| Background Tuberculosis(TB)is a chronic infectious disease caused by Mycobacterium tuberculosis(MTB)infection,which is mainly transmitted by the respiratory tract.According to the World Health Organization’s(WHO)Global Tuberculosis Report in 2022,the estimated number of new cases worldwide in 2021 is10.6 million,with an incidence rate of 134 per 100,000.(The estimated number of deaths was 1.413 million,with a mortality rate of 17 per 100,000.)China is one of the countries with a high burden of TB,with an estimated 780,000 new cases in 2021 and an incidence rate of 55/100,000.(At present,the global spread of the novel coronavirus pneumonia poses more challenges to the prevention and control of tuberculosis.)tuberculous pleural effusion(TPE)is common in patients with pulmonary tuberculosis,and its incidence is second only to that of lymph node tuberculosis in extrapulmonary tuberculosis.TPE is common in patients with pulmonary tuberculosis,and its incidence is second only to that of lymph node tuberculosis in extrapulmonary tuberculosis.During the development of TPE,fibrous connective tissue hyperplasia,pleural adhesion,and caseous necrosis gradually appeared.Finally,local lesions were absorbed and concentrated into caseous masses wrapped by fibrous tissue,namely pleural tuberculoma(PTM).PTM lacks specificity in clinical manifestations and is often difficult to distinguish from pleural mesothelioma,tuberculous spheres,lung tumors,and other diseases,which makes clinical diagnosis difficult and may prolong the course of tuberculosis.Therefore,an in-depth analysis of the influencing factors of PTM occurrence in TPE patients for early diagnosis and intervention has important clinical significance.Objective To analyze the influencing factors of PTM in TPE patients,and provide scientific basis for formulating treatment plans for patients.Methods Patients with TPE who received treatment in the outpatient and inpatient departments of the tuberculosis Department of Anhui Chest Hospital and Shanghai Pulmonary Hospital from December 2017 to June 2021 were selected as subjects.According to whether patients with PTM were concomitant,all subjects were divided into a case group(patients with PTM)and a control group(patients without PTM).The patient’s data were collected,including basic data,clinical manifestations(whether the patient was initially treated,the location of pleural effusion,the volume of pleural effusion,etc.),and laboratory test indicators,such as pleural effusion pathogenic examination results,nucleated cell count,adenosine deaminase(ADA),lactic dehydrogenase(LDH),protein content,etc.The above variables were analyzed by single-factor analysis,and the variables with statistical differences were included in the logistic regression model for multi-factor analysis.Results A total of 276 TPE patients aged(39.22 ± 18.12)years were included in this study,of which 84 patients(30.4%)had PTM.The results of the univariate analysis showed that there was a statistical difference between the case group and the control group in the amount of pleural effusion,the injection of urokinase,and the use of glucocorticoids(P < 0.05).Binary and multivariate Logistic regression analysis was carried out for the above variables.The results showed that the amount of pleural effusion(OR = 1.717,P = 0.003),whether urokinase was injected into the pleural cavity(OR = 0.246,P < 0.001),and whether glucocorticoid was used(OR = 0.371,P =0.001)were independent factors influencing the occurrence of PTM in TPE patients.Conclusion The incidence of PTM is higher in patients with TPE.Pleural effusion volume,pleural urokinase injection,and glucocorticoid use were independent factors influencing the occurrence of PTM in TPE patients.The occurrence of PTM should be vigilant for TPE patients with moderate or small pleural effusion.Rational use of urokinase and glucocorticoid on the basis of regular chemotherapy may reduce the occurrence of PTM. |
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