ABSTRACT
OBJECTIVE: To investigate the long-term effect and the key factors associated with relapse of double embolization of bronchial artery in patients with lung tuberculosis and hemoptysis. METHODS: Fifty patients with lung tuberculosis and hemoptysis receiving the radiography and double embolization of bronchial artery (BAG + BAE) had been followed up for two years. The causes for hemoptysis relapse was determined, followed by specific treatment, and the effect was evaluated. Among them, 37 were males, 13 females, with the age of 8-75 years (mean age 47.6 years). RESULTS: The 2 year follow-up showed that the cure rate and the effective rate were 62% (31/50) and 94% (47/50) respectively. In a short term after embolization, hemoptysis relapsed in 9 cases, the major causes being active tuberculosis and secondary bronchiectasis complicated with infection. Other responsible factors included missed-embolization of bronchial artery and remaining blood supply from systemic circulation. In mid and long term follow-up, hemoptysis relapsed in 10 cases, the major causes being secondary pulmonary mycotic infection and recurrence of tuberculosis. CONCLUSIONS: The long term result of double embolization of bronchial artery in patients with lung tuberculosis and hemoptysis was significant. It could prevent the danger from massive hemoptysis, and therefore allows the medical therapy for tuberculosis. Embolization of bronchial artery is effective for hemostasis, while etiologic therapy aimed at removing the infection leading to chronic inflammation is the cure for tuberculosis and hemoptysis.
Subject(s)
Embolization, Therapeutic , Hemoptysis/therapy , Tuberculosis, Pulmonary/therapy , Adolescent , Adult , Aged , Bronchial Arteries/diagnostic imaging , Child , Embolization, Therapeutic/methods , Female , Follow-Up Studies , Hemoptysis/diagnostic imaging , Hemoptysis/etiology , Humans , Male , Middle Aged , Radiography , Recurrence , Retrospective Studies , Treatment Outcome , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnostic imagingABSTRACT
OBJECTIVE: To study the change of peripheral blood CD4+ helper T cells and T helper subtype I and II (Th1/Th2) in patients with pulmonary tuberculosis and to explore their changes during anti-tuberculosis chemotherapy. METHODS: CD4+ T cells from 105 patients with pulmonary tuberculosis and 25 normal controls were counted by Flow Cytometry. Peripheral blood cells were stimulated in vitro by phorbol myristate acetate (PMA) (25 ng/ml) and ionomycin (250 ng/ml). Cytokines were confined to the cells by using the protein transporting inhibitor containing monensin (2 micro mol/ml). These cells were incubated in 5% CO(2) for 4 h-4.5 h. The membrane and plasma of CD4+ helper T cells were marked by CD3 -PC5 + CD8 -FITC + INF-gamma -PE/CD3 -PC5 + CD8 -FITC + IgG1 -PE, CD3 -PC5 + CD8 -FITC + IL-4 -PE/CD3 -PC5 + CD8 -FITC + IgG1 -PE monoclonal antibodies respectively. Th1 and Th2 cells were counted and the ratio of Th1/Th2 cells was calculated. The levels of Th1 and Th2 cells in the 67 patients with pulmonary tuberculosis were detected at the end of intensive chemotherapy and at the sixth month of chemotherapy. RESULTS: (1) The levels of CD4+ T and Th1 cells in patients with tuberculosis were significantly lower than those of controls. Their values were (663 +/- 160)/ microl vs (735 +/- 156)/ microl and (9.56 +/- 3.60)% vs (18.7 +/- 5.03)% respectively (P < 0.05). (2) The levels of CD4+ T and Th1 cells in patients with severe pulmonary tuberculosis were lower than those in patients with moderate or mild pulmonary tuberculosis. Their values were (579 +/- 120)/ microl vs (726 +/- 166)/ microl, (684 +/- 192)/ microl and (5.43 +/- 2.33)% vs (12.2 +/- 1.81)% and (10.9 +/- 2.30)% respectively (P < 0.05). The level of Th2 cells was in contrast to Th1 cells and their values were (5.63 +/- 1.26)% vs (2.93 +/- 0.87)% and (3.22 +/- 1.01)% (P < 0.01). (3) The level of Th1 cells increased while that of Th2 decreased in the 61 patients who gradually recovered. (4) The level of Th2 cells in patients with smear positive tuberculosis was strikingly higher than that in patients with smear negative tuberculosis and their values were (5.20 +/- 0.97)% vs (2.77 +/- 1.96)% (P < 0.05). CONCLUSION: The detection of CD4+ helper T cells and Th1/Th2 cells in the peripheral blood cells from patients with pulmonary tuberculosis is useful in evaluating the state of disease and the effect of chemotherapy.
