Respiratory Department, Logan Hospital, Logan City, Queensland, Australia.
School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
Intern Med J. 2023 Dec;53(12):2313-2318. doi: 10.1111/imj.16084. Epub 2023 Apr 26.
Pleural infection is life-threatening and increasingly prevalent. In addition to usual care, twice-daily, separate administration of tissue plasminogen activator and deoxyribonuclease (tPA-DNase) reduces radiological pleural opacity with lower surgical referral rates.
This retrospective cohort study examines the use of once-daily, concurrent administration of tPA-DNase for complex parapneumonic pleural effusion and empyema.
Patients with pleural infection who received intrapleural tPA-DNase between October 2014 and July 2020 at Logan Hospital, where it is given concurrently and once-daily as salvage therapy, were retrospectively identified. Radiographic opacification, inflammatory markers, clinical response and complications were examined.
Thirty-one patients were identified. Mean age was 48.8 years (standard deviation [SD], 17.2). Median tPA-DNase administration was 3 (interquartile range [IQR], 2-3). Chest x-ray pleural opacity decreased significantly (P = 0.047) from a median of 39.6% (IQR, 28.8-65.7%) to 9.7% (IQR, 2.5-23.2%), a median relative reduction of 75.5% (IQR, 47.7-93.9%). White cell count and C-reactive protein improved significantly (P = 0.002 and P = 0.032, respectively) from a median of 16.3 × 10 /L (IQR, 11.8-20.6 × 10 /L) to 9.9 × 10 /L (IQR, 8.0-12.3 × 10 /L) and 311.0 mg/L (IQR, 218.8-374.0 mg/L) to 69.0 mg/L (IQR, 36.0-118.0 mg/L), respectively. No patients experienced significant bleeding or died. Five patients (16.1%) were referred for surgery.
This is pilot evidence that a practical regimen of concurrent, once-daily intrapleural tPA-DNase improved pleural opacification and inflammatory markers without bleeding or mortality. The surgical referral rate was higher than in studies assessing twice-daily administration, though the validity of this outcome as a measure of treatment success is limited, and further studies are needed to assess the optimal dose and frequency of intrapleural therapy and indications for surgical referral.
胸膜感染具有生命威胁性且日益普遍。除常规治疗外，每日两次、分别给予组织型纤溶酶原激活物和脱氧核糖核酸酶（tPA-DNase）可降低放射状胸膜不透明度，并降低手术转诊率。
本回顾性队列研究探讨了每日一次、同时给予 tPA-DNase 治疗复杂性类肺炎性胸腔积液和脓胸的效果。
Logan 医院于 2014 年 10 月至 2020 年 7 月期间对接受胸腔内 tPA-DNase 治疗的胸膜感染患者进行了回顾性识别，该医院将 tPA-DNase 作为挽救性治疗每日一次同时给药。研究人员检测了影像学胸膜不透明度、炎症标志物、临床反应和并发症。
共确定了 31 例患者。平均年龄为 48.8 岁（标准差[SD]，17.2）。中位 tPA-DNase 给药时间为 3（四分位距[IQR]，2-3）。胸片胸膜不透明度显著降低（P=0.047），中位数从 39.6%（IQR，28.8-65.7%）降至 9.7%（IQR，2.5-23.2%），中位相对降幅为 75.5%（IQR，47.7-93.9%）。白细胞计数和 C 反应蛋白显著改善（P=0.002 和 P=0.032），中位数分别从 16.3×10 /L（IQR，11.8-20.6×10 /L）降至 9.9×10 /L（IQR，8.0-12.3×10 /L）和 311.0 mg/L（IQR，218.8-374.0 mg/L）降至 69.0 mg/L（IQR，36.0-118.0 mg/L）。没有患者发生明显出血或死亡。5 名患者（16.1%）被转诊手术。
本研究初步证实，每日一次、同时给予胸腔内 tPA-DNase 的实用方案可改善胸膜不透明度和炎症标志物，且不会发生出血或死亡。手术转诊率高于评估每日两次给药的研究，但作为治疗成功指标，该结果的有效性有限，需要进一步研究来评估胸腔内治疗的最佳剂量和频率以及手术转诊的指征。
