结核性胸膜炎胸膜粘连相关因素的研究

发布时间：2018-01-23 02:58

  本文关键词： 肺结核 结核性胸膜炎 内科胸腔镜 胸膜粘连　出处：《昆明医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：[目的]通过内科胸腔镜对结核性胸膜炎胸膜粘连严重程度进行分级,探讨影响结核性胸膜炎胸膜粘连程度的相关因素。[方法]选取昆明医科大学附属第一医院呼吸内2科2015年1月至2017年1月行局麻下内科胸腔镜确诊的结核性胸腔积液的70例病例资料,在内科胸腔镜检查下将患者胸膜粘连严重程度划分为6级。分析研究胸腔积液中PH值、腺苷脱氨酶、乳酸脱氢酶、总蛋白、红细胞、白细胞、单核细胞百分比、葡萄糖、氯离子,外周血白细胞、C反应蛋白以及患者年龄、患病时间等因素与结核性胸膜炎胸膜粘连程度的相关性。上述所有数据均采用SPSS17.0软件包进行统计学分析。计量资料若符合正态分布用均数±标准差(x±s)来表示,不符合正态分布用四分位数间距(P25、P50、P75)表示。计数资料以例数或率来表示。内科胸腔镜下结核性胸膜炎胸膜粘连程度的相关因素分析采用Kruskal-Wallis H检验、Spearman秩相关分析以及有序多分类Logistic回归分析。用F的显著性概率作为变量选入或剔除的标准,选入标准为≤0.05,剔除的标准为≥0.10,以P0.0,5为差异具有统计学意义。[结果]70例患者中胸膜粘连程度分级分别为0级11例(15.71%),1级 25 例(35.71%),2 级 16 例(22.86%),3 级 10 例(14.29%),4 级 8 例(11.43%),5级0例(0%)。胸腔积液PH的相关系数为-0.874,p值0.01,结果具有统计学差异。患者患病时间的相关系数为0.954,p值0.01,结果具有统计学差异。胸腔积液中腺苷脱氨酶、乳酸脱氢酶、总蛋白、红细胞、白细胞、单核细胞百分比、葡萄糖、氯离子,外周血白细胞、C反应蛋白以及患者年龄等因素的p值均大于0.05,均无统计学意义。[结论]在内科胸腔镜直视下可以对结核性胸腔积液胸膜粘连程度进行分级判断。在结核性胸膜炎中胸腔积液PH值接近正常对胸膜粘连程度是保护因素,而患者患病时间是胸膜粘连程度增加的危险因素,故胸腔积液pH值和患者患病时间有助于胸膜粘连程度的预测。而胸腔积液中的腺苷脱氨酶、乳酸脱氢酶、总蛋白、单核细胞百分比、葡萄糖,外周血白细胞、C反应蛋白及患者年龄等因素在预测胸膜粘连程度并没有太多价值。
[Abstract]:[Objective] to study the related factors influencing the degree of pleural adhesion in tuberculous pleurisy. [Methods: 70 cases of tuberculous pleural effusion diagnosed by thoracoscopy under local anesthesia from January 2015 to January 2017 in 2 departments of the first affiliated Hospital of Kunming Medical University were selected. The degree of pleural adhesion was divided into 6 grades by thoracoscopic examination. The PH value, adenosine deaminase, lactate dehydrogenase, total protein, erythrocyte and white blood cell in pleural effusion were analyzed and studied. Percentage of monocytes, glucose, chloride, peripheral leukocyte C reactive protein, and age of patients. All the above data were statistically analyzed by SPSS17.0 software package. If the measured data were in accordance with the mean 卤standard of normal distribution, the relationship between the time of the disease and the degree of pleural adhesion in tuberculous pleurisy was analyzed by SPSS17.0 software package. Difference (. X 卤s). It does not fit the normal distribution with the quartile spacing of P25 and P50. Kruskal-Wallis H test was used to analyze the factors related to the degree of pleural adhesion of tuberculous pleurisy under internal thoracoscopic examination. Spearman rank correlation analysis and ordered multiple classification Logistic regression analysis. Using the significant probability of F as the criterion of variable selection or elimination, the selection standard is 鈮，

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