Multivariate Analysis Of Tuberculous Pleurisy Thoracoscopic Biopsy-Pathological Negative

Objective:Explore the independent risk factors and clinical features of pathologically negative tuberculous pleurisy,deepen the understanding of pathologically negative tuberculous pleurisy,and guide the clinical interpretation of the pathological results of thoracoscopy.Methods :A retrospective study was conducted on 185 patients diagnosed as tuberculous pleurisy by medical thoracoscopy in our hospital from February 2016 to September 2020.According to whether the biopsy results were granulomatous inflammation,they were divided into pathologically negative group and pathologically positive group.The results of baseline data,clinical symptoms,laboratory indicators,and thoracoscopic subtypes of the patients between the two groups were analyzed by SPSS23.0software.Results :1.A total of 185 patients with tuberculous pleurisy were enrolled,including 122 males and 63 females,with an average age of 48.48±17.18 years old.Among them,41 were in the pathological negative group and144 were in the pathological positive group.The positive rate of thoracoscopic biopsy-pathology was 77.8%.There was no statistically significant difference in age and gender composition between the two groups.In the pathology-negative group,there were more alcoholics.The incidence of bilateral pleural effusion,multiple serous effusion was higher than that of the pathology-positive group.At the same time,the use of anti-tuberculosis drugs was more,all the differences were Statistical significance(P<0.05).The pathology-negative group had less cough and chest pain than the pathology-positive group,and the difference was statistically significant(P<0.05).In terms of routine and biochemical indicators of pleural effusion,the ratio of mononuclear cells and albumin levels in the pathologically negative group were lower than those in the pathologically positive group;in terms of blood routine and biochemical indicators,the level of fibrinogen in the pathologically negative group was higher,but albumin The level is lower than that of the pathological positive group,and the difference is statistically significant(P<0.05).2.Logistic regression analysis found that chest pain [Exp(B)=0.304,95%CI(0.107,0.866),P=0.026],combined with multiple serous effusion[Exp(B)=15.182,95%CI(1.518,151.855),P=0.021],anti-tuberculosis treatment [Exp(B)=5.214,95%CI(1.378,19.729),P=0.015],pleural effusion single nuclear ratio [Exp(B)=1.051,95%CI(1.019,1.084),P=0.002] is an independent influencing factor of non-granulomatous inflammation in patients with tuberculous pleurisy.Conclusion:In patients who are clinically diagnosed as tuberculous pleurisy,if such patients have been treated with anti-tuberculosis in the past,have no obvious clinical symptoms of chest pain,have multiple serous effusions,or have a low mononuclear cell ratio in pleural effusions.In practice,it is found that the results of thoracoscopy in such patients are mostly not typical granulomatous inflammation.The pathological results of thoracoscopy need to be interpreted reasonably,and patients with these related factors need to be strictly guided before making a decision on thoracoscopy.