张良基+刘建南+林立+纪淑莹

[摘要] 目的 探讨闭式胸膜活检联合腺苷脱氨酶以及其他检查指标与胸腔镜诊断效率的在临床应用中的诊断价值比较。 方法 该研究方便选取了2013年8月—2015年8月收治的85例符合渗出液性质且胸水性质不明确的患者，分别对比了支气管刷检、胸水生化指标、闭式胸膜活检以及胸腔镜检查在结核性胸膜炎的诊断意义。结果 有67例患者确诊为结核性胸膜炎，18例患者确诊为恶性肿瘤；胸水ADA≥45 U/L诊断结核的敏感性为85.1%，特异性为77.8%；闭式胸膜活检敏感性为55.2%，特异性100.0%；而胸腔镜检查敏感性以及特异性分别为91.0%以及100.0%；然而闭式胸膜活检联合胸水ADA≥45U/L以及胸水淋巴细胞中性粒细胞比值≥0.75的敏感性达到77.6%，特异性为100.0%。结论 闭式胸膜活检联合胸水ADA以及胸水淋巴细胞中性粒细胞比值在结核性胸膜炎患者中有很高的诊断价值。该联合检查方法是相对无创、经济的且且有较高的诊断价值。

[关键词] 结核性胸膜炎；胸腔镜；闭式胸膜活检

[中图分类号] R121 [文献标识码] A [文章编号] 1674-0742（2017）05（a）-0028-03

[Abstract] Objective To compare the diagnostic value of closed pleural biopsy combined with adenosine deaminase and other indicators in the diagnosis of thoracoscopy. Methods Altogether， 85 patients with undiagnosed exudative pleural effusions between August 2013 to August 2015 were recruited for a prospective， direct comparison between bronchial wash， pleural fluid microbiology and biochemistry （adenosine deaminase （ADA） and cell count）， closed needle biopsy， and medical thoracoscopy. Results The final diagnosis was tuberculous pleurisy in 67 patients， malignancy in 18 patients. Pleural fluid ADA of ≥ 45 U/L was 85.1% sensitive and 77.8% specific. Sensitivity of closed needle biopsy and medical thoracoscopy was 55.2% and 91.0%，respectively. Both were 100.0% specific. Combined ADA， lymphocyte/neutrophil ratio of≥0.75 plus closed needle biopsy reached 77.6% sensitivity and 100.0% specificity. Conclusion A combination of pleural fluid adenosine deaminase， differential cell count and closed needle biopsy has a high diagnostic accuracy in undiagnosed exudative pleural effusions. This combined method is relatively noninvasive， economic， and has an important value in the diagnosis of tuberculous pleurisy.

[Key words] Tuberculous pleurisy；Medical thoracoscopy；Closed needle biopsy

结核作为发展中国家的常见病和多发病之一，对人群的危害巨大，而结核性胸膜炎是结核在肺外的典型表现形式。在发达国家以及地区，90%以上胸腔积液是由充血性心衰、恶性肿瘤、肺栓塞引起，而在发展中国家，结核性胸膜炎是胸腔积液常见的病因[1]。2011年世界范围内870万新发活动性结核以及140万病死率[2]。我国也是结核高负荷国家。对于结核性胸膜炎患者，临床医生常需要综合症状、体征、影像学、胸水化验及胸膜活检等来明确诊断。……