Ko Yousang, Song Jinkyung, Lee Suh-Young, Moon Jin-Wook, Mo Eun-Kyung, Park Ji Young, Kim Joo-Hee, Park Sunghoon, Hwang Yong Il, Jang Seung Hun, Jhun Byung Woo, Sim Yun Su, Shin Tae Rim, Kim Dong-Gyu, Hong Ji Young, Lee Chang Youl, Lee Myung Goo, Kim Cheol-Hong, Hyun In Gyu, Park Yong Bum
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Lung Research Institute of Hallym University College of Medicine, Chuncheon, Republic of Korea.
PLoS One. 2017 Jul 27;12(7):e0181798. doi: 10.1371/journal.pone.0181798. eCollection 2017.
Despite recent advances in methods for culturing Mycobacterium tuberculosis (MTB), the diagnostic yield of tuberculous pleural effusion (TBPE) remains unsatisfactory. However, unlike repeated sputum cultures of pulmonary tuberculosis, little is known about the role of repeated pleural cultures. We examined whether repeated pleural cultures are associated with increased MTB yield from TBPE.
A multicenter, retrospective cohort study was performed from January 2012 to December 2015 in South Korea. Patients were categorized into two groups: single- or repeated-culture groups. The diagnostic yield of MTB and clinical, radiological, and pleural fluid characteristics were evaluated.
Among the 329 patients with TBPE, 77 (23.4%) had repeated cultures and 252 (76.5%) had a single culture. Pleural culture was performed twice in all 77 patients in the repeated-culture group at a 1-day interval (inter-quartile range, 1.0-2.0). In the repeated-culture group, the yield of MTB from the first culture was 31.2%, which was similar to that in the single-culture group (31.2% vs. 29.8%, P = 0.887). However, the yield of MTB from the second culture (10/77, 13.0%) was more than that from the first. These results may be attributable to the insufficient immune clearance for MTB invasion into the pleural space between the first and second cultures. Over time, the yield of the second cultures decreased from 17.4% to 6.7% and then 6.3%. Finally, the overall yield of MTB in the repeated- and single-culture groups was 44.2% and 29.8% respectively (P < 0.001).
The results showed that repeated pleural cultures increased MTB yield from TBPE in human immunodeficiency virus-negative individuals. Furthermore, repeated cultures may increase yield when carried out for two consecutive days.
尽管近年来结核分枝杆菌（MTB）培养方法取得了进展，但结核性胸腔积液（TBPE）的诊断阳性率仍不尽人意。然而，与肺结核的多次痰培养不同，关于多次胸腔积液培养的作用知之甚少。我们研究了多次胸腔积液培养是否与TBPE中MTB检出率的提高相关。
2012年1月至2015年12月在韩国进行了一项多中心回顾性队列研究。患者分为两组：单次培养组或多次培养组。评估了MTB的诊断阳性率以及临床、影像学和胸腔积液特征。
在329例TBPE患者中，77例（23.4%）进行了多次培养，252例（76.5%）进行了单次培养。多次培养组的77例患者均间隔1天进行了两次胸腔积液培养（四分位间距为1.0 - 2.0）。在多次培养组中，第一次培养的MTB检出率为31.2%，与单次培养组相似（31.2%对29.8%，P = 0.887）。然而，第二次培养的MTB检出率（10/77，13.0%）高于第一次。这些结果可能归因于在第一次和第二次培养之间MTB侵入胸腔时免疫清除不足。随着时间推移，第二次培养的检出率从17.4%降至6.7%，然后为6.3%。最后，多次培养组和单次培养组MTB的总体检出率分别为44.2%和29.8%（P < 0.001）。
结果表明，多次胸腔积液培养可提高人类免疫缺陷病毒阴性个体TBPE中MTB的检出率。此外，连续两天进行多次培养可能会提高检出率。
