结核性渗出性胸膜炎86例临床分析

目的进一步探讨结核性渗出性胸膜炎的临床特点以及与肺实质结核的关系。方法回顾性分析2006年1月～2008年12月收治的86例结核性渗出性胸膜炎住院患者的临床特点、治疗及转归。结果结核性胸膜炎好发于青少年及老年人,最常见症状为发热、胸痛及咳嗽,以单侧淋巴细胞为主型渗出性胸膜炎为主。86例患者中经CT检查观察到合并肺实质损害的有69例,占80.2%,其中42例表现为活动性肺结核影像学特点,占48.8%;最常见为渗出及增殖性病灶,病灶位于上叶者42例,占60.9%。肺内病灶与胸水在同一侧59例,双侧都有病灶8例,二者之和远高于肺内病灶在胸水对侧的2.9%(2/69)(P<0.05)。经统计学处理对比继发性结核性胸膜炎组与单纯性结核性胸膜炎组发病年龄、PPD阳性率、血清结核抗体阳性率、胸水蛋白含量、胸水细胞数及淋巴细胞数比例无显著性差异(P>0.05),两组胸水PCR-TB-DNA检出阳性率分别为81.3%和16.7%,经统计学处理对比差异具有显著性(P<0.05)。本组病例89.5%采用短程化疗方案2HRZE/4HR、2HRE/4HR抗结核治疗,近期疗效显著。继发性结核性胸膜炎组与单纯性结核性胸膜炎组疗效无明显差异。结论结核性胸膜炎与肺结核关系密切,将其与肺结核一并列入结核病归口管理对象,对控制结核病疫情具有重要意义。

Clinical analysis of 86 cases with tuberculous exudative pleurisy

Objective To investigate the clinical characteristics of tuberculous exudative pleurisy and the relationship with the pulmonary parenchymal tuberculosis.Methods Retrospective analysis the clinical manifestations and treatment of the 86 cases of tuberculous pleurisy from Jan 2006 to Dec 2008.Results Tuberculous pleurisy was often predilection in adolescent and the aged,the most common clinical symptoms were fever,chest pain and cough.Most of pleural effusion was lymphocytic predominance exudates and unilateral.86 patients had the CT scans,69 of them(80.2%) had found the parenchymal lesion,42 patients(48.8%) had active pulmonary tuberculosis in terms of radiographic characteristics.The most common forms of parenchymal lesions were exudation and proliferation.42 patients(60.9%) had upper-lobe-dominant lesions.Parenchymal lesion and the pleural fluid at the same side was found in 59 patients,and both side was found in 8 patients.The total number of the parenchymal lesions and the pleural fluid at the same side was more than 2 of the 69 patients(2.9%) at the opposite side(P<0.05).There was no significant difference between the primary and secondary tuberculous pleurisy in age of onset,positive rate of PPD reaction and serum anti-tubercle antibody,protein level,cell population and lymphocyte proportion in pleural fluid,which were compared with chi-square test or t test(P>0.05).The positive rate of pleural fluid PCR-TB-DNA in these two groups was 81.3% and 16.7%,which was compared with chi-square test showed the difference being statistically significant between the two groups(P<0.05).89.5% of the all patients had received the short-course chemotherapy with the program of 2HRZE/4HR or 2HRE/4HR,the current treatment outcome was fine.There was no difference in the treatment outcome between the primary and secondary tuberculous pleurisy.Conclusion The relationship of the tuberculous pleurisy and the pulmonary parenchymal tuberculosis is close,so it is important to conjunct them together to the convergence case-management of tuberculosis.