内科胸腔镜下结核性胸腔积液胸膜粘连程度分级及影响因素分析*

Grading of pleural adhesion of tuberculous pleural effusion in medical thoracoscopy and analysis of related factors*

摘要:

目的   通过内科胸腔镜对结核性胸腔积液胸膜粘连严重程度进行分级，探讨影响胸膜粘连程度的相关因素。方法   选取99例局麻下内科胸腔镜确诊的结核性胸腔积液患者，在内科胸腔镜下将患者胸膜粘连严重程度分为6级。以胸膜粘连程度作为因变量，以患者相关因素及一般情况作为自变量，包括患者胸水pH值、总蛋白、乳酸脱氢酶（LDH）、腺苷脱氨酶（ADA）、葡萄糖（Glu)、单核细胞百分比，及患者年龄、患病时间与外周血白细胞计数（WBC）、C-反应蛋白（CRP）、纯蛋白衍生物（PPD）试验，采用有序多分类Logistic回归分析法研究胸膜粘连程度的影响因素。结果   99例患者中胸膜粘连程度分级分别为0级12例（12.12%），1级33例（33.34%），2级21例（21.21%），3级21例（21.21%），4级12例（12.12%），5级0例（0.00%）。患者胸膜粘连程度与胸水pH值和患者患病时间两个因素有相关性（P <0.05）。结论   对内科胸腔镜下结核性胸腔积液胸膜粘连程度可以进行分级判断，胸水中pH值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，故胸水pH值和患者患病时间有助于胸膜粘连程度的预测。

Abstract:

Objective Grading pleural adhesion of tuberculous pleural effusion by medical thoracoscopy, then explore the possible influential factors. Methods 99 patients with tuberculous pleural effusion were diagnosed by local anesthesia-assisted thoracoscopy, and the pleural adhesion  was divided into 6 levels. With degree of plueral adhesion as dependent variable and general conditions including pH, total protein, lactate dehydrogenase, adenosine deaminase, glucose, percentage of mononuclear cells, age, duration, peripheral blood white blood cell count, C- reactive protein, pure protein derivatives test as independent variables, then screened the influencing factors with logistic regression analysis of ordered multi classification. Results The degree of pleural adhesion in 99 patients was grade 0 (n = 12), grade 1 (n = 33), grade 2 (n = 21), grade 3 (n = 21), grade 4 (n = 12), grade 5 (n = 0), respectively. Pleural adhesion was significantly related to pH of pleural effusion and duration of disease(P < 0.05). Conclusions The pleural adhesion of tuberculous pleural effusion could be classified by medical thoracoscopy. The value of pH in pleural effusion was the protective factor, and the duration of disease was the risk factor for the increase in the degree of pleural adhesion. Therefore, pH and duration are helpful to the prediction of the degree of pleural adhesion.