Ferrer J
Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Eur Respir J. 1997 Apr;10(4):942-7.
Tuberculous pleural effusions occur in up to 30% of patients with tuberculosis. It appears that the percentage of patients with pleural effusion is comparable in human immunodeficiency virus (HIV)-positive and HIV-negative individuals, although there is some evidence that HIV-positive patients with CD4+ counts <200 cells x mL(-1) are less likely to have a tuberculous pleural effusion. There has recently been a considerable amount of research dealing with the immunology of tuberculous pleurisy. At present, we have more evidence that activated cells produce cytokines in a complex pleural response to mycobacteria. Intramacrophage elimination of mycobacterial antigens, granuloma formation, direct neutralization of mycobacteria and fibrosis are the main facets of this reaction. With respect to diagnosis, adenosine deaminase and interferon gamma in pleural fluid have proved to be useful tests. Detection of mycobacterial deoxyribonucleic acid (DNA) by the polymerase chain reaction is an interesting test, but its usefulness in the diagnosis of tuberculous pleurisy needs further confirmation. The recommended treatment for tuberculous pleurisy is a 6 month regimen of isoniazid and rifampicin, with the addition of pyrazinamide in the first 2 months. HIV patients may require a longer treatment. The general use of corticosteroids is not recommended at this time, but they can be used in individuals who are markedly symptomatic.
结核性胸腔积液见于高达30%的结核病患者。人类免疫缺陷病毒（HIV）阳性和HIV阴性个体中胸腔积液患者的比例似乎相当，不过有一些证据表明，CD4+细胞计数<200个/毫升的HIV阳性患者发生结核性胸腔积液的可能性较小。最近有大量关于结核性胸膜炎免疫学的研究。目前，我们有更多证据表明，活化细胞在对分枝杆菌的复杂胸膜反应中产生细胞因子。巨噬细胞内对分枝杆菌抗原的清除、肉芽肿形成、对分枝杆菌的直接中和以及纤维化是该反应的主要方面。关于诊断，胸腔积液中的腺苷脱氨酶和干扰素γ已被证明是有用的检测方法。通过聚合酶链反应检测分枝杆菌脱氧核糖核酸（DNA）是一项有趣的检测，但它在结核性胸膜炎诊断中的实用性需要进一步证实。结核性胸膜炎的推荐治疗方案是异烟肼和利福平6个月疗程，头2个月加用吡嗪酰胺。HIV患者可能需要更长疗程的治疗。目前不建议常规使用皮质类固醇，但对于症状明显的个体可以使用。
