Department of Pulmonary and Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Tuberc. 2024 Oct;71(4):389-394. doi: 10.1016/j.ijtb.2023.06.013. Epub 2023 Jul 4.
Tubercular Pleural effusion (TBPE) is one of most common extrapulmonary tuberculosis. It can be difficult to diagnose due to low sensitivity of pleural fluid smear, culture and CBNAAT. Diagnosis of TBPE is then dependent on the level of pleural fluid Adenosine Deaminase (ADA). Thoracoscopic pleural biopsy gives definite diagnosis specially in Low Pleural fluid ADA setting.
This study was planned to find out the prevalence of tubercular etiology in patients of exudative pleural effusion with low ADA (ADA <40 IU/L).
A Prospective, observational study was carried out in a tertiary teaching institute in north India. Total 142 patients of pleural effusion with low ADA were enrolled. All patients underwent rigid thoracoscopy for confirmation of their diagnosis.
Out of 142 patients, male were 78 (55%) and female were 64 (45%). Mean age of patients were 57.4 years. Tuberculosis was diagnosed as a cause of effusion in 22 (15.5%) out of 142 patients. Majority of TBPE patients had pleural thickening as thoracoscopic finding. Mean ADA level in TBPE was 27.36 ± 11.6 as compared to 18.55 ± 9.02 in non tubercular pleural effusion patients and this difference was significant statistically (P- 0.002).
The diagnosis of patients having exudative, low ADA pleural effusion can be very easily confirmed by thoracoscopy guided pleural biopsy which has a very high diagnostic yield.
结核性胸腔积液（TBPE）是最常见的肺外结核之一。由于胸腔积液涂片、培养和 CBNAAT 的敏感性低，因此诊断较为困难。TBPE 的诊断依赖于胸腔液腺苷脱氨酶（ADA）水平。胸腔镜胸膜活检在低胸腔液 ADA 环境下可提供明确的诊断，特别是在这种情况下。
本研究旨在找出低 ADA（ADA<40IU/L）渗出性胸腔积液患者中结核病因的患病率。
在印度北部的一家三级教学医院进行了一项前瞻性观察性研究。共纳入 142 例 ADA 低的胸腔积液患者。所有患者均接受了硬性胸腔镜检查以确认其诊断。
在 142 例患者中，男性 78 例（55%），女性 64 例（45%）。患者的平均年龄为 57.4 岁。142 例患者中，22 例（15.5%）被诊断为结核性胸腔积液。大多数 TBPE 患者的胸腔镜检查发现胸腔增厚。TBPE 患者的平均 ADA 水平为 27.36±11.6，而非结核性胸腔积液患者的平均 ADA 水平为 18.55±9.02，差异具有统计学意义（P<0.002）。
通过胸腔镜引导的胸膜活检可以非常容易地确认 ADA 低的渗出性胸腔积液患者的诊断，这种方法具有很高的诊断率。
