Tuberculous pleural effusion and lymphadenitis treated with rifampin-containing regimen

Rifampin, isoniazid, and ethambutol were administered in single daily dose for nine months to 91 patients with pleural effusion and 45 patients with lymphadenitis, both of tuberculous etiology. Clinical and roentgenographic clearance of pleural effusion was successfully achieved in all cases at the end of nine months of treatment. Followup of 80 cases of pleural effusion up to nine months, in 55 cases up to one year, and up to two years in 30 cases after completion of therapy, showed no recurrence. In the cases of tuberculous lymphadenitis, resolution of lymph nodes occurred in 31 cases (68.8 percent) at the end of nine months of treatment. Therapy had to be extended for varying periods for achieving successful response, and in five cases, medical treatment had to be supplemented with surgical drainage and excision of the nodes. Short course chemotherapy can be used to treat pleural effusion, but the same mode of treatment is less effective for cases of tuberculous lymphadenitis.     

微导管在胸腔积液患者中的临床应用

任何原因导致胸膜腔内出现过多的液体称胸腔积液,俗称胸水。胸腔积液可以分为渗出液和漏出液两种,其中漏出液一般根据原发病进行对症治疗即可,无需反复胸水抽吸,而渗出液需要进行反复抽吸,避免出现胸膜增厚、胸腔粘连等不良事件发生[1-2]。我科主要收治肺癌、结核性胸膜炎等患者,以渗出性胸膜炎最为常见。此类胸水多发展迅速,积液呈中大量且无法自行吸收,导致患者出现肺扩张受限,纵隔脏器受压,进一步发展则严重影响呼吸功能和心泵功能,甚至危及生命[3],导致患者生活质量显著下降。治疗上以缓解症状、改善呼吸循环状态为主要目的,目前主要治疗手段是胸腔穿刺放液治疗。传统治疗主要是局部麻醉切开置入硅胶管,随着医学技术的发展,我科使用微导管即中心静脉导管置管引流胸腔积液,取得良好的治疗效果,降低了并发症的发生,提高了患者服务满意度。现报道如下。     

艾迪注射液胸腔内注射治疗恶性胸腔积液52例

目的观察艾迪注射液胸腔内注射治疗恶性胸腔积液的疗效。方法将52例恶性胸腔积液患者随机分为两组,艾迪治疗组和顺铂（DDP）对照组,艾迪治疗组每周一次胸腔内注射,对照组采用顺铂胸腔内注射,每周一次,2～4周为一疗程。结果艾迪治疗组治疗胸水总有效率与对照组相比无统计学意义（P〉0．05）,但是艾迪治疗组生活质量改善显著高于对照组、毒副反应发生率显著低于对照组（P〈0．05）。结论艾迪治疗恶性胸水与顺铂（DDP）对照组疗效相当,但生活质量明显改善且毒副作用小,患者易于接受。     

肺栓塞并胸腔积液的相关临床分析

目的探讨肺栓塞(Pulmonary Embolism,PE)并胸腔积液患者的临床特点。方法对确诊的115例肺栓塞患者,根据患者是否存在胸腔积液分为肺栓塞并胸腔积液组(实验组)及肺栓塞无胸腔积液组(对照组),比较两组的临床特点。结果合并胸腔积液有52例,无胸腔积液有63例。肺栓塞并胸腔积液患者的发热比率、呼吸次数、PT、APTT、FIB、INR、DD、HSCRP、cTnT、NTproBNP、RAD及mPAP高于无胸腔积液患者,差异有统计学意义(P<0.05);肺栓塞并胸腔积液患者的LYMPH、AT水平低于无胸腔积液患者,差异有统计学意义(P<0.05);经多因素logistic回归分析,FIB、DD、RAD及AT可能是PE发生胸腔积液独立预测因子,FIB、DD及RAD可能是PE患者发生胸腔积液的危险因素,AT可能为PE发生胸腔积液的保护因素。52例肺栓塞合并胸腔积液患者中,双侧胸腔积液33例(63.5%),单侧胸腔积液19例(36.5%);少量胸腔积液44例(84.6%),中-大量胸腔积液8例(15.4%);双侧少量胸腔积液29例(55.77%)。肺栓塞栓塞部位与是否发生胸腔积液比较,差异无统计学意义(P>0.05)。在肺栓塞并胸腔积液组中,肺栓塞栓塞部位与胸腔积液部位比较,差异无统计学意义(P>0.05);肺栓塞栓塞部位与胸腔积液量比较,差异无统计学意义(P>0.05);胸腔积液部位与胸腔积液量比较,差异无统计学意义(P>0.05)。肺栓塞并胸腔积液组不良事件发生率高于肺栓塞无胸腔积液组,差异有统计学意义(P<0.05)。结论FIB、DD、RAD及AT可能是PE发生胸腔积液的影响因素。肺栓塞并胸腔积液多为双侧少量胸腔积液。肺栓塞部位、胸腔积液量及胸腔积液部位之间未发现有相关性。胸腔积液对PE患者短期预后的评估具有一定价值。     

