El Solh Ali A, Abdo Toufic, Pineda Lilibeth, Ramadan Fadi, Berbary Eileen
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York 14215, USA.
J Am Geriatr Soc. 2005 Nov;53(11):1957-60. doi: 10.1111/j.1532-5415.2005.00475.x.
To assess the long-term prognosis of older patients with idiopathic exudative lymphocytic pleural effusion.
Prospective observational study.
A university-affiliated tertiary care center.
Forty-seven consecutive patients (aged 74.9+/-5.4) with idiopathic exudative lymphocytic pleural effusion were enrolled over a 42-month period.
Baseline sociodemographic information, clinical data, and Charlson Comorbidity Index score were obtained. After an exhaustive examination, clinical evaluation and periodic chest radiographs were taken until one of the endpoints was met: complete resolution of the pleural effusion, death from all causes, or the end of the study period.
The mean follow-up period was 16.3+/-17.0 months. During the course of the study, complete resolution of the pleural effusion occurred in 17% of the patients, whereas it remained stable in 45%, and progressed in 38%. In seven cases, the cause of the effusion was established after an average of 84 days, and in another two, the diagnosis was made postmortem. Malignancy was documented in eight of the nine cases. Although the burden of comorbidities and cardiac function at baseline were similar in the three categories, the 3-year survival rate was 63%, 5%, and 0%, respectively. None of the patients developed active tuberculosis, although 15% had positive tuberculin test.
By categorizing the presence of idiopathic effusion into resolving, persistent, or progressive, this study may provide a more practical approach to the long-term prognosis of older patients with idiopathic exudative lymphocytic effusion who refuse or are considered too frail to undergo an invasive procedure.
评估老年特发性渗出性淋巴细胞性胸腔积液患者的长期预后。
前瞻性观察性研究。
一所大学附属的三级医疗中心。
在42个月的时间里，连续纳入了47例（年龄74.9±5.4岁）特发性渗出性淋巴细胞性胸腔积液患者。
获取基线社会人口学信息、临床数据和查尔森合并症指数评分。经过详尽检查后，进行临床评估并定期拍摄胸部X线片，直至达到以下终点之一：胸腔积液完全消退、各种原因导致的死亡或研究期结束。
平均随访期为16.3±17.0个月。在研究过程中，17%的患者胸腔积液完全消退，45%保持稳定，38%病情进展。7例患者平均84天后明确了胸腔积液病因，另外2例在死后确诊。9例中有8例记录为恶性肿瘤。尽管三类患者基线时的合并症负担和心功能相似，但3年生存率分别为63%、5%和0%。尽管15%的患者结核菌素试验呈阳性，但无一例发生活动性结核病。
通过将特发性胸腔积液的情况分为消退型、持续型或进展型，本研究可能为拒绝或被认为过于虚弱而无法接受侵入性检查的老年特发性渗出性淋巴细胞性胸腔积液患者长期预后提供更实用的方法。
