恶性胸腔积液与结核性胸腔积液的诊断进展

Diagnostic Approaches to Tuberculosis and Malignant Pleural Effusions

胸腔积液分为渗出液和漏出液,而渗出性胸腔积液以结核性胸腔积液和恶性胸腔积液较为常见,这两种积液的治疗和预后差异很大。因此,及时而准确地找到胸腔积液的成因,才能使患者得到早期诊断和治疗,改善患者的预后。但目前,临床工作中两者的鉴别仍较为困难,因此需要从多方面入手。系统的询问病史、体格检查是判断患者是否存在胸腔积液的第一步,然后行X线、B超、CT检查判断积液的位置及积液量,后行胸腔穿刺检查明确积液的性质是渗出液或漏出液,结合肿瘤标志物、细胞因子检查进一步判断积液病因,最后通过胸腔穿刺胸膜活检、胸腔镜检查明确病理诊断而获得确诊,对于疑难性胸腔积液,PET/CT检查也具备较好的优势。本文就近年来恶性胸腔积液与结核性胸腔积液的鉴别诊断技术和方法进展作简要综述。

There are two kinds of pleural effusion,i.e.exudate and transudate,while the tuberculous and malignant pleural effusions are frequently found in exudate.The therapy and prognosis of the two kinds are quite different.The etiology must be defined exactly in order to receive good therapies.Nowadays,the differential diagnosis of the tuberculosis and malignant pleural effusions is still difficult.But the medical history and physical examination are the first step to identify the origin.Next,X-line,B-ultrasonic and CT-scan were used to judge the location and volume of the effusion.Finally,pathologic diagnosis was explicit by pleural biopsy and pleuroscopy.PET/CT is a good approach in the diagnosis of the tuberculosis and malignant pleural effusions.This article was aimed to review the research progress of diagnostic approaches to tuberculosis and malignant pleural effusions.