66例大量胸腔积液病因及诊断分析

The clinical analysis of 66 cases of massive pleural effusions

目的分析大量胸腔积液的病因和诊断方法。方法回顾性分析66例大量胸腔积液住院患者的临床资料。结果 66例大量胸腔积液病因的前5位依次为恶性肿瘤(56.1%),结核(24.2%),肺炎旁积液和脓胸(6.1%),肝硬化(4.5%),外伤(3.0%)。大量良性胸腔积液以40岁以下患者为主;恶性胸腔积液以60岁以上患者居多。66例大量胸腔积液癌胚抗原水平均为恶性组高于良性组(P<0.05),腺苷脱氨酶水平均为恶性组低于良性组(P<0.05)。结论大量胸腔积液主要病因是恶性肿瘤和结核,恶性肿瘤多见于60岁以上患者,结核病以40岁以下患者居多。胸腔积液癌胚抗原及腺苷脱氨酶含量鉴别良恶性胸腔积液有重要的价值。

Objective To report the most frequent causes of massive pleural effusions and analyze diagnosis.Methods Retrospective chart reviews were performed in patients having undergone thoracentesis between July 2007 and October 2009.Pleural effusions were deemed to be massive if they occurred in two thirds or more of one hemithorax.Results The most frequent causes of massive pleural effusions were malignancy（37;56.1%） followed by tuberculosis（16;24.2%）,parapneumonic effusion（4;6.1%）,cirrhosis of liver（3;4.5%）,and trauma（2;3.0%）.Malignant pleural effusion occurred mainly in patients over 60 years of age and Tuberculous pleural effusion in patients under 40 years of age.Compared with massive benign effusions,patients with massive malignant pleural effusions were more likely to have lower adenosine deaminase（ADA） activity and a higher Carcinoembryonic antigen（CEA） activity in their pleural fluids（P 0.05）.Conclusion The most common etiologies of massive pleural effusions are malignancy and tuberculosis,malignant tumors mainly in elderly patients,tuberculosis especially in young-aged patients.A high ADA content favors a tuberculous condition,while bloody effusions with a higher CEA and relatively lower ADA content favors malignancy.