结核性胸腔积液与恶性胸腔积液患者危险因素的对比研究

The comparative study of risk factors between patients with tuberculous pleural effusion and malignant pleural effusion

目的探索结核性胸腔积液与恶性胸腔积液患者危险因素的不同,为临床个体化诊治胸腔积液提供依据。方法连续性入选2006年1月至2012年12月间在青岛市中心医院呼吸科确诊为结核性胸腔积液或恶性胸腔积液的患者264例,其中结核性胸腔积液患者147例,恶性胸腔积液患者117例。调查并比较两组患者的年龄、性别、合并糖尿病、呼吸系统基础疾病史、经济状况、工作劳累感、群体居住行为、运动量不足、进食规律性、睡眠时间、心理应激程度、吸烟指数、类似病家族史等13个项目,采用logistic单因素和多因素回归分析,对结核性胸腔积液和恶性胸腔积液的发病独立危险因素进行对比,以说明两者危险因素的差异。结果单因素分析结果显示,结核性胸腔积液与恶性胸腔积液两组数据比较,合并糖尿病[15.0%(22/147)vs 6.8%(8/117),χ2=4.571,P=0.034]、经济状况差[38.1%(56/147)vs 29.9%(35/117),χ2=5.103,P=0.028]、有群体居住行为[29.3%(43/147)vs 9.4%(11/117),χ2=4.977,P=0.030],是结核性胸腔积液的危险因素;年龄>40岁[45.6%(67/147)vs 78.6%(92/117),χ2=4.752,P=0.032]、心理应激程度高[15.0%(22/147)vs 33.3%(39/117),χ2=6.031,P=0.017]、吸烟指数>400[25.9%(38/147)vs 32.5%(38/117),χ2=5.228,P=0.024]和有类似病家族史[9.5%(14/147)vs 34.2%(40/117),χ2=3.976,P=0.046]是恶性胸腔积液的危险因素。在排除其他因素影响后,合并糖尿病(χ2=5.391,P=0.027,OR=2.457,95%CI:5.051～1.773)和群体居住行为(χ2=5.491,P=0.022,OR=3.636,95%CI:6.494～2.584)仍然是结核性胸腔积液的危险因素;年龄>40岁(χ2=5.364,P=0.022,OR=2.323,95%CI:1.197～2.588)和有类似病家族史(χ2=5.897,P=0.021,OR=3.080,95%CI:2.233～4.018)是恶性胸腔积液危险因素。结论胸腔积液患者如果合并糖尿病或有群体居住行为更容易出现结核性胸腔积液,如果年龄>40岁或有类似病家族史,更容易出现恶性胸腔积液。

Objective To explore the differences of risk factors between patients with tuberculous pleural effusion and malignant pleural effusion and to provide basis of clinical diagnosis of pleural effusion.Methods We consecutively enrolled the 264 patients who was diagnosed of tuberculous pleural effusion or malignant pleural effusion in January 2006—December 2012 in respiratory department of the 2nd Affiliated Hospital of Qingdao University,of which 147 cases were tuberculous pleural effusion and 117 cases were malignant pleural effusion.We compared the patients＇ age,gender,whether with diabetes,respiratory disease history,the economic status,work tired feeling,group living behavior,lack of exercise,eating regularity,sleep time,psychological stress,smoking index,disease family history between the 2 groups.The univariate and multivariate logistic regression analysis was made on the risk factor for morbidity of tuberculous pleural effusion and malignant pleural effusion.Results The univariate results showed that diabetes mellitus[15.0%（22/147） vs 6.8%（8/117）,χ^24.571,P=0.034],low economic status[38.1%（56/147） vs 29.9%（35/117）,χ^25.103,P=0.028],with group living behavior[29.3%（43/147） vs 9.4%（11/117）,χ^24.977,P=0.030],are risk factors for tuberculous pleural effusion;Age 40 years[45.6%（67/147） vs 78.6%（92/117）,χ^24.752,P=0.032],high degree of psychological stress[15.0%（22/147） vs 33.3%（39/117）,χ^26.031,P=0.017],smoking index 400[25.9%（38/147） vs 32.5%（38/117）,χ^25.228,P=0.024],and with family history of similar disease[9.5%（14/147） vs 34.2%（40/117）,χ^23.976,P=0.046] are risk factors for malignant pleural effusion.After the exclusion of other factors,diabetes mellitus（χ^25.391,P=0.027,OR=2.457,95%CI： 5.051-1.773） and group living behavior（χ^25.491,P=0.022,OR=3.636,95%CI： 6.494-2.584） are still risk factors for tuberculous pleural effusion;aged 40 years（χ^25.364,P=0.022,OR=2.323,95%CI： 1.197-2.588） and with family history of similar disease（χ^25.897,P=0.021,OR=3.080,95%CI： 2.233-4.018） are risk factors for malignant pleural effusions.Conclusion Pleural effusion in patients with diabetes mellitus or with group living behaviors are more prone to have tuberculous pleural effusion,and if patients age more than 40 years or have a family history of similar di-sease,are more prone to have malignant pleural effusion.