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[结核性胸腔积液中的胸膜增厚。相关因素]

[Pleural thickening in tuberculous pleural effusion. The associated factors].

作者信息

Soler J J, Gil Suay V, Cordero P, Perpiñá M, Martínez E, Sanchis J

机构信息

Servicio de Neumología, Hospital Universitario La Fe, Valencia.

出版信息

Arch Bronconeumol. 1995 Apr;31(4):157-61. doi: 10.1016/s0300-2896(15)30942-x.

Abstract

We aimed to determine which factors were related to the development of residual pleural thickening (RPT) after completion of prescribed treatment. Sixty-two patients with pleural tuberculosis (PTB) were assigned to 2 groups according to the presence or absence of RPT > 2 mm in the side and lower portion of a chest film after completion of prescribed treatment. No patient had been given corticoids. Thickening developed in 72.6%, more often in men (OR, 4.06; p = 0.034), in older patients (36 +/- 21 versus 27 +/- 12 years; p = 0.05). Smoking, size of effusion, duration of symptoms, encapsulation, PPD, pleural biopsy, bacteriology and pH, glucose, proteins and cholesterol in pleural fluids, as well as their respective pleura/serum coefficients, were similar in both groups. Pleural LDH (LDHp) and its pleura/serum coefficient (LDHp/LDHs) were 454.3 +/- 234.6 U/l and 3.21 +/- 1.67 U/l in the group with RPT and 306.0 +/- 137.2 U/l and 2.00 +/- 1.16 in the group with no sequelae (p = 0.004 and p = 0.016, respectively). Using 2.10 as the cutoff for LDHp/LDHs, sensitivity was 78.9% and specificity was 71.4%, giving a positive predictive value of 88.2% and a negative predictive value of 55.5%. We conclude that RPT a) is a frequent complication, b) is mainly found in men, c) is age-related and d) can be fairly safely predicted using 2.10 as the cutoff for LDHp/LDHs.

摘要

我们旨在确定哪些因素与规定治疗结束后残余胸膜增厚(RPT)的发生有关。62例胸膜结核(PTB)患者在规定治疗结束后,根据胸部X线片侧方和下部RPT>2mm的有无分为两组。所有患者均未使用过皮质类固醇。72.6%的患者出现增厚,男性更常见(比值比,4.06;p = 0.034),老年患者也更常见(36±21岁对27±12岁;p = 0.05)。两组患者在吸烟、胸腔积液大小、症状持续时间、包裹性积液、结核菌素试验(PPD)、胸膜活检、细菌学以及胸腔积液中的pH值、葡萄糖、蛋白质和胆固醇,以及它们各自的胸膜/血清系数方面相似。有RPT组的胸膜乳酸脱氢酶(LDHp)及其胸膜/血清系数(LDHp/LDHs)分别为454.3±234.6 U/l和3.21±1.67 U/l,无后遗症组分别为306.0±137.2 U/l和2.00±1.16(p分别为0.004和0.016)。以2.10作为LDHp/LDHs的临界值,敏感性为78.9%,特异性为71.4%,阳性预测值为88.2%,阴性预测值为55.5%。我们得出结论,RPT:a)是一种常见并发症,b)主要见于男性,c)与年龄有关,d)以2.10作为LDHp/LDHs的临界值可较为安全地进行预测。

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