老年结核性胸膜炎的胸腔镜下表现特点及临床特征  

Clinical features and manifestations under thoracoscopy in elderly tuberculous pleurisy patients

作　　者：田江华 涂军伟 童海芬 TIAN Jianghua;TU Junwei;TONG Haifen(Department of Respiratory Medicine,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,China.)

机构地区：[1]浙江大学医学院附属金华医院呼吸与危重症医学科二区,浙江金华321000 [2]浙江大学医学院附属金华医院乳甲外科,浙江金华321000

出　　处：《全科医学临床与教育》2023年第3期218-222,F0002,共6页Clinical Education of General Practice

基　　金：金华市科学技术局公益类项目(2017-4-006)。

摘　　要：目的观察老年结核性胸膜炎(TBP)患者的临床特征及内科胸腔镜下表现。方法回顾性分析TBP患者143例临床资料,按照年龄分为老年TBP患者51例、非老年TBP患者92例。分析两组的临床特点及胸腔镜下表现、病理类型。结果两组病程、发热、胸闷、胸痛表现及胸水总蛋白、葡萄糖水平、血清及胸水癌胚抗原(CEA)、乳酸脱氢酶(LDH)比较,差异均有统计学意义(t=-2.17,χ^(2)分别=11.22、-5.92、4.96,Z分别=-3.80、-3.41、-3.19、-4.29、-3.62,P均<0.05)。两组TBP患者胸腔镜下均有充血水肿型、粟粒样结节型、大小不等结节型、胸膜粘连肥厚型表现,老年TBP组胸腔镜下大小不等结节发生率高于非老年TBP组,差异有统计学意义(χ^(2)=4.06,P<0.05)。两组病理学类型及并发症发生率比较,差异均无统计学意义(χ^(2)分别=0.01、0.06、2.73、0.76、0.02,P均>0.05)。Pearson相关性分析显示,胸水腺苷脱氨酶(ADA)与年龄呈负相关(r=-0.24,P<0.05);病程与年龄呈正相关(r=0.22,P<0.05)。结论与非老年TBP相比,老年TBP患者的临床表现、实验室检查及胸腔镜下表现有其特异性,对于老年不明原因胸腔积液,应考虑行内科胸腔镜检查。Objective To explore the clinical characteristics and manifestations under medical thoracoscopy in elderly tuberculous pleurity(TBP)patients.Methods A total of 143 patients with TBP were retrospectively reviewed.Out of which,51 patients were elderly and 92 patients were non-aged.The clinical characteristics,thoracoscopic findings,and pa⁃thologies between two groups were analyzed.Results The differences were statistically significant in the duration of dis⁃ease,fever,chest tightness,chest pain,total protein in pleural fluid,glucose in pleural fluid,serum and pleural fluid car⁃cinoembryonic antigen(CEA)and lactate dehydrogenase(LDH)between the two groups(t=-2.17,χ^(2)=11.22,-5.92,4.96,Z=-3.80,-3.41,-3.19,-4.29,-3.62,P<0.05).TBP patients in both groups had signs of congestive edema,millet grain-like nodules,heterogeneously sized nodules,and adherent hypertrophic pleura on thoracoscopy,with a higher inci⁃dence of unequal sized nodules in the elderly TBP group than in the non-aged TBP group(χ^(2)=4.06,P<0.05).There was no significant difference between the two groups in pathological types and complications(χ^(2)=0.01,0.06,2.73,0.76,0.02,P>0.05).Pearson correlation analysis showed that pleural fluid adenosine deaminase(ADA)was negatively correlated with age(r=-0.24,P<0.05).The duration of disease was positively correlated with age(r=0.22,P<0.05).Conclusion Compared with the non-aged patients with TBP,the clinical manifestations,laboratory examination and thoracoscopy man⁃ifestations of the elderly TBP patients are specific.Medical thoracoscopy should be considered for the elderly unexplained pleural effusion.

关 键 词：老年 结核性胸膜炎 临床特征 内科胸腔镜 

分 类 号：R521.7[医药卫生—内科学]