Abstract：
BACKGROUND: Patients with pulmonary tuberculosis may present with deterioration of pleural effusion during anti-tuberculosis therapy, referred to as a paradoxical response (PR), with some patients requiring additional intervention. However, PR may be confused with other differential diagnoses, and the predictive factors for recommending additional therapies are unknown. Therefore, this study aimed to reveal useful information for the diagnosis and intervention of PR.
METHODS: Data from human immunodeficiency virus-negative patients with tuberculous pleurisy (n = 210), including 184 patients with pre-existing pleural effusion and 26 patients with PR at Fukujuji Hospital, were retrospectively collected from January 2012 to December 2022 and compared. Furthermore, patients with PR were divided into the intervention group (n = 9) and the no intervention group (n = 17) and were compared.
RESULTS: Patients in the PR group had lower pleural lactate dehydrogenase (LDH) (median 177 IU/L vs. 383 IU/L, p < 0.001) and higher pleural glucose (median 122 mg/dL vs. 93 mg/dL, p < 0.001) levels than those in the preexisting pleural effusion group. Other pleural fluid data were not significantly different. Patients in the intervention group had a shorter duration from the initiation of anti-tuberculosis therapy to the development of PR than patients in the no intervention group (median 19.0 days [interquartile range (IQR): 18.0-22.0] vs. median 37.0 days [IQR: 28.0-58.0], p = 0.012).
CONCLUSIONS: This study demonstrates that, apart from lower pleural LDH and elevated pleural glucose levels, PR presents with similar features to preexisting pleural effusion and that patients who develop PR faster tend to require intervention.
METHODS: Data from human immunodeficiency virus-negative patients with tuberculous pleurisy (n = 210), including 184 patients with pre-existing pleural effusion and 26 patients with PR at Fukujuji Hospital, were retrospectively collected from January 2012 to December 2022 and compared. Furthermore, patients with PR were divided into the intervention group (n = 9) and the no intervention group (n = 17) and were compared.
RESULTS: Patients in the PR group had lower pleural lactate dehydrogenase (LDH) (median 177 IU/L vs. 383 IU/L, p < 0.001) and higher pleural glucose (median 122 mg/dL vs. 93 mg/dL, p < 0.001) levels than those in the preexisting pleural effusion group. Other pleural fluid data were not significantly different. Patients in the intervention group had a shorter duration from the initiation of anti-tuberculosis therapy to the development of PR than patients in the no intervention group (median 19.0 days [interquartile range (IQR): 18.0-22.0] vs. median 37.0 days [IQR: 28.0-58.0], p = 0.012).
CONCLUSIONS: This study demonstrates that, apart from lower pleural LDH and elevated pleural glucose levels, PR presents with similar features to preexisting pleural effusion and that patients who develop PR faster tend to require intervention.
摘要：
背景：肺结核患者在抗结核治疗期间可能出现胸腔积液恶化，被称为矛盾反应(PR)，一些患者需要额外的干预。然而,PR可能与其他鉴别诊断混淆，推荐额外治疗的预测因素未知.因此,本研究旨在揭示PR诊断和干预的有用信息。
方法：来自人类免疫缺陷病毒阴性结核性胸膜炎患者的数据（n=210），包括184例预先存在胸腔积液的患者和26例PR患者，回顾性收集了2012年1月至2022年12月的数据，并进行了比较。此外，将PR患者分为干预组（n=9）和无干预组（n=17），并进行比较。
结果：PR组患者胸膜乳酸脱氢酶（LDH）较低（中位数177IU/Lvs.383IU/L,p<0.001）和更高的胸膜葡萄糖（中位数122mg/dL与93mg/dL,p<0.001）水平高于先前存在的胸腔积液组。其他胸膜积液数据没有显着差异。干预组患者从开始抗结核治疗到发生PR的持续时间比无干预组患者短（中位数19.0天[四分位距（IQR）：18.0-22.0]vs.中位数37.0天[IQR：28.0-58.0]，p=0.012)。
结论：这项研究表明，除了胸膜LDH降低和胸膜葡萄糖水平升高外，PR具有与先前存在的胸腔积液相似的特征，并且发生PR更快的患者倾向于需要干预。
方法：来自人类免疫缺陷病毒阴性结核性胸膜炎患者的数据（n=210），包括184例预先存在胸腔积液的患者和26例PR患者，回顾性收集了2012年1月至2022年12月的数据，并进行了比较。此外，将PR患者分为干预组（n=9）和无干预组（n=17），并进行比较。
结果：PR组患者胸膜乳酸脱氢酶（LDH）较低（中位数177IU/Lvs.383IU/L,p<0.001）和更高的胸膜葡萄糖（中位数122mg/dL与93mg/dL,p<0.001）水平高于先前存在的胸腔积液组。其他胸膜积液数据没有显着差异。干预组患者从开始抗结核治疗到发生PR的持续时间比无干预组患者短（中位数19.0天[四分位距（IQR）：18.0-22.0]vs.中位数37.0天[IQR：28.0-58.0]，p=0.012)。
结论：这项研究表明，除了胸膜LDH降低和胸膜葡萄糖水平升高外，PR具有与先前存在的胸腔积液相似的特征，并且发生PR更快的患者倾向于需要干预。
