结核性胸膜炎抗结核中发生类赫氏反应的危险因素

Paradoxical response in patients with pleural tuberculosis: a retrospective cohort study

目的研究结核性胸膜炎抗结核过程中发生类赫氏反应(paradoxical response,PR)的频率、临床特点及其危险因素。方法采用病历资料的回顾性列队研究。结果符合条件的527例结核性胸膜炎患者抗结核后80例发生PR(15%),发生PR的时间是抗结核后(54±38)d。发热(36%)和呼吸困难(30%)是PR的最常见症状。80例PR误诊为耐药结核26例(33%)、肺炎12例(15%)、肺癌7例(9%)。发生PR的危险因素是:年龄较年轻、低蛋白血症,以及胸液中白细胞总数较低、淋巴细胞比例较低和中性粒细胞比例较高(P<0.05)。结论在结核性胸膜炎患者抗结核中出现PR是常见的现象,且易误诊。年龄较轻、低蛋白血症、胸液中白细胞总数及其淋巴细胞比例降低和中性粒细胞比例升高是结核性胸膜炎发生PR的危险因素。

Objective To evaluate the incidence,clinical characteristics and risk factors of the development of paradoxical response（PR） in patients with pleural tuberculosis（TB）.Methods A retrospective cohort study including 527 patients with diagnosed pleural TB and received anti-TB treatment was carried out.Results PR was present in 80（15%） of 527 patients after（54±38） d following the initiation of treatment.Fever and dyspnoea were the most common symptoms associated with PR.Twenty-six（33%） patients were misdiagnosed as drug-resistant TB,12（15%） patients were misdiagnosed as pneumonia,and 7（9%） patients were misdiagnosed of lung cancer.The risk factors for PR were younger age,low serum albumin level,and low white blood cell（WBC） count,low proportion of lymphocyte and high proportion of polymorphonuclear neutrophil（PMN） in pleural fluid（all P0.05）.Conclusion PR is common in pleural TB treatment and is frequently misdiagnosed.Younger age,hypoalbuminemia,low WBC count,low proportion of lymphocyte and high proportion of PMN in pleural fluid are associated with the development of PR.