Study to identify incidence and risk factors associated Residual pleural opacity in tubercular pleural effusion

IntroductionResidual pleural opacity (RPO) is a common radiographic sequela in patients with tubercular pleural effusion at the end of the treatment. This study was designed to find out the risk factors associated with residual pleural opacity (RPO).Materials & methodsThis was a prospective longitudinal study performed to analyse data of 56 patients (46 males & 10 females) who were diagnosed as tubercular pleural effusion and treated for the same between 1st Jan 2019 to 30th March 2020. Chest X-ray posteroanterior & Lateral view was done (performed) at 0 and 6 months of treatment to quantify the amount of pleural effusion and measured the residual pleural opacity at the end of the treatment. RPO included both non resolving pleural effusion as well as residual pleural thickening (RPT). All statistical analysis was done using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Multivariate logistic regression was performed to explore the association of risk factors and Residual pleural opacity. The statistical significance level was set at 0.05 (two-tailed).ResultsThe incidence of Residual pleural opacity (RPO) at the end of 6 months of antituberculosis treatment was 53.57% (30/56)). The study patients were divided into RPO and non- RPO group. Male gender had significantly higher incidence of RPO (93.3% vs 69.2% P = 0.01)). Patients with RPO group had significantly more cough and weight loss as compared to non RPO group (96.6% vs 65.3% P = 0.002 and 60% vs 23% P = 0.005). The proportion of patients who underwent therapeutic aspiration and gained weight of more than 5kg during treatment (19.5% vs 7.6% P = 0.02 & 46.6% vs 7.6% P = 0.001) was significantly higher in RPO group. A significantly lower protein, glucose and higher LDH level in pleural fluid was observed in the RPO group compared to non-RPO group (P = 0.006, P = 0.01, P = 0.001)). No significant difference was found in the pleural fluid ADA, lymphocyte, neutrophil levels between the two groups (p > 0.05). Logistic regression analysis showed that the male gender, low pleural fluid glucose, presence of cough and weight loss were associated with significantly increased risk of residual pleural opacity and thickening (p < 0.05).ConclusionTubercular pleural effusion is associated with residual pleural opacity in more than half of the patients. Male gender and low glucose levels in pleural fluid was associated with increased risk of residual pleural opacity.     

CA125、CA153、CEA联合检测鉴别结核性与癌性积液的对比分析

目的 研究和评价CA125、CA153、CEA在结核性及癌性积液中的临床应用及检验效能。方法 选结核性积液患者92例,癌性积液患者32例,采用化学发光免疫法检测胸腹水及血清中的CA125、CA153、CEA。结果 恶性积液患者积液及血清的CA125、CA153、CEA含量均明显增高,且CA153、CEA明显高于结核性者,而两者间CA125的差异无显著性,积液中的CA125、CA153、CEA含量明显高于血清中的CA125、CA153、CEA含量。结论 单一检测肿瘤标志物CA125,检验效能差,特异性差,而与CA153、CEA联合检测提高了敏感性和特异性,应强调多种标志物的联合检测及动态观察。     

80岁以上老年男性患者103例胸腔积液临床分析

目的探讨80岁以上老年男性患者胸腔积液的病因、诊断、鉴别诊断及治疗特点。方法对我科收治的资料完整的103例胸腔积液患者的临床资料进行分析。结果103例患者中良性胸腔积液72例,其中主要因肺部感染引起的胸腔积液35例,由心功能衰竭引起的胸腔积液10例,肺部感染合并心衰或肾功能不全等原因导致的胸腔积液17例,肝硬化、慢性肾功能不全引起的胸腔积液6例,结核性胸腔积液4例;恶性胸腔积液的29例中,原发病为肺癌22例,其他肿瘤7例;此外,不能明确诊断者2例。结论在老年男性患者中,肺部感染、肺部肿瘤、心功能不全是导致胸腔积液的主要原因。     

血清CA125测定在胸腔积液患者中的临床意义

目的检测不同原因引起的胸腔积液的血清肿瘤标志物CA125(癌胚抗原125)在胸腔积液患者中的临床价值。方法选择130例胸腔积液患者,检测所有患者血清CA125的浓度,分别按照疾病的良恶性、胸水量的大小、渗出液与漏出液分组,比较各组间患者浓度水平的差别。结果 130例胸腔积液患者中有123例血清CA125升高,阳性率为94.62%;恶性胸腔积液组与良性胸腔积液组相比血清CA125浓度有显著性差异(P0.05);大量胸腔积液组与中小量胸腔积液组、渗出液与漏出液之间相比,血清CA125浓度无显著性差异(P0.05)。结论血清CA125可作为鉴别良恶性胸腔积液的重要辅助指标,但其对量的大小及渗出液、漏出液的鉴别无临床应用价值。     

