恶性胸膜间皮瘤合并肺结核/结核性胸腔积液的临床特征分析  

Clinical characteristics of malignant pleural mesothelioma combined with pulmonary tuberculosis/tuberculous pleural effusion

作　　者：阳苑[1] 胡明明[1] 鲁葆华[1] 张同梅[1] 聂文娟[1] 李宝兰[1] Yang Yuan;Hu Mingming;Lu Baohua;Zhang Tongmei;Nie Wenjuan;Li Baolan(Department of General,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京胸科医院综合科,101149

出　　处：《国际呼吸杂志》2021年第2期133-137,共5页International Journal of Respiration

基　　金：首都临床特色应用与成果推广(Z171100001017038);北京市通州区科技计划项目(KJ2020CX010)。

摘　　要：目的分析恶性胸膜间皮瘤(MPM)合并肺结核/结核性胸腔积液(TPE)患者的临床特征,以加强对该类疾病的认识,减少误诊误治。方法收集首都医科大学附属北京胸科医院2012年2月至2020年2月MPM并肺结核/TPE患者病例资料14例,回顾性分析其临床症状、体征、实验室检查,胸部影像特征等,以总结其特点。结果剧烈且进行性加重的胸痛为MPM合并肺结核/TPE患者突出症状;胸腔积液以黄色渗出液多见,且易出现在TPE同侧。血清/胸腔积液中肿瘤标志物癌胚抗原阴性,细胞角蛋白21-1片段升高。胸部CT提示MPM患侧胸膜呈不规则环形增厚,结节状增厚,掩盖了原有结核性胸膜炎征象。12例患者经CT引导下胸膜活检确诊MPM,2例经胸腔镜检查确诊MPM。结论MPM合并肺结核/TPE的患者临床表现及胸腔积液常规检查缺乏特异性。剧烈而进行性加重的胸痛症状、癌胚抗原阴性,细胞角蛋白21-1片段升高、胸膜增厚明显均提示应警惕MPM诊断;胸腔积液中腺苷脱氨酶增高提示TPE。及时行CT引导下胸膜穿刺活检术或胸腔镜检查是明确诊断的有效策略。Objective To analyze the clinical characteristics of patients with malignant pleural mesothelioma(MPM)accompany with pulmonary tuberculosis/tuberculous pleural effusion(TPE),in order to avoid misdiagnosis and mistreatment.Methods The clinical data of 14 cases with MPM and pulmonary tuberculosis/TPE in the Beijing Chest Hospital,Capital Medical University)from February 2012 to February 2020 and analyzed their clinical symptoms,physical signs,laboratory examinations and chest imaging characteristics retrospectively.Results Severe and gradually aggravated chest pain was the prominent symptom of the coexistence of two diseases.The pleural effusion of MPM patients was mostly yellow exudative,and it was easy to appear on the same side of TPE.The tumor markers in serum/pleural effusion showed carcinoembryonic antigen negative and Cytokeratin fragment 21-1 ascended.Chest CT showed irregular annular thickening and nodular thickening of pleura in affected pleura of MPM patients,which covered up the original signs of tuberculous pleurisy.A total of 12 patients were diagnosed with MPM by CT guided pleural biopsy,and 2 patients were diagnosed by thoracoscopy.Conclusions The clinical manifestations and pleural effusion of patients with pulmonary tuberculosis/TPE combined with MPM are lack of specificity.Prominent and progressive chest pain,carcinoembryonic antigen negative,Cytokeratin fragment 21-1 elevated,thickening of pleura are signs of MPM.Elevated adenosine deaminase in pleural effusion suggested tuberculous pleurisy.CT guided lung puncture and thoracoscopy are effective strategy for the diagnosis.

关 键 词：诊断 鉴别 恶性胸膜间皮瘤 结核 肺 结核性胸腔积液 

分 类 号：R734.3[医药卫生—肿瘤] R521[医药卫生—临床医学] R561.3