超声引导下胸膜活检诊断结核性胸膜炎影响因素分析

Influencing factors of ultrasound guided cutting needle biopsy in diagnosis of tuberculous pleurisy

目的：探讨超声引导下切割式胸膜活检诊断结核性胸膜炎的影响因素。方法回顾分析2011年3月至2014年12月期间解放军309医院超声科经穿刺或随访确诊为结核性胸膜炎的患者200例（共进行206次穿刺）。探讨影响穿刺确诊率的因素。结果超声引导下切割式胸膜活检对结核性胸膜炎的确诊率为79．6％（164／206）。患者年龄、病程、胸膜厚度对穿刺确诊率的影响均有统计学意义（P＜0．05）。多因素logistic 回归分析显示，胸膜厚度≥3 mm、病程≥21 d和年龄≥40岁是影响穿刺活检确诊率的独立危险因素。胸膜厚度≥3 mm时，穿刺活检获得确诊的概率是胸膜厚度＜3 mm患者的近5倍（OR＝4．77，P＝0.001）；病程≥21 d的患者，穿刺获得确诊的概率是病程＜21 d患者的近4倍（OR＝3.65，P＝0.018）；年龄＜40岁者，其穿刺获得确诊的概率是年龄≥40岁者的近3倍（ OR＝2.69，P＝0．012）。结论超声引导下切割式胸膜活检安全、方便、经济，确诊率高。胸膜厚度、患者病程、年龄是影响穿刺确诊率的重要因素。

Objective To analyze the factors affecting the diagnostic yield of ultrasound guided cutting needle pleural biopsy for tuberculous pleurisy.Methods A total of 200 cases of tuberculous pleurisy confirmed by pleural biopsy （206 biopsies） or during follow up in our hospital from March 2011 to December 2014 were enrolled in this retrospective study .The influencing factors for the diagnostic yield of ultrasound guided pleural biopsy were analyzed .Results The overall diagnostic yield was 79.6% （164/206） for ultrasound guided cutting needle biopsy for pleural tuberculosis .Patient’s age, disease duration, and pleural thickness had statistical significances for the diagnostic yield of pleural biopsy （P〈0.05）.Multivariate logistic regression analysis showed that the pleural thickness ≥3 mm, duration ≥21 d, and age ≥40 years were independent risk factors for the diagnostic yield .For the patients with pleural thickness ≥3 mm, the diagnostic yield of aspiration biopsy was approximately 5 times higher than those with the thickness 〈3 mm （OR=4.77, P=0.001）.The yield was almost 4 times higher in the patients with duration ≥21 d than those with the duration 〈21 d （OR=3.65, P=0.018）, and was almost 3 times higher in the patients younger than 40 years old than those older （OR=2.69, P=0.012）.Conclusion Ultrasound guided cutting needle biopsy is a safe , simple, and economical approach with high diagnostic yield for tuberculous pleurisy .Age, disease duration and pleural thickness are the important factors to influence the diagnostic yield of pleural tuberculosis .