Tuberculous pleural effusion. Twenty-year experience

We reviewed the records of 1,738 cases of tuberculosis seen during the period from 1968 to 1988 in Mobile, Alabama. Seventy cases of tuberculous pleural effusion were identified and constituted 4.9 percent of all disease due to Mycobacterium tuberculosis during this period. Tuberculous pleural effusion was diagnosed if the patient had M tuberculosis cultured from sputum, pleura, or pleural fluid and had a roentgenographic pleural effusion without an alternative explanation for the presence of the effusion. The diagnosis of tuberculous pleural effusion was made in the absence of a positive culture if the patient had an undiagnosed lymphocytic exudative pleural effusion and all clinical and roentgenographic abnormalities resolved on antimycobacterial chemotherapy. The mean age of all patients was 47 +/- 18.4 years. The 70 cases were evenly divided between 35 that were accompanied by roentgenographic pulmonary parenchymal infiltrates and 35 that occurred in the absence of parenchymal infiltrates. We conclude that cultures of all potentially diagnostic specimens (sputum, pleural fluid, and pleura) and an intermediate-strength skin test, are sensitive tests for the diagnosis of tuberculous pleural effusion. In addition, the age of patients with tuberculous pleural effusion appears to be increasing.     

Clinical relevance and characteristics of pleural effusion in patients with Mycoplasma pneumoniae pneumonia

Abstract Data regarding parapneumonic pleural effusion in Mycoplasma pneumoniae pneumonia (MP) patients are limited. In this study MP patients with pleural effusion tended to be younger and had longer hospital stays and more common use of systemic steroids compared to those without pleural effusion. In 5 of the 6 patients for whom pleural fluid data were available, the pleural effusion was lymphocyte-predominant rather than polymorphonuclear leukocyte-predominant; these patients also had elevated adenosine deaminase levels. Taken together, these results indicate that MP patients with pleural effusion may have a more severe form compared to those without pleural effusion. M. pneumoniae should be considered an aetiological agent of lymphocyte-predominant pleural effusion.     

结核性与恶性胸水患者血清及胸水IL-6，IL-8水平的检测及其临床意义

目的探讨细胞因子白细胞介素6（interleukin-6,IL-6）和白细胞介素8（interleukin8,IL-8）的水平在结核性和恶性胸水患者血清及胸水中含量变化及对胸水性质的鉴别诊断价值。方法采用用酶联免疫吸附试验（ELISA）检测36例结核性胸水,36例恶性胸水患者血清和胸水中IL-6、IL-8水平及30例健康者血清IL-6、IL-8水平。结果结核组与恶性胸水组的IL-6分别为533.18±425.20pg／ml,122.50±92.41pg／ml,两组数据具显著性差异（P〈0.002）;结核组和恶性组中胸水与对应血清中的IL-6的含量具有显著性差异（P〈0.001）;而结核组和肺癌组血清IL-6的含量则不具有显著性差异（P〉0.05）。结核组与恶性胸腔积液组的IL-8分别为434.24±68.52ng／ml,364.38±46.21ng／ml,无显著性差异（P〉0.05）。结核组和恶性组中胸水与对应血清中的IL-8的含量具有显著性差异（P〈0.05）;而结核组和肺癌组血清IL-8的含量则不具有显著性差异（P〉0.05）。结论结核性与恶性胸水患者胸水中IL-6、IL-8水平较正常人有明显升高,对在鉴别结核性与恶性胸水患者诊断中有一定价值。     

结核性与恶性胸水患者血清及胸水IL-6,IL一8水平的检测及其临床意义

目的 探讨细胞因子白细胞介素6(interleukin-6,IL-6)和白细胞介素8(interleukin8,IL-8)的水平在结核性和恶性胸水患者血清及胸水中含量变化及对胸水性质的鉴别诊断价值.方法 采用用酶联免疫吸附试验(ELISA)检测36例结核性胸水,36例恶性胸水患者血清和胸水中IL-6、IL-8水平及30例健康者血清IL-6、IL-8水平.结果 结核组与恶性胸水组的IL-6分别为533.18±425.20 pg/ml,122.50±92.41 pg/ml,两组数据具显著性差异(P＜0.002);结核组和恶性组中胸水与对应血清中的IL-6的含量具有显著性差异(P＜0.001);而结核组和肺癌组血清IL-6的含量则不具有显著性差异(P＞0.05).结核组与恶性胸腔积液组的IL-8分别为434.24±68.52 ng/ml,364.38±46.21 ng/ml,无显著性差异(P＞0.05).结核组和恶性组中胸水与对应血清中的IL-8的含量具有显著性差异(P＜0.05);而结核组和肺癌组血清IL-8的含量则不具有显著性差异(P＞0.05).结论 结核性与恶性胸水患者胸水中IL-6、IL-8水平较正常人有明显升高,对在鉴别结核性与恶性胸水患者诊断中有一定价值.     

