胸水γ-干扰素释放试验与老年结核性胸膜炎预后的关系

目的 探讨胸水的γ-干扰素释放试验与老年结核性胸膜炎患者预后的关系.方法 选取2012年3月至2014年5月在我院就诊并确诊的结核性胸膜炎患者80例,根据年龄分为2组:A组(年龄＜60岁)和B组(年龄≥60岁),每组40例.取胸水采用T-SPOT.TB检测γ-干扰素释放试验.抗结核治疗的同时动态观察患者治疗1个月时的胸水吸收情况和治疗6个月时的胸膜粘连、肥厚情况,综合分析患者预后.结果 A组γ-干扰素释放试验阳性患者37例,阳性率为92.5％;B组γ-干扰素释放试验阳性患者25例,阳性率为62.5％.A组胸水γ-干扰素释放试验阳性率高于B组(x2=10.323,P＜ 0.05).1个月综合治疗结束后,A组患者胸水吸收比例为85.0％,B组患者胸水吸收比例为70.0％,2组比较差异无统计学意义(x2 =2.581,P＞0.05).6个月治疗结束后,A组患者胸膜肥厚比例为27.5％,B组患者胸膜肥厚比例为57.5％,B组发生胸膜肥厚患者比例高于A组(x2=7.366,P＜0.05).结论 老年结核性胸膜炎患者早期的胸水γ-干扰素释放试验阳性率相对偏低,可能与老年患者细胞免疫功能低下有关.而老年患者治疗后期胸膜肥厚、粘连较中青年患者更加明显,提示老年胸膜炎预后欠佳.

Relationship of interferon-gamma release assay in pleural effusion and prognostic assessment of tuberculous pleurisy in elderly patients

Objective To explore the relationship of interferon-gamma release assay in pleural effusion and the prognostic assessment of tuberculous pleurisy in elderly patients.Methods 80 patients with tuberculous pleurisy in our hospital from March 2012 to May 2014 were selected.They were divided into group A (＜60 years old) and group B (≥60 years old),40 cases in each group.The pleural effusion was taken for interferon-gamma release assay by T-SPOT.TB.The pleural effusion absorption in one month,the pleural adhesion and hypertrophy in six months were observed dynamically when antituberculosis treatment was conducted.The patients' outcomes were analysed comprehensively.Results There were 37 patients in the group A whose interferon-gamma release assay was positive,and the positive rate was 92.5 ％.There were 25 patients in the group B whose interferon-gamma release assay was positive,and the positive rate was 62.5 ％.The positive rate of group A was higher than that of group B (x2=10.323,P ＜0.05).After treatment for one month,the rate of pleural effusion absorption in group A and group B was 70.0％ and 85.0％,there was no significant difference between the two groups (x2=2.581,P＞0.05).After treatment for six months,the rate of pleural hypertrophy in group A and group B was 27.5％ and 57.5％,the rate of patients with pleural hypertrophy in group B was higher than that in group A (x2 =7.366,P ＜0.05).Conclusions The positive rate of interferon-gamma release assay in elderly patients with tuberculous pleurisy is relatively low,which may be related to low immune function of the elderly patients.And the pleural hypertrophy in those elderly patients is more serious than youngers,which means elderly patients with tuberculous pleurisy had poor prognosis.