结核性与恶性胸腔积液内科胸腔镜下特征比较及诊断相关因素分析

Comparison of characteristics of tuberculous and malignant pleural effusion under medical thoracoscopy and analysis of diagnostic factors

目的对比结核性与恶性胸腔积液内科胸腔镜下的特征及常见危险因素、临床表现的差异,为不明原因胸腔积液鉴别诊断提供依据。方法收集山西医科大学第一医院呼吸科2016年1月至2018年1月“胸腔积液待查”的90例患者临床资料,均因病因不明行内科胸腔镜下胸膜活检,按病理结果分为结核组与恶性组,对比分析2组镜下特征和常见危险因素、临床表现等指标。结果90例患者经胸腔镜和病理检查明确诊断85例,确诊率为944%,其中结核性胸腔积液40例,恶性胸腔积液36例。结核组镜下表现以胸膜充血水肿、广泛粘连、胸膜均匀一致小结节为主(χ^2值分别为23.175、7.361、6.064,P值均<005);恶性组镜下表现以胸膜增生增厚、大小不等结节、白斑样改变、肿块为主(χ^2值分别为23.095、8.717、11.577、5.127,P值均<005)。单因素回归分析:发热、体质量减轻对结核性胸腔积液诊断有意义;年龄>40岁、气促、病程>1个月、吸烟指数>400年支及血性胸腔积液对恶性胸腔积液的诊断有提示意义。多因素回归分析:发热和体质量减轻是结核性胸腔积液的特征性表现;年龄>40岁、病程>1个月、吸烟指数>400年支和血性胸腔积液对恶性胸腔积液诊断有较大价值。结论内科胸腔镜是确诊不明原因胸腔积液的有效检查方法,恶性胸腔积液和结核性胸腔积液是最常见的病因。危险因素、临床表现等指标及内镜下特征性表现对结核性与恶性胸腔积液鉴别有较大提示意义。

Objective To compare the difference of the morphologic features under medical thoracoscopy, common risk factors and clinical manifestations between tuberculous pleural effusion and malignant pleural effusion, and provide the basis for the differential diagnosis of unexplained pleural effusion. Methods The clinical date of 90 patients with unexplained pleural effusion in the Department of Respiratory Medicine, the First Hospital of Shanxi Medical University from January 2016 to January 2018 were collected. All patients underwent medical thoracoscopy pleural biopsy due to unknown etiology. According to the pathological results, they were divided into tuberculosis group and malignant group. The morphological features, common risk factors, clinical manifestations and other indicators of the two groups were compared and analyzed. Results Totally 85 of 90 patients were diagnosed by thoracoscopy and pathological examination, the rate of diagnosis was 94.4%, including 40 eases of tuberculous pleural effusion and 36 eases of malignant pleural effusion. In the tuberculosis group, the main microscopic manifestations were pleura hyperemia and edema, extensive adhesion, and uniform small nodules (X^2=23.175,7. 361,6.064, all P <0.05). Inrhe malignant group, the main microscopic manifestations were pleura hyperplasia and rhickcning, unequal sized nodules, leukoplakia, and masses ( X^2 = 23.095,8.717,11.577,5.127, all P <0.05).Univariate regression analysis showed that fever and weight loss were significant in the diagnosis of tuberculous pleural effusion, age >40 years old, shortness of breath, course >onc month, smoking index A 400 and bloody pleural effusion were significant in the diagnosis of malignant pleural effusion. Multivariate regression analysis showed that fever and weight loss were the characteristic manifestations of tuberculous pleural effusion, age > 40 years old, course one month, smoking index >400 and bloody pleural effusion were of great value in the diagnosis of malignant pleural effusion. Conclusions Medical thoracoscopy is an effective method for the diagnosis of unexplained pleural effusion. Malignant pleural effusion and tuberculous pleural effusion arc the most common causes. The risk factors, clinical manifestations and endoscopic characteristics arc of great significance in the differentiation of tuberculous and malignant pleural effusion.