Single-center experience with 250 tunnelled pleural catheter insertions for malignant pleural effusion

INTRODUCTION: Malignant pleural effusions (MPEs) are a common cause of dyspnea in patients with advanced cancer. Tunnelled pleural catheters (TPCs) can be used in patients with this condition, but the published experience with them is limited. OBJECTIVE: To describe the use of TPCs in the management of MPE in a large group of patients in a clinical setting. METHODS: Retrospective analysis of 250 sequential TPC insertions in patients with MPEs in a single center. RESULTS: Two hundred fifty TPC procedures for MPE were performed in 223 patients (19 contralateral procedures and 8 repeat ipsilateral procedures) during a 3-year period. Symptom control was complete following 97 procedures (38.8%), was partial in 125 procedures (50%), and was absent in 9 procedures (3.6%); in addition, there were 10 failed TPC insertions (4.0%) and 9 TPC insertions (3.6%) without assessment of symptoms at the 2-week follow-up visit. Spontaneous pleurodesis occurred following 103 of the 240 successful TPC procedures (42.9%) and was more frequent when < or = 20% of the hemithorax contained fluid at the 2-week follow-up visit (57.2% vs 25.3%, respectively; p < 0.001). Catheters stayed in place for a median duration of 56 days. Following successful TPC placement, no further ipsilateral pleural procedures were required in 90.1% of cases. The overall median survival time following TPC insertion was 144 days. Complication rates were low and compared favorably with those seen with other treatment options. CONCLUSIONS: TPC placement is an effective method of palliation for MPE that allows outpatient management and low complication rates. The insertion of a TPC should be considered as a first-line treatment option in the management of patients with MPE.     

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临床上肺外结核越来越多,结核性胸腔积液(TPE)是肺外结核中第2种常见的形式,仅次于淋巴结结核.结核病患者中约5%会发生TPE[1]. 1临床特点     

门静脉高压并发胸腔积液226例临床分析

为研究门静脉高压并发胸、腹水之间关系、性质、以及产生机理，提高对肝脏疾病肺部表现的认识，总结226例肝硬化失代偿期－－门静脉高压并发胸腔积液患者的临床资料。结果提示，往往先产生腹水，后并发胸水，有些病例只有胸水，而无腹水，胸、腹水的性质均为漏出液，治疗上除采取综合治疗外，还可选用胸腔放液后，胸腔内注射地塞米松和高聚金葡素等治疗。     

胸水N-末端脑钠肽前体在胸腔积液患者中的诊断价值

目的 探讨检测胸液中N-末端脑钠肽前体(NT-proBNP)对于胸腔积液的鉴别诊断价值.方法 选取在本院因胸腔积液而进行诊断性胸腔穿刺的患者126例,根据临床表现、胸液常规检验结果及细胞学分为充血性心力衰竭胸腔积液33例(心源性组)和非心源性组93例(恶性胸腔积液18例、结核性胸腔积液22例、肾功能衰竭性胸腔积液19例、肝硬化腹水伴胸腔积液15例、肺炎性胸腔积液19例).检测2组患者胸水及血浆中NT proBNP水平,分析血浆NT proBNP水平与胸水NT-proBNP的相关性,并采用受试者工作曲线(ROC)计算用于判别胸水性质的最佳界值.结果 心源性组胸水及血浆中的NT-proBNP水平显著高于非心源性组、恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组,且差异均具有统计学意义(P＜0.05);恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组胸水及血浆中NT proBNP水平差异均无统计学意义(P＞0 05);胸水中NT proBNP水平与血浆中NT-proBNP水平呈显著正相关(r=0.894,P＜0.01).绘制ROC曲线结果显示,当胸水中NT-proBNP水平为1 500 ng/L时,鉴别心源性和非心源性胸水具有最大诊断指数(1.757 3),此时敏感度为89.19％、特异度为86.54％.结论 心源性胸腔积液患者胸水中NT-proBNP水平显著升高,与血浆水平呈显著正相关,以1 500 ng/L为界值时,具有鉴别诊断心源性胸水的最高价值.