| Objective:we analyze the clinical features of patients with tuberculous pleurisy in different age groups,in order to strengthen the clinical understanding of tuberculous pleurisy.Sum up the phenotype of tuberculous pleurisy by medical thoracoscopy,to explore the diagnostic ability of thoracoscopy in tuberculous pleurisy.Methods:A retrospective study was conducted on 129 patients diagnosed as tuberculous pleurisy underwent medical thoracoscopy in the department of respiratory medicine of the second affiliated hospital of chongqing medical university from February 2016 to August 2019.The results of clinical data,laboratory indicators and thoracoscopic phenotypes of the patients were analyzed by SPSS25.0 software.Results:1?The mean age of all patients in this study was 48.50 ± 17.74.Included 86 male patients,their average age was 48.85±16.41.There were43 female patients and their average age was 47.81 ± 17.56.The age difference between male patients and female patients is not statistically significant(P > 0.05).Among the patients in the youth,middle and old groups,the elderly group had the most chronic diseases and the longest course of disease(P < 0.05).In the elderly group,more bilateral pleural effusion was detected than in the middle-aged and young groups(P < 0.01).Comparing the clinical manifestations of the three groups,the incidence of cough,respiratory distress,fatigue,and night sweats among the three groups showed no statistical difference(P > 0.05).Compared with the old group,The Youth group had more fever and chest pain.Laboratory indicators: There were differences in the mean values of ADA,LDH,pleural fluid protein,and positive rates of PPD,T-spot,and pleural tuberculosis antibody(P <0.05).Between the three age groups the positive rates of blood tuberculosis antibody and ESR,mononuclear cell ratio showed no statistical significant difference(P> 0.05).2?Pathological phenotype of patients with tuberculous pleurisy under medical thoracoscopy:(1)Pleural congestion and edema with miliary nodules(49 cases,38.0%);(2)Pleural sporadic or multiple nodules(37cases in total,28.7%).(3)Pleural thickening,adhesions,or localized wrapping(43 cases,33.3%).Under medical thoracoscopy,compare with the miliary nodules group and scattered nodules or multiple nodules group,the pleural adhesion group had a longer course(P <0.01).At the same time,Spearman correlation analysis showed that there was a moderately positive correlation between thoracoscopic manifestations and disease course in patients with tuberculous pleurisy(R=0.562,P < 0.001).3?The pleural biopsy results of 129 patients with tuberculous pleurisy under medical thoracoscopy are as follows:(1)78 cases of tuberculous granulomatous inflammation(60.5%),(2)5 cases of caseous necrosis(3.9%),(3)37 cases of chronic inflammation or lymphocytic infiltration(28.7%),(4)9 cases of fibrous tissue or fibroplasia 6.9%).Compared with the pathologically positive group,the levels of pleural fluid protein and the positive rate of ADA were lower and the LDH level was higher in the pathologically negetive group(P<0.05).Between the two groups of patients,the level of ESR and the positive rates of pleural tuberculosis antibodies,and the positive rates of blood tuberculosis antibodies,and the positive rates of T-spot in two groups of patients showed no statistical difference(P>0.05).Conclusion:The main phenotype of tuberculous pleurisy under medical thoracoscopy is pleural congestion and edema with miliary nodules,and Pleural sporadic or multiple nodules,and Pleural thickening,adhesions,or localized wrapping.Medical thoracoscopy has higher diagnostic value for tuberculous pleurisy.Elderly patients have complex underlying diseases and a longer course of disease.Their clinical symptoms,laboratory indicators,and medical thoracoscopy performance are not as typical as those of young and middle-aged patients.In the absence of contraindications,we should perform thoracoscopic examination and pathological biopsy in time to reduce missed diagnosis and misdiagnosis. |
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