本文關(guān)鍵詞： 耐藥 結(jié)核 胸膜炎　出處：《廣東醫(yī)學(xué)》2017年17期 　論文類型：期刊論文

【摘要】：目的對耐藥結(jié)核性胸膜炎胸液生化指標(biāo)及臨床特點進(jìn)行分析,探討其臨床特點。方法回顧性分析59例耐藥結(jié)核性胸膜炎患者(耐藥組),同時選擇同期住院63例敏感結(jié)核性胸膜炎患者作為對照(敏感組)。對兩組患者的人口學(xué)資料、全身多器官影像學(xué)特征、痰涂片找抗酸桿菌及培養(yǎng)、頸部淋巴結(jié)活檢病理、腦脊液檢查、大便培養(yǎng)結(jié)核分枝桿菌、外周血及胸液腺苷脫氨酶(ADA)、乳酸脫氫酶(LDH)、蛋白含量、白細(xì)胞及分類細(xì)胞計數(shù)、胸液吸收時間等指標(biāo)進(jìn)行分析。結(jié)果 (1)耐藥組復(fù)治病例45例(76.27%),敏感組復(fù)治病例22例(34.92%)(X~2=21.04,P0.01)。(2)耐藥組合并肺外結(jié)核13例(22.03%),敏感組為5例(7.94%)(P=0.02)。(3)胸膜厚度耐藥組為(0.66±0.33)cm,敏感組為(0.44±0.22)cm(P0.01)。(4)耐藥組胸液吸收時間為(9.39±8.56)d,敏感組為(4.73±3.69)d(P=0.000 1)。(5)耐藥組患者胸液白細(xì)胞數(shù)目為(5 444.76±4 270.35)×10~6·L~(-1),較敏感組患者的(3 427.95±2 294.60)×10~6·L~(-1)明顯升高,差異有統(tǒng)計學(xué)意義(P0.05),中性粒細(xì)胞及淋巴細(xì)胞數(shù)目均較敏感組升高(P0.05)。但分析耐藥組中耐多藥(MDR)與非MDR組患者間白細(xì)胞及分類細(xì)胞數(shù)目間比較差異無統(tǒng)計學(xué)意義(P0.05)。(6)兩組患者胸液及外周血的ADA、LDH、蛋白含量等理化方面的比較,差異均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論耐藥結(jié)核性胸膜炎患者的臨床特點以復(fù)治患者多見、多同時合并其他肺外結(jié)核、胸膜增厚明顯及胸液吸收時間延長。胸液白細(xì)胞總數(shù)及淋巴細(xì)胞及中性粒細(xì)胞計數(shù)均較敏感組明顯升高,考慮耐藥胸膜炎多發(fā)展為結(jié)核性膿胸或合并感染。其他理化性質(zhì)(ADA、LDH、蛋白含量)與敏感組對照,差異無統(tǒng)計學(xué)意義。胸液理化檢測未能作為預(yù)測耐藥結(jié)核性胸膜炎的早期預(yù)測指標(biāo),期盼更簡便、快速、準(zhǔn)確、經(jīng)濟(jì)的檢測方法。
[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 鹵0. 33 cm ~ (-1), the sensitive group was 0. 66 鹵0. 33 cm ~ (-1), the sensitive group was 0. 06 鹵0. 33 cm ~ (-1), and the sensitive group was 0. 66 鹵0. 33 cm ~ (-1). The absorption time of pleural effusion in resistant group was 9.39 鹵8.56 days, and that in sensitive group was 4.73 鹵3.69 d ~ 0.000 ~ (-1).) the number of leucocyte in pleural effusion of drug resistant group was 5444.76 鹵4 270.35 脳 10 6 路L ~ (-1), which was significantly higher than that in sensitive group (3 427.95 鹵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 鹵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.
【作者單位】： 廣州市胸科醫(yī)院結(jié)核內(nèi)科呼吸疾病國家重點實驗室;
【基金】：國家衛(wèi)生和計劃生育委員會“艾滋病和病毒性肝炎等重大傳染病防治”科技重大專項(編號:2013ZX10003008) 廣州市醫(yī)藥衛(wèi)生科技重大項目(編號:20151A031002)
【分類號】：R521.7

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