The Therapy Of Urokinase In Unloculated Tuberculous Pleural Effusion:A Meta Analysis

Objective:To evaluate the efficacy of intrapleural urokinase treatment of unloculated tuberculous pleural effusion.Methods:Chinese Conference Data, Chinese Biomedical Database, VIP Database, Wanfang Data, Cochrane Library, PubMed, Evidence-based Medical Evaluation Database were searched up to February2012, and the studies as references of eligible articles were also searched. Included studies were randomized controlled trials and evaluated the efficacy of intrapleural urokinase treatment of early tuberculous pleural effusion. According to including criteria, articles were evaluated by "bias risk assessment" tool which Cochrane Handbook5.0recommended. According to the literature describes the formulas and methods, WMD and95%confidence interval (CI) were calculated the efficacy of urokinase in the treatment. After the test for heterogeneity, forest map, using the Weighted mean difference (WMD) method, was analyzed the efficacy of intrapleural urokinase treatment of early tuberculous pleural effusion. The funnel plot was used to discuss the publication bias.Results:9trials met all eligible criteria in unloculated tuberculous pleural effusion (TPE). This Meta-analysis indicated that compared with the conventional treatment control group, the urokinase treatment group in patients with unloculated TPE can increase the total drainage (pumping liquid)[WMD777.10,95%CI(659.23,894.96); P<0.00001], decrease RPT [WMD-0.72,95%CI(-0.91,-0.53); P<0.00001]. The improvement in lung function FEV1%with UK group versus control group was significant differences[WMD9.06,95%CI(7.68,10.45); P<0.00001].The meta analysis fails to compare FVC%and the absorption time of pleural effusion between the two groups. Subgroup analysis:the RPT between different doses of UK group and control group in patients who were diagnosed unloculated TPE was also decreased[WMD-0.74,95%CI(-0.83,-0.65); P<0.00001]; the total drainage (pumping liquid) of thoracentesis with UK group versus control group in patients who were diagnosed unloculated TPE was also increased.Conclusions:Compared with the conventional treatment (anti-tubercular treatment in combination with pumping pleural effusion), the treatment which injects urokinase to chest cavity can increase total pleural effusion, decrease residual pleural thickening and reduce tuberculous exudative pleurisy fiber space, improve the lung function FEV1%; the treatment with different doses of UK to unloculated TPE patients was also effective, however, the complication and the adverse reaction were little described in order not to make meta analysis; to increase the total drainage was also effective with different ways to discharge the pleural effusion.