背景:为了探索临床,病态,胸膜结核患者抗结核(TB)治疗期间胸膜肿块的细菌学特征。
方法:将新诊断的胸膜结核患者纳入研究。在整个治疗过程中对患者进行了随访,并记录临床资料。对胸膜肿块的经皮活检和手术组织进行组织学检查,并将样品送去PCR。收集并比较不同患者胸腔积液中的细胞因子和临床因素。
结果:共纳入122例胸膜结核患者,34.4%(42/122)在治疗期间显示新观察到的基于胸膜的肿块。12例患者在治疗过程中12±0.5个月进行了手术切除。根据手术观察,58.3%(7/12)位于胸膜,41.7%(5/12)位于肺实质。病理观察显示胸膜肿块分型为肉芽肿性炎症,纤维增生和坏死。结核分枝杆菌PCR阳性占57.1%(24/42)。任何一线抗结核药物耐药基因突变阳性的仅有9.5%(4/42)。除12例接受外科手术外,在12个月的疗程结束时,86.7%的患者(26/30)仍具有基于胸膜的肿块。胸膜基肿块的患者更年轻,胸膜较厚,胸膜粘连的比例较高,局部胸腔积液和残余胸腔积液,和更高水平的LDH,治疗期间胸腔积液中ADA和葡萄糖低于无胸膜基肿块发生的患者(所有Pcorr<0.05)。
结论:在约三分之一的胸膜结核患者中观察到胸膜性肿块。肿块位于肺或胸膜,分为三种病理类型。
BACKGROUND: To explored the clinical, pathological, and bacteriological characteristics of pleural-based masses occurred during anti-tuberculosis (TB) treatment in patients with pleural TB.
METHODS: Patients referred with newly diagnosed pleural TB were prospectively enrolled into the
study. Patients were followed up throughout the treatment, and clinical data were recorded. Percutaneous biopsy and surgical tissues from pleural-based masses were examined histologically and samples sent for PCR. Cytokines in the pleural effusions and clinical factors were collected and compared between different patients.
RESULTS: A total of 122 patients with pleural TB were enrolled, and 34.4% (42/122) displayed newly observed pleural-based mass during the treatment. Twelve cases underwent surgical resection at the 12 ± 0.5 months during the treatment course. Based on the surgical observation, 58.3% (7 /12) were located in pleura, 41.7% (5/12) were located in the lung parenchyma. Pathological observations showed that the pleural-based masses were typed as granulomatous inflammation, fibrous hyperplasia and necrosis. Mycobacterium tuberculosis PCR was positive in 57.1% of the cases (24/42). Any first-line anti-TB drug resistance gene mutations were positive in only 9.5% (4/42). Aside from 12 cases who underwent the surgical operation, 86.7% of the patients (26/30) still had a pleural-based mass at the end of 12 months treatment course. Patients with a pleural-based mass were younger, had a thicker pleural, a higher proportion of pleural adhesive, loculated pleural effusion and residual pleural effusion, and a higher level of LDH, ADA and lower glucose in pleural effusion than those without a pleural-based mass occurrence during the treatment (all Pcorr < 0.05).
CONCLUSIONS: Pleural-based masses were observed in about one-third of patients with pleural TB. The masses were in the lung or pleura and were divided into three pathological types.