恶性肿瘤患者胸腔积液结核杆菌DNA检测的临床意义

The Clinical Significance of Detection of Mycobacterium Tuberculosis DNA on Pleural Effusion of Malignant Tumor

目的探讨恶性肿瘤患者胸腔积液结核杆菌DNA检测的临床意义。方法选择2013年1月至2014年12月成都市第二人民医院住院的合并胸腔积液的恶性肿瘤患者121例,分别采用胸水涂片、胸水培养和结核杆菌DNA检测确诊结核性胸膜炎。采用logistic多因素回归分析了解恶性肿瘤患者发生结核性胸膜炎的危险因素。结果 121例合并胸腔积液的恶性肿瘤患者,胸水涂片阳性率4.96%,胸水培养阳性率12.40%,而结核杆菌DNA阳性率15.70%。在各种类型恶性肿瘤中,肺癌结核杆菌DNA阳性率最高,达20.00%。恶性肿瘤患者发生结核性胸膜炎的危险因素为盗汗和胸水高ADA水平,而与咳嗽、咯血、胸痛、发热、消瘦、贫血、性别、年龄、血性胸水、PPD试验、胸水LDH、CEA以及GLU水平无关。结论对合并胸腔积液的恶性肿瘤患者应常规行胸水结核杆菌DNA检测,以降低结核病的漏诊率,尤其应该注意合并盗汗和胸水ADA水平高的肿瘤患者。

Objective To explore the clinical significance of detection of Mycobacterium Tuberculosis DNA in pleural effusion of malignant tumor. Methods 121 cancer patients with pleural effusion in January of 2013 to December of 2014 were involved. Tuberculous pleurisy was diagnosed by pleural effusion smear, cuture and Mycobacterium Tuberculosis DNA, respectively. Futhermore, the risk factors of tuberculous pleurisy in malignant tumor patients were analysed by logistic regression analysis. Results In 121 cancer patients with pleural effusion, the positive rate by pleural effusion smear was 4. 96% ,and the positive rate by pleural effusion culture was 12.40%. But the positive rate by Mycobacterium Tuberculosis DNA was 15. 70%, far higher than the other two detection methods. Among the different types of cancers, the positive rate of Mycobacterium Tuberculosis DNA was 20.00 % in lung cancer patents, higher than other types of cancer. We also found that the risk factors of tuberculous pleurisy in malignant tumor were night sweating,high ADA in pleural effusion, without relation to cough, hemoptysis, chest pain, fever, emaciation, anemia, gender, age, bloody pleural effusion, PPD, LDH, CEA, and GLU in pleural effusion. Conclusion Mycobacteriurn Tuberculosis DNA should be detected in cancer patients with pleural effusion routinely, especially for those patients with night sweating,high ADA in pleural effusion.