中国防痨杂志2017，Vol.39Issue(11)：1157-1161,5.DOI:10.3969/j.issn.1000-6621.2017.11.002
内科胸腔镜活检在结核性胸膜炎诊断中的临床价值
Clinical value of pleural biopsy using medical thoracoscopy in diagnosis of tuberculous pleurisy
摘要
Abstract
Objective To investigate the clinical value of pleural biopsy using medical thoracoscopy in diagno sis of tuberculous pleurisy.Methods The clinical data were analyzed retrospectively in 55 patients with suspected tuberculous pleural effusions and histological morphology was examined for formalin-fixed,paraffimembedded pleu ral tissues stained by hematoxylin and eosin (HE).Acid-fast bacilli and fluorescent quantitative polymerase chain reaction (FQ-PCR) were perforrned in 36 patients with suspected tuberculous pleurisy and irnmunohistochemistry was performed to diagnose and differentiate diagnosis in 19 patients with suspected malignant pleurisy.Results Of 55 cases with pleural effusions,36 (65.5 ％) patients were diagnosed with tuberculous pleurisy by pleural biopsy.The appearances of tuberculous pleurisy showed pleural thickening in 23 (63.9％) cases,different size of pleural nodules in 7 (19.4 ％) cas es,diffuse military nodules in 12 (33.3 ％) cases,fibrinous exudate,hyperemic or pleural adhesion in 26 (72.2 ％) cases under thoracoscopy.The pathological features of tuberculous pleurisy showed that granulomas containing langhans giant cell in 27 (75.0％) cases,caseous necrosis in 15 (41.7％) cases,only fibroinflammatory exudation in 6 (16.7％) cases,and only caseous necrosis in 3 (8.3％) cases.Of 32 cases with tuberculous pleurisy detected with ADA,18 cases (56.2％) showed ADA level over than 40 U/L.Acid-fast bacilli was positive in 11(30.6％) cases.Mycobacterium tuberculosis DNA was detected in 25 (69.4％) pleural tissue samples by FQ-PCR.Totally,19 cases were confirmed with malignant pleurisy by histologic examination including metastatic lung adeno carcinoma in 9 (16.4％) cases,mesothelioma in 8 (14.5％) cases,metastatic squamous-cell carcinoma in 1 (1.8％)case,and metastatic renal collecting duct carcinoma in 1 (1.8％) case.Conclusion Medical thoracoscopy and histological examination have important value in the diagnosis and differential diagnosis of tuberculous pleurisy.关键词
胸腔镜检查/胸腔积液/结核,胸膜/诊断,鉴别/有效性研究Key words
Thoracoscopy/Pleural effusion/Tuberculosis, pleural/Diagnosis, differential/Validation studies引用本文复制引用
董宇杰,杨新婷,闫东杰,张莉,李琨,车南颖,陈效友..内科胸腔镜活检在结核性胸膜炎诊断中的临床价值[J].中国防痨杂志,2017,39(11):1157-1161,5.基金项目
国家自然科学基金(81572077) （81572077）
北京市医院管理局临床医学发展专项(XMLX201506) （XMLX201506）
北京市卫生系统高层次卫生技术人才培养计划(2014-03-082,2014-03-083) （2014-03-082,2014-03-083）
首都卫生发展科研专项(2014-4-2161) （2014-4-2161）
北京市医管局登峰计划(DFL20151501) （DFL20151501）
北京市科学技术委员会重点项目(D14117005214003) （D14117005214003）
