. Tissue plasminogen activator as a adjunctive therapy of empyema in pediatric patients. J Intensive Care Med, 2004, 19: 44-50.
15.	Simpson G, Roomes D, Heron M. Effects of streptokinase and deoxyribonuclease on viscosity of human surgical and empyema pus. Chest, 2000, 117: 1728-1733.
16.	Zhu Z, Hawthorne ML, Guo Y, et al. Tissue plasminogen activator combined with human recombinant DNase is effective therapy for empyema in a rabbit model. Chest, 2006, 129: 1577-1583.

1. Laisaar T, Puttsepp E, Laisaar V, et al. Early administration of intrapleural streptokinase in the treatment of multiloculated pleaural effusions and pleural empyemas. Thorac Cardiovasc Surg, 1996, 44 :252-256.
2. 吕友堤, 陈平, 徐敏. 测定胸液中D-二聚体含量的临床意义. 湖南医科大学学报, 2000, 25: 71-72.
3. Cochran JB, Tecklenburg FW, Turner RB. Intrapleural instillation of fibrinolytic agents for treatment of pleural empyema. Pediatr Crit Care Med, 2003, 4: 39-43.
4. Basile A, Boullosa-Seoane E, Dominguez Viguera L, et al.Intrapleural fibrinolysis in the management of empyemas and haemothoraces. Our experience. Radiol Med, 2003, 105: 12-16.
5. 姜轶飞, 程海英, 姚杨伟. 胸腔内注射肝素防治包裹性胸腔积液. 临床医学, 2007, 27: 57.
6. Park CS, Chung WM, Lim MK, et al. Transcatheter instillation of urokinase into loculated pleural effusion: analysis of treatment effect. Am J Roentgenol, 1996, 167: 649-652.
7. Kornecki A, Sivan Y. Treatment of loculated pleural effusion with intrapleural urokinase in children. J Pediatr Surg, 1997, 32: 1473 -1475.
8. Kwak SM, Park CS, Cho JH, et al. The effects of urokinase instillation therapy via percutaneous transthoracic catheter inloculated tuberculous pleural effusion: a randomized prospective study. Yonsei Med J, 2004, 45: 822-828.
9. 黄秀云. 肝素钠胸腔内注入治疗结核性渗出性胸膜炎的临床观察. 临床荟萃, 2006, 21: 1041-1042.
10. Strange C, Baumann MH, Sahn SA, et al. Effects of intrapleural heparin or urokinase on the extent of tetracycline-induced pleural disease. Am J Respir Crit Care Med, 1995, 151: 508-515.
11. 李家增, 贺石林, 王鸿利, 主编. 血栓病学. 北京: 科学出版社,1998, 53-64, 439-455.
12. Lantz M, Thysell E, Nilsson E, et al. On the binding of tumor necrosis factor( TNF) to heparin and the release in vivo of the TNFbinding protein 1 by heparin. J Clin Invest, 1991, 88: 2026-2031.
13. Dikensoy O, Zhu Z, Na MJ, et al. Intrapleural heparin or heparin combined with human recombinant DNase is not effective in the treatment of empyema in a rabbit model. Respirology, 2006, 11: 755-760.
14. Ray RL, Berkenbosh JW, Russo P, et al. Tissue plasminogen activator as a adjunctive therapy of empyema in pediatric patients. J Intensive Care Med, 2004, 19: 44-50.
15. Simpson G, Roomes D, Heron M. Effects of streptokinase and deoxyribonuclease on viscosity of human surgical and empyema pus. Chest, 2000, 117: 1728-1733.
16. Zhu Z, Hawthorne ML, Guo Y, et al. Tissue plasminogen activator combined with human recombinant DNase is effective therapy for empyema in a rabbit model. Chest, 2006, 129: 1577-1583.

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A Clinical Comparative Study on Intrapleural Heparin Versus Urokinase in the Management of Tuberculous Pleurisy

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