Hong Yu Jin, Kim Hyung Woo, Kim Yun Seok, Kim Kyung Hoon, Shin Ah Young, Choi Joon Young, Ahn Joong Hyun, Kim Ju Sang, Ha Jick Hwan
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Thorac Dis. 2024 Aug 31;16(8):4904-4913. doi: 10.21037/jtd-24-143. Epub 2024 Aug 5.
Due to the pauci-bacillary nature of tuberculous (TB) pleurisy, clinical diagnosis is common, but microbiological confirmation is necessary to determine drug resistance. This study aimed to investigate the diagnostic yield of medical thoracoscopy (MT) for microbiological confirmation of TB pleurisy.
Medical records of patients diagnosed as TB pleurisy with microbiological or histologic evidence who underwent MT between May 2015 and July 2023 at Incheon St. Mary's Hospital were retrospectively reviewed. Sensitivities of microbiological results [acid-fast bacilli (AFB) culture or TB-polymerase chain reaction (PCR)] of pre-MT pleural fluid and those of targeted pleural washing fluid and pleural tissues obtained during MT were compared. Difference in sensitivity was verified with McNemar's test.
A total of 72 patients were enrolled. With pre-MT pleural fluid, sensitivities of AFB culture and TB PCR were 5.6% (4/72) and 1.4% (1/72), respectively. With targeted pleural washing fluid, sensitivities of AFB culture and TB-PCR were 23.6% (17/72) and 12.5% (9/72), respectively. With pleural tissues, sensitivities of AFB culture and TB-PCR were 18.1% (13/72) and 40.3% (29/72), respectively. MT showed an additional 27.8% [95% confidence interval (95% CI): 14.2-40.1%, P<0.001] of sensitivity gain in AFB culture and 40.3% (95% CI: 25.7-52.5%, P<0.001) of sensitivity gain in TB-PCR. With pleural washing, additional 19.4% (95% CI: 6.8-31.6%, P=0.001) of sensitivity gain in microbiological confirmation was identified, whereas additional 37.5% (95% CI: 22.6-50.2%, P<0.001) of sensitivity gain was identified with pleural biopsy.
With MT, 44.4% of additional sensitivity gain in microbiological confirmation of TB pleurisy was identified. This underscores the role of MT in the diagnosis of TB pleurisy.
由于结核性胸膜炎的少菌性，临床诊断较为常见，但确定耐药性需要微生物学确认。本研究旨在探讨内科胸腔镜检查（MT）对结核性胸膜炎微生物学确诊的诊断价值。
回顾性分析2015年5月至2023年7月在仁川圣母医院接受MT检查且有微生物学或组织学证据确诊为结核性胸膜炎患者的病历。比较MT术前胸腔积液、MT术中靶向胸腔冲洗液和胸膜组织微生物学检查结果[抗酸杆菌（AFB）培养或结核聚合酶链反应（PCR）]的敏感性。敏感性差异采用McNemar检验进行验证。
共纳入72例患者。MT术前胸腔积液中，AFB培养和结核PCR的敏感性分别为5.6%（4/72）和1.4%（1/72）。靶向胸腔冲洗液中，AFB培养和结核PCR的敏感性分别为23.6%（17/72）和12.5%（9/72）。胸膜组织中，AFB培养和结核PCR的敏感性分别为18.1%（13/72）和40.3%（29/72）。MT检查在AFB培养中的敏感性额外提高了27.8%[95%置信区间（95%CI）：14.2 - 40.1%，P<0.001]，在结核PCR中的敏感性额外提高了40.3%（95%CI：25.7 - 52.5%，P<0.001）。胸腔冲洗在微生物学确诊中的敏感性额外提高了19.4%（95%CI：6.8 - 31.6%，P = 0.001），而胸膜活检的敏感性额外提高了37.5%（95%CI：22.6 - 50.2%，P<0.001）。
通过MT检查，结核性胸膜炎微生物学确诊的敏感性额外提高了44.4%。这突出了MT在结核性胸膜炎诊断中的作用。
