胸水间皮细胞计数在鉴别结核性和恶性胸腔积液中的价值

Value of mesothelitum-count in differential diagnosis of malignant and tubercular pleural effusion

目的 探讨胸腔积液中间皮细胞计数对鉴别结核性和恶性胸腔积液的临床价值。方法对７２例胸腔积液住院患者进行间皮细胞计数，其中确诊结核性胸腔积液４７例，确诊恶性胸腔积液２５例。常规胸腔穿刺，取胸液１００ｍｌ，１５００ｒｐｍ离心５ｍｉｎ，吸去上清液，采取底部沉淀物１～２滴滴在载物玻片上，采用推片法推成薄厚适当的涂片，湿固定，瑞氏染色１５～２０ｍｉｎ，用血细胞计数器计数２００个细胞，计算出间皮细胞所占比例。对结果进行统计学评价。结果４７例结核性胸腔积液中６例间皮细胞消失，３６例间皮细胞小于 ０．０５，５例大于 ０．０５；２５例恶性胸腔积液中 １６例间皮细胞占 ０．１５～０．５４，９例间皮细胞为大量。二者间皮细胞含量经ｔ检验，Ｐ＜０．０５。结论通过对７２例胸腔积液问皮细胞计数测定，结核性胸腔积液间皮细胞明显减少（＜０．０５）或消失。恶性胸腔积液中间皮细胞大于０．１５。二者之间存在显著性差异，对鉴别结核性和恶性胸腔积液有重要意义，值得推广。

Objective To evaluate the clinical value of mesothelium-count in the differential diagnosis of malignant and tubercular pleural effusion. Methods Seventy-two cases with definite diagnosis, 47 tuberculosis cases and 25 malignant tumour cases were selected in the study. Routine pleurocentesis on them was performed I or 2 drops of the sediment was obtained from 100ml eccentric pleural effusion at the speed of 1500 rpm. for 5 minutes and the supernatant was abandoned. The sediment into a picture with proper thickness on a slide teas male and it was fixed in wet condition. Wright Stain was performed on it,200 cells were counted out with a blood cell-counter. Then the rate of mesothelium was worked out, and the results were statisticly analysed. Results Among the 47 tuberculous cases, the mesothelium in the pleural effusion of 6 cses disappeared and the mesothelium ratios of 36 cases were less than 0.05; on the other hand, 16 of all 25 malignant diseases had the ratios of 0.15 to 0.54 and the effusion of others was full of mesothelia. t-test was used in the study (P< 0.05). Conclusions According to our reseach, we found the ratios of mesothelium in the tuberculous pleural effusion were significanttly lower (P<0.05) or even were zero; while, the ratios of malignant disease were significantly higher (P>0.15). There was difference evidently. We draw a conclusion that the mesothelium-count is valuable in wide use of differentiation of tubelculous and malignant pleural effusion.