Comparison Of Thoracic Features And Risk Factors Between Tuberculous And Malignant Pleural Effusions

Objective:Comparing the thoracic findings and risk factors of tuberculous and malignant pleural effusions,it can provide some help for the clinical diagnosis of unexplained pleural effusion.Methods:A retrospective approach was used to conduct the study.The study subjects were from January 2016 to January 2018,90 cases of inpatients in the Department of Respiratory and Critical Care Medicine of the First Hospital of Shanxi Medical University with“pleural effusion to be investigated”.The routine methods such as pleural effusion test and chest imaging were not clear.The cause was a thoracoscopic pleural biopsy.The following data were collected from the enrolled patients:age,gender,smoking index,duration of disease,clinical presentation,pleural fluid-test,pleural effusion volume,thoracoscopic features,pathological findings,intraoperative and postoperative complications.According to the pathological results,the patients were divided into two groups:tuberculous and malignant pleural effusion.The X~2test was used to compare the thoracoscopic features of the two groups.Age,gender,course of disease,fever,shortness of breath,chest pain,weight loss,bloody pleural effusion,plenty of pleural effusion and smoking.The situation was dependent variable,and logistic regression analysis of risk factors was performed in patients with tuberculous and malignant pleural effusions.The differences in risk factors between the two groups were compared.Results:1.The diagnosis of 90 patients with unexplained pleural effusion:85 cases were diagnosed,5 cases were not diagnosed,and the diagnosis rate was 94.4%.Of the 85patients diagnosed,49(54.4%)had benign pleural effusion and 36(40%)had malignant pleural effusion.pathological type of malignant pleural effusion:8 cases(8.9%)of pleural mesothelioma;28 cases(31.1%)of metastatic carcinoma,including 23 cases(25.6%)of lung cancer,1 case(1.1%)of lymphoma,1 case of breast cancer(1.1%),melanoma in 1 case(1.1%),choriocarcinoma in 1 case(1.1%),and bladder cancer in 1case(1.1%).There were 18 cases of lung adenocarcinoma(20.0%),2 cases of lung squamous cell carcinoma(2.2%),1 case of small cell lung cancer(1.1%),and 1 case of large cell lung cancer(1.1%).benign pleural effusion type:tuberculosis 40 cases(44.4%),chronic non-specific inflammation in 4 cases(4.4%),empyema in 3 cases(3.3%),chylothorax in 1 case(1.1%),pneumonia-like pleural effusion 1 case(1.1%).2.Tracheoscopic features and comparison of tuberculous and malignant pleural effusion:16 cases(77.5%)with pleural congestion and edema,16 cases(40.0%)with uniform pleural nodules or micronodules.Adhesion,separation and encapsulation in 21cases(52.5%),the incidence of the above three kinds of microscopic performance were higher than the malignant group(P<0.05);malignant group showed pleural hyperplasia,thickening,surface unevenness in 26 cases(72.22%),21 cases(58.3%)with different sizes of nodules,6 cases(16.7%)with lumps,13 cases(36.1%)with leukoplakia,and the incidence of the above four kinds of microscopic findings were higher than those of the tuberculosis group(All P<0.05).3.Tuberculous pleural effusion and malignant pleural effusion were compared under thoracic morphology.Thoracoscopy found pleural congestion,edema(77.5%)in tuberculous pleural effusion,diffusely distributed miliary small nodules in 16 cases(40%)and extensive adhesions,separation and entrapment in 21 cases(52.5%)was the main manifestation,the incidence rate was higher than patients with malignant pleural disease(P<0.05);malignant pleural effusion with pleural hyperplasia,thickening,surface irregularities in 26 cases(72.22%),diffuse multiple sizes There were 21 cases(58.3%)with nodules,6 cases(16.7%)with various forms of lumps,and 13 cases(36.1%)with white spot-like changes and fibrin-like material coverage.The incidence rate was higher than tuberculous pleurisy.Group(P<0.05).4.Logistic multivariate regression analysis of risk factors for tuberculosis and malignant pleural effusions:fever and weight loss were risk factors for tuberculosis pleural effusion(X~2=5.723,P=0.017,OR=0.086,95%CI=0.011)~0.642;X~2=4.783,P=0.029,OR=0.086,95%CI=0.010-0.775).Age greater than 40 years,duration>1month,smoking index>400 and bloody pleural effusion are risk factors for malignant pleural effusion(X~2=6.669,P=0.010,OR=17.021,95%CI=1.980~146.297;X~2=6.342),P=0.012,OR=17.898,95%CI=1.896~168.985;X~2=3.918,P=0.048,OR=7.688,95%CI=1.020~57.945;X~2=5.160,P=0.023,OR=20.300,95%CI=1.511~272.656).5.Complications and management of medical thoracoscopic examination:postoperative wound pain in 9 cases(10%),intraoperative biopsy site bleeding in 8 cases,postoperative wound oozing in 1 case,postoperative hypothermia in 5 cases,and recurrent pulmonary edema in 1 case.All patients had different degrees of pneumothorax after surgery.One case of hemorrhage at the biopsy site was treated with drugs to stop bleeding;the re-expanded pulmonary edema was treated with dexamethasone combined with metoclopramide hydrochloride for symptomatic treatment;the pneumothorax indwelling thoracic closed drainage tube was drained as scheduled,and the rest were not treated specially.conclusion:1.Internal medicine thoracoscopic surgery is an effective method for the diagnosis of unexplained pleural effusion,with high diagnostic rate and few adverse reactions.Malignant pleural effusion and tuberculous pleural effusion are the most common causes.Malignant pleural effusion is common in lung cancer pleural metastasis and pleural mesothelioma.2.Thoracic pleural edema,extensive adhesions,and uniform small nodules or micronodules suggest a tuberculous pleural effusion;pleural irregular hyperplasia,lumps,leukoplakia and squamous nodules are more prone to malignancy Pleural effusion,but the final diagnosis is still based on pathological results.3.Clinically associated with fever and weight loss should focus on tuberculous pleural effusion;age>40 years,smoking index>400,chronic disease course(>1 month)and bloody pleural effusion prone to malignant pleural effusion.