耐药结核性胸膜炎胸液生化及临床特点

发布时间：2018-03-02 05:14

本文关键词： 耐药结核胸膜炎　出处：《广东医学》2017年17期 　论文类型：期刊论文

【摘要】：目的对耐药结核性胸膜炎胸液生化指标及临床特点进行分析,探讨其临床特点。方法回顾性分析59例耐药结核性胸膜炎患者(耐药组),同时选择同期住院63例敏感结核性胸膜炎患者作为对照(敏感组)。对两组患者的人口学资料、全身多器官影像学特征、痰涂片找抗酸杆菌及培养、颈部淋巴结活检病理、脑脊液检查、大便培养结核分枝杆菌、外周血及胸液腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)、蛋白含量、白细胞及分类细胞计数、胸液吸收时间等指标进行分析。结果 (1)耐药组复治病例45例(76.27%),敏感组复治病例22例(34.92%)(X~2=21.04,P0.01)。(2)耐药组合并肺外结核13例(22.03%),敏感组为5例(7.94%)(P=0.02)。(3)胸膜厚度耐药组为(0.66±0.33)cm,敏感组为(0.44±0.22)cm(P0.01)。(4)耐药组胸液吸收时间为(9.39±8.56)d,敏感组为(4.73±3.69)d(P=0.000 1)。(5)耐药组患者胸液白细胞数目为(5 444.76±4 270.35)×10~6·L~(-1),较敏感组患者的(3 427.95±2 294.60)×10~6·L~(-1)明显升高,差异有统计学意义(P0.05),中性粒细胞及淋巴细胞数目均较敏感组升高(P0.05)。但分析耐药组中耐多药(MDR)与非MDR组患者间白细胞及分类细胞数目间比较差异无统计学意义(P0.05)。(6)两组患者胸液及外周血的ADA、LDH、蛋白含量等理化方面的比较,差异均无统计学意义(P0.05)。结论耐药结核性胸膜炎患者的临床特点以复治患者多见、多同时合并其他肺外结核、胸膜增厚明显及胸液吸收时间延长。胸液白细胞总数及淋巴细胞及中性粒细胞计数均较敏感组明显升高,考虑耐药胸膜炎多发展为结核性脓胸或合并感染。其他理化性质(ADA、LDH、蛋白含量)与敏感组对照,差异无统计学意义。胸液理化检测未能作为预测耐药结核性胸膜炎的早期预测指标,期盼更简便、快速、准确、经济的检测方法。
[Abstract]:Objective to analyze the biochemical indexes and clinical features of the pleural effusion of drug-resistant tuberculous pleurisy. Methods 59 patients with drug-resistant tuberculous pleurisy (drug-resistant group) and 63 patients with sensitive tuberculous pleurisy in the same period (sensitive group) were analyzed retrospectively. Imaging features of multiple organs of the whole body, sputum smear for acid-fast bacilli and culture, cervical lymph node biopsy and pathology, cerebrospinal fluid examination, stool culture of Mycobacterium tuberculosis, adenosine deaminase in peripheral blood and pleural fluid, adenosine deaminase (ADAA), lactate dehydrogenase (LDH), protein content, White blood cell and classified cell count, Results the time of pleural effusion absorption was analyzed. Results: in the drug resistant group, 45 cases were treated again (76.27%), 22 cases in the sensitive group (34. 922 cases) were treated, and 22 cases (34. 922 cases) were treated.) the combination of drug resistance and extrapulmonary tuberculosis was 22. 03cm. In the sensitive group, 5 cases were 7.94P0. 02P0. 02n. 3) the pleural thickness resistance group was 0. 66 卤0. 33 cm ~ (-1), the sensitive group was 0. 66 卤0. 33 cm ~ (-1), the sensitive group was 0. 06 卤0. 33 cm ~ (-1), and the sensitive group was 0. 66 卤0. 33 cm ~ (-1). The absorption time of pleural effusion in resistant group was 9.39 卤8.56 days, and that in sensitive group was 4.73 卤3.69 d ~ 0.000 ~ (-1).) the number of leucocyte in pleural effusion of drug resistant group was 5444.76 卤4 270.35 脳 10 6 路L ~ (-1), which was significantly higher than that in sensitive group (3 427.95 卤2 294.60) 脳 10 ~ (-6) 路L ~ (-1) 路L ~ (-1), and the number of leucocyte in pleural effusion of resistant group was 5444.76 卤4 270.35 脳 10 ~ (-6) 路L ~ (-1) 路L ~ (-1). The number of neutrophils and lymphocytes was significantly higher than that of the sensitive group, but there was no significant difference in the number of leukocytes and classified cells between the multidrug resistant group and the non-MDR group (P 0. 05 and P 0. 05%, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05). The physical and chemical aspects of ADA-LDH and protein content in pleural effusion and peripheral blood were compared. Conclusion the clinical features of patients with drug-resistant tuberculous pleurisy are more common in patients with relapsed pleurisy and more complicated with other extrapulmonary tuberculosis at the same time. The pleural thickening and the time of pleural effusion absorption were prolonged. The total number of leucocytes in pleural effusion and the count of lymphocytes and neutrophils in pleural effusion were significantly higher than those in the sensitive group. Drug resistant pleurisy was considered to develop into tuberculous empyema or coinfection. Other physical and chemical properties of Ada LDH (protein content) were compared with sensitive group. The physicochemical test of pleural effusion could not be used as an early predictor of drug-resistant tuberculous pleurisy, and was expected to be a simple, rapid, accurate and economical method.
【作者单位】：广州市胸科医院结核内科呼吸疾病国家重点实验室;
【基金】：国家卫生和计划生育委员会“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项(编号:2013ZX10003008) 广州市医药卫生科技重大项目(编号:20151A031002)
【分类号】：R521.7

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