结核性胸膜炎胸膜组织病理学检查及胸水结核分枝杆菌和腺苷脱氨酶活性检测的价值

Value of biopsy of tuberculous pleurisy and activity of Mycobacterium tuberculosis and adenosine deaminase in pleural effusion

目的 探讨应用胸膜病理组织学检测及胸水结核分枝杆菌和腺苷脱氨酶（ADA）活性检测结核性胸膜炎的价值.方法 选取30例结核性胸膜炎患者为研究对象,另选取非结核性胸膜炎引发胸腔积液患者30例为对照,两组患者均接受胸膜腔穿刺,取胸腔积液检测及胸膜组织活检.结果 一次活检病理检查确诊结核性胸膜炎18例（60.0％）,6例（20.0％）经再次胸膜组织活检确诊.胸膜组织病理学检查诊断符合率80.0％.结核性胸膜炎患者胸腔积液ADA活性（71.3±16.2）,ADA阳性率86.7％,TB-PCR阳性率为66.7％,显著高于对照组的（19.3 ±10.8）、3.3％、20.0％（t=23.42,x2=14.64,x2=8.65,均0＜0.05）.应用胸膜组织病理学检查及胸腔积液TB-PCR和ADA联合检测,对结核性胸膜炎诊断符合率为100.0％,显著高于各种方法单独应用（x2 =4.36、5.87、4.16,P＜0.05）.结论 应用胸膜组织病理学检查及胸腔积液TB-PCR和ADA联合检测,可以提高结核性胸膜炎诊断符合率.

Objective To investigate the histological detection and pleural effusion Mycobacterium tuberculosis and adenosine deaminase（ADA） activity assay value of tuberculous pleurisy.Methods 30 patients with tuberculous pleurisy were chosen as the research object,and selected another non-tuberculous pleurisy caused by pleural effusion in 30 patients as controls,patients received pleural puncture,take detect pleural effusion and pleural biopsy.Results A biopsy to confirm the diagnosis of tuberculous pleurisy in 18 cases,compared to 60.0 percent.Six cases of patients with pleural tissue biopsy again,a ratio of 20.0%.Pleural histopathology diagnosis was 80.0%.Patients with tuberculous pleurisy pleural effusion ADA average activity was （71.3 ± 16.2）,which was significantly higher than that of the control [（19.3 ± 10.8）] （t =23.42,P 〈 0.05）.ADA-positive patients with tuberculous pleurisy was 86.7%,which was significantly higher than 3.3% of the confrol group （x2 =14.64,P 〈 0.05）.Patients with tuberculous pleurisy pleural effusion TB-PCR positive rate was 6 6.7 %,significantly higher than the 2 0.0 % （x2 =8.6 5,P 〈0.05）.Application and histopathological examination of pleural effusion TB-PCR and ADA joint detection,diagnosis of tuberculous pleurisy was 100.0%,significantly higher than that of various methods alone（x2 =4.36,5.87,4.16,all P 〈 0.05）.Conclusion Histopathological examination of pleural effusion TB-PCR and ADA joint detection can improve diagnostic accuracy of tuberculous pleurisy.