Antoniskis D, Amin K, Barnes P F
Department of Medicine, University of Southern California Medical Center, Los Angeles 90033.
Am J Med. 1990 Oct;89(4):447-50. doi: 10.1016/0002-9343(90)90374-m.
The purpose of this study was to determine the frequency with which tuberculous pleuritis is a manifestation of reactivation tuberculosis and to compare the clinical manifestations of reactivation tuberculous pleuritis with "classic" tuberculous pleuritis, in which chest roentgenograms reveal no parenchymal infiltrates.
We evaluated the medical records of 59 patients in whom tuberculous pleuritis was confirmed by histologic findings or mycobacterial culture. Twenty-seven patients (46%) had typical chest roentgenographic findings of reactivation tuberculosis, whereas 32 (54%) had classic tuberculous pleuritis. The clinical and laboratory features of these two groups were compared.
Symptoms were more prolonged and pleural fluid glucose and lactate dehydrogenase concentrations were more markedly abnormal in patients with reactivation pleuritis than in those with classic pleuritis, suggesting a more chronic inflammatory process in the former group. Compared with patients with classic tuberculous pleuritis, those with reactivation pleuritis had a lower frequency of reactive tuberculin skin tests (61% versus 88%) and granulomatous pleural inflammation (25% versus 72%), but a higher bacillary burden, manifest by a higher frequency of positive sputum smears for acid-fast bacilli (50% versus 0%) and positive mycobacterial cultures from sputum (60% versus 23%) and pleural fluid (91% versus 66%).
In contrast to previous reports, tuberculous pleuritis was a manifestation of reactivation tuberculosis in 46% (27 of 59) of patients. Tuberculous pleuritis is a more chronic process in patients with reactivation disease than in those with classic pleuritis. The lower frequency of reactive tuberculin skin tests and granuloma formation, combined with the higher bacillary burden in patients with reactivation pleuritis, suggest that these patients mount a less effective immune response to Mycobacterium tuberculosis infection than do patients with the classic form of tuberculous pleuritis.
本研究的目的是确定结核性胸膜炎作为复发性结核病表现形式的发生频率，并比较复发性结核性胸膜炎与“典型”结核性胸膜炎的临床表现，后者胸部X线片无实质浸润。
我们评估了59例经组织学检查结果或分枝杆菌培养确诊为结核性胸膜炎患者的病历。27例（46%）患者有复发性结核病典型的胸部X线表现，而32例（54%）有典型的结核性胸膜炎。比较了这两组患者的临床和实验室特征。
与典型胸膜炎患者相比，复发性胸膜炎患者的症状持续时间更长，胸腔积液葡萄糖和乳酸脱氢酶浓度异常更明显，提示前一组炎症过程更慢性。与典型结核性胸膜炎患者相比，复发性胸膜炎患者结核菌素皮肤试验反应阳性率较低（61%对88%），肉芽肿性胸膜炎症发生率较低（25%对72%），但细菌负荷较高，表现为痰涂片抗酸杆菌阳性率较高（50%对0%）、痰和胸腔积液分枝杆菌培养阳性率较高（60%对23%和91%对66%）。
与既往报道不同，46%（59例中的27例）患者的结核性胸膜炎是复发性结核病的表现。与典型胸膜炎患者相比，复发性疾病患者的结核性胸膜炎是一个更慢性的过程。复发性胸膜炎患者结核菌素皮肤试验反应阳性率和肉芽肿形成率较低，同时细菌负荷较高，提示这些患者对结核分枝杆菌感染的免疫反应不如典型结核性胸膜炎患者有效。
