胸膜结核瘤的临床特征及发病高危因素分析  

Analysis of the clinical features and high-risk factors of pleural tuberculoma

作　　者：高卫卫[1] 杨楠 尹春阳 曾谊 GAO Wei-wei;YANG Nan;YIN Chun-yang;ZENG Yi(Department of Tuberculosis,The Second Hospital of Nanjing,Nanjing University of Chinese Medicine,Nanjing Public Health Medical Center,Nanjing,Jiangsu 211131,China;Department of Cardiothoracic Surgery,General Hospital of Eastern Theater Command,Nanjing,Jiangsu 210002,China)

机构地区：[1]南京中医药大学附属南京医院,南京市第二医院,南京市公共卫生医疗中心结核科,江苏南京211131 [2]东部战区总医院心胸外科,江苏南京210002

出　　处：《临床肺科杂志》2023年第1期1-5,共5页Journal of Clinical Pulmonary Medicine

基　　金：江苏省卫生健康委员会课题(No.M2021073);南京市卫生科技发展专项资金一般项目(No.YKK18150)。

摘　　要：目的总结胸膜结核瘤(pleural tuberculoma,PTM)的临床特征,分析发病高危因素。方法回顾性分析2017年4月至2021年4月在南京市第二医院收治的56例PTM患者(病例组)资料,首先总结该56例患者的临床特征,其次与60例结核性胸膜炎(tuberculous pleurisy,TPE)(对照组)未合并PTM的病例对比,分析罹患PTM的高危因素。结果PTM的平均年龄为(29.04±6.95)岁,男女性别无差异。从诊断TPE起,PTM的平均发病时间为(4.29±2.34)个月。42例(75%)PTM位于下肺叶。病例组和对照组临床症状、基础疾病差异无显著性,在合并影像学比较中,病例组胸膜增厚更常见(44.64%vs 23.33%,P=0.02),同时胸水ADA(adenosine deaminase)水平高于对照组[(48.32±19.19)U/L vs(44.79±24.57)U/L,P=0.03]。在细胞免疫功能检测中,CD_(4)^(+)、CD_(8)^(+)T淋巴细胞绝对计数和CD_(4)^(+)/CD_(8)^(+)T比值2组差异无显著性(P>0.05),而病例组CD_(4)^(+)和CD_(8)^(+)T细胞的活化标志物Ki-67+的表达明显高于对照组(36.64±16.50 vs 7.19±5.23,P<0.001;33.31±15.94 vs 5.02±7.13,P<0.001)。结论PTM的发病年龄较轻,多见于TPE治疗半年内出现。罹患PTM的高危因素较复杂,胸膜增厚、ADA水平升高以及T淋巴细胞的免疫活化失调可能是PTM发病的高危因素。Objective To summarize the clinical features and analyze the high-risk factors of pleural tuberculoma(PTM).Methods The data of 56 patients with PTM(case group)admitted to the Second Hospital of Nanjing from April 2017 to April 2021 were analyzed retrospectively.The clinical characteristics of these 56 patients were summarized and then compared with 60 tuberculous pleurisies(TPE)without PTM(control group).Finally,the risk factors of PTM were analyzed.Results The mean age of PTM was(29.04±6.95)years,and there was no difference between males and females.The onset time of PTM from TPE diagnosis was(4.29±2.34)months.In 42 cases,PTM was located in the lower lobe(75%).There was no significant difference in clinical symptoms and underlying diseases between the case group and the control group.In the combined imaging comparison,pleural thickening was more common in the case group(44.64%vs 23.33%,P=0.02),while the level of adenosine deaminase(ADA)was higher than that of the control group(48.32±19.19 vs 44.79±24.57,P=0.03).In the cellular immune detection,the absolute counts of CD_(4)^(+)and CD_(8)^(+)T lymphocytes and the CD_(4)^(+)/CD_(8)^(+)T ratio were not significantly different between the two groups(P>0.05),while the activation markers of Ki-67+in the CD_(4)^(+)and CD_(8)^(+)T cells were significantly higher than that in the case group(36.64±16.50 vs 7.19±5.23,P<0.001;33.31±15.94 vs 5.02±7.13,P<0.001,respectively).Conclusion The age of onset of PTM is younger,and it is more likely to occur within six months of TPE treatment.The high-risk factors of PTM are complex.Pleural thickening increased ADA levels and dysregulated immune activation of T lymphocytes may be the high-risk factors of PTM.

关 键 词：胸膜结核瘤 结核性胸膜炎 腺苷脱氨酶 T淋巴细胞亚群 T淋巴细胞活化 

分 类 号：R52[医药卫生—内科学]