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| Clinical characteristics and treatment analysis of suspected tuberculous pleural effusion |
| PENG Bo1, HUANG Jianliang2, XIA Mingkai2, HUANG Jiale2, LEI Mingsheng2,3 |
1. Medical College of Jishou University, Jishou 416000, China;
2. Zhangjiajie Hospital Affiliated to Hunan Normal University, Zhangjiajie 427000, China;
3. Jishou University Zhangjiajie College, Zhangjiajie 427000, China |
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Abstract Objective Summary of clinical characteristics and treatment of suspected tuberculous pleural effusion (TPE), providing a basis for accurate clinical diagnosis and personalized treatment. Methods This study analyzed clinical data from 24 cases of confirmed TPE and 63 cases of suspected TPE patients at Zhangjiajie People’s Hospital between January 2021 and December 2022. The data included general information, clinical manifestations, auxiliary inspection, treatment measures, and complications. etc. This study aims to compare the TPE group and the suspected TPE group to determine if there are any differences. Results A total of 87 patients were included in this study, with a median age of 49.0(29.0, 65.0) years in the TPE group and 58.0(44.0, 74.0) years in the suspected TPE group. The median age of the suspected TPE group was significantly higher than that of the TPE group, the TPE group exhibited higher levels of lactate dehydrogenase (LDH) at 586.0(346.8, 1016.3) U/L and adenylate dehydrogenase (ADA) at 45.5(31.5, 54.2) IU/L. The median LDH/ADA ratio was 11.6(8.07, 19.4). Yellow turbidity is the most common appearance of pleural effusion, and there is a difference in the appearance of pleural effusion between the TPE group and the suspected TPE group; The most common clinical manifestations included cough, dyspnea, chest pain, fever, and night sweats. All patients tested positive for mucin qualitative analysis; 56(64.4%) patients were positive for tuberculosis antibodies; 85(97.7%) patients with Mycobacterium tuberculosis γ- Positive interferon test, After suspected empirical anti tuberculosis treatment in the TPE group, 61(96.8%) patients had reduced pleural effusion, with 2(3.2%) forming encapsulated effusion. After anti tuberculosis treatment in the TPE group, 23(95.8%) patients had reduced pleural effusion, with 1(4.2%) forming encapsulated effusion. There was no significant difference between the two groups. Conclusion Fully understanding the clinical characteristics of suspected tuberculous pleural effusion, combined with empirical anti tuberculosis treatment, can help improve diagnostic accuracy.
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Received: 03 September 2023
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[1] HARDING E.WHO global progress report on tuberculosis elimination[J]. Lancet Respir Med, 2020, 8(1): 19.
[2] BOONSARNGSUK, V, MANGKANG, K, SANTANIRAND P.Prevalence and risk factors of drug-resistant extrapulmonary tuberculosis[J]. Clin Respir J, 2018, 12(6): 2101-2109.
[3] BAGCCHI S.WHO's Global Tuberculosis Report 2022[J]. Lancet Microbe, 2023, 4(1): e20.
[4] GOPI A, MADHAVAN SM, SHARMA SK, et al.Diagnosis and treatment oftuberculous pleural effusion in 2006[J]. Chest, 2007, 131(3): 880-889.
[5] VON GROOTE-BIDLINGMAIER F, KOEGELENBERG CF, BOLLIGER CT, et al. The yield of different pleural fluid volumes for Mycobacterium tuberculosis culture[J]. Thorax, 2013, 68(3): 290-291.
[6] 肺结核诊断标准(WS 288—2017)[J]. 新发传染病电子杂志, 2018, 3(01): 59-61.
[7] 何玉麟, 许传军. 肺结核影像诊断标准[J]. 新发传染病电子杂志, 2021, 6(01): 1-6.
[8] 黄毅, 左蕾, 崔文琦. 结核性胸膜炎超声诊断、分型及介入治疗专家共识 (2022年版)[J]. 中国防痨杂志, 2022, 44(09): 880-897.
[9] 陈效友. 重视结核性胸膜炎的综合诊断[J]. 中国防痨杂志, 2020, 42(11): 1137-1141.
[10] VORSTER MJ, ALLWOOD BW, DIACON AH, et al.Tuberculous pleural effusions: advances and controversies[J]. J Thorac Dis, 2015, 7(6): 981-991.
[11] DRENT M, COBBEN N A, HENDERSON, R F, et al.Usefulness of lactate dehydrogenase and its isoenzymes as indicators of lung damage or inflammation[J]. Eur Respir J, 1996, 9(8): 1736-1742.
[12] HO C Y, TSAI Y H, CHANGC C, et al.The role of pleural fluid lactatedehydrogenase-to-adenosine deaminase ratio in differentiating the etiology ofpleural effusions[J]. Chin J Physiol, 2022, 65(3): 105-108.
[13] KIM S B, SHIN B, LEE J H, et al.Pleural fluid ADA activity in tuberculous pleurisy can be low in elderly, critically ill patients with multi-organ-failure[J]. BMC Pulm Med, 2020, 20(1): 13.
[14] 尉艳霞, 童朝晖, 龚娟妮, 等. 腺苷脱氨酶诊断结核性胸膜炎价值的再评价[J]. 中国结核和呼吸杂志, 2010, 33(4): 273-275.
[15] 《临床结核病学 (第2版) 》出版发行[J]临床结核病学 (第2版) 》出版发行[J]. 中国防痨杂志, 2019, 41(07): 737.
[16] 邹泽琛, 王勇生. 胸腔积液MNC/LEU比值、ADA与外周血PLR对结核性胸腔积液的诊断价值[J]. 中国现代医药杂志, 2023, 25(01): 28-32.
[17] 李娜. 老年结核性胸膜炎临床特点与内科诊治分析[J]. 中国农村卫生, 2021, 13(02): 48+47. |
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2024, Vol. 21 
