超声引导下胸膜活检与内科胸腔镜在结核性胸膜炎诊断中的价值

doi:10.19983/j.issn.2096-8493.20210149

摘要/Abstract

摘要：

目的: 评价超声引导下胸膜活检(USPB)与内科胸腔镜胸膜活检(MTPB)诊断结核性胸膜炎的价值。方法: 以“结核性胸膜炎”为关键词在联众HIS系统电子病历数据库中进行检索,按照入组标准搜集到2014年1月至2019年12月重庆市涪陵中心医院呼吸与危重症医学科诊断为结核性胸膜炎且有病理活检的139例患者(43例行USPB,96例行MTPB),按照1∶1倾向性评分匹配(PSM)方法,USPB组和MTPB组各匹配成功31例患者。比较两组患者的取材成功率、病理诊断率、术后并发症及住院天数。结果: USPB组与MTPB组患者在结核病病理诊断率[74.2%(23/31)和64.5%(20/31)]、取材成功率[96.8%(30/31)和100.0%(31/31)],以及术后并发症的皮下血肿[9.7%(3/31)和0.0%(0/31)]、医源性气胸[0.0%(0/31)和9.7%(3/31)]等方面的差异均无统计学意义(χ²=2.018,P=0.402;χ²=1.016,P=1.000;χ²=3.153,P=0.238;χ²=3.153,P=0.238);且USPB组术后并发症中的皮下气肿、疼痛的发生率[分别为6.5%(2/31)和6.5%(2/31)]和住院时间[8(7,9)d]均低于或短于MTPB组[分别为35.5%(11/31)、58.1%(18/31)和11(8,12)d],差异均有统计学意义(χ²=7.784,P=0.011;χ²=18.895,P=0.000;Z=3.851,P=0.000)。结论: USPB和MTPB对结核性胸膜炎患者的取材成功率和病理诊断率均较高,而USPB在减轻术后皮下气肿、疼痛及缩短住院时间等方面要优于MTPB。

关键词: 超声检查,介入性, 结核,胸膜, 活组织检查, 胸腔镜检查, 倾向评分

Abstract:

Objective: To evaluate the diagnostic value of ultrasound-guided pleural biopsy (USPB) and medical thoracoscopic pleural biopsy (MTPB) in detecting tuberculous pleurisy. Methods: The keyword “tuberculous pleurisy” was searched in Lianzhong Electronic Medical Record Database. According to the inclusion criteria, electronic medical records of 139 patients (43 cases of USPB and 96 cases of MTPB) were collected. These patients were hospitalized in the Department of Respiratory and Critical Care Medicine, Chongqing Fuling Central Hospital from January 2014 to December 2019 and diagnosed with tuberculous pleurisy with biopsy pathology reports. Performing 1∶1 propensity score matching, 31 patients in USPB group and 31 patients MTPB group were successfully matched. We compared the biopsy sampling success rate, the pathological diagnosis rate, postoperative complications, and the length of hospital stays. Results: In USPB group and MTPB group, there were no significant differences in the pathological diagnosis rate (74.2% (23/31) and 64.5% (20/31), χ²=2.018, P=0.402), the sampling success rate (96.8% (30/31) and 100.0% (31/31), χ²=1.016, P=1.000), and postoperative complications of subcutaneous hematoma (9.7% (3/31) and 0.0% (0/31), χ²=3.153, P=0.238) and medical pneumothorax (0.0% (0/31) and 9.7% (3/31), χ²=3.153, P=0.238); The incidences of subcutaneous emphysema and pain in the USPB group (6.5% (2/31) and 6.5% (2/31), respectively) and average hospital stays (8 (7, 9) d) were lower or shorter than that in the MTPB group (35.5% (11/31), 58.1% (18/31), 11 (8, 12) d), the differences were statistically significant (χ²=7.784, P=0.011; χ²=18.895, P=0.000; Z=3.851, P=0.000). Conclusion: Both USPB and MTPB had high sampling success rate and pathological diagnosis rate in tuberculous pleurisy patients, while USPB was superior than MTPB in lowering postoperative subcutaneous emphysema, pain and shortening hospital stays.

Key words: Ultrasonography,interventional, Tuberculosis,pleural, Biopsy, Thoracoscopy, Propensity score

中图分类号:

陶韬, 吴鹏, 鲍晓利, 唐楠. 超声引导下胸膜活检与内科胸腔镜在结核性胸膜炎诊断中的价值[J]. 结核与肺部疾病杂志, 2022, 3(1): 9-13. doi: 10.19983/j.issn.2096-8493.20210149

TAO Tao, WU Peng, BAO Xiao-li, TANG Nan. The diagnostic value of ultrasound-guided pleural biopsy and medical thoracoscopy on detecting tuberculous pleurisy[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(1): 9-13. doi: 10.19983/j.issn.2096-8493.20210149

图/表 2

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表2

参考文献 20

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基线特征	USPB组(31例)	MTPB组(31例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	51(30,64)	48(31,65)	Z=0.106	0.916
性别[例(构成比,%)]			χ²=0.000	1.000
男性	21(67.7)	21(67.7)
女性	10(32.3)	10(32.3)
体质量指数($\bar{x}±s$)	21.9±3.5	23.0±3.4	t=1.281	0.205
结核病史[例(发生率,%)]	1(3.2)	1(3.2)	χ²=0.000	1.000
就诊病程[d,M(Q₁,Q₃)]	13(7,30)	20(10,40)	Z=0.976	0.333
合并症[例(发生率,%)]
尘肺	2(6.5)	1(3.2)	χ²=0.350	1.000
糖尿病	3(9.7)	3(9.7)	χ²=0.000	1.000
高血压	4(12.9)	4(12.9)	χ²=0.000	1.000
冠心病	1(3.2)	0(0.0)	χ²=1.016	1.000
血清白蛋白(g/L,$\bar{x}±s$)	35.2±4.5	34.8±4.9	t=0.279	0.781
胸腔积液
白细胞总数[×10⁹/L,M(Q₁,Q₃)]	1721.0(1232.0,3580.0)	2055.0(1196.0,3600.0)	Z=0.056	0.955
淋巴细胞比值[%,M(Q₁,Q₃)]	90.0(80.0,94.0)	89.0(78.0,90.0)	Z=0.785	0.432
白蛋白(g/L,$\bar{x}±s$)	29.6±4.1	29.0±4.7	t=0.586	0.560
腺苷脱氨酶 [U/L,M(Q₁,Q₃)]	47.2(36.4,62.9)	37.4(28.8,45.1)	Z=1.612	0.317
乳酸脱氢酶 [U/L,M(Q₁,Q₃)]	417.0(270.0,757.0)	319.0(249.0,475.0)	Z=1.739	0.082
分隔包裹[例(发生率,%)]	16(51.6)	13(41.9)	χ²=0.583	0.611
最大前后径[cm,M(Q₁,Q₃)]	5.0(4.5,7.2)	4.8(3.8,7.2)	Z=1.078	0.281
壁层胸膜厚度[mm,M(Q₁,Q₃)]	3.0(1.6,4.3)	3.0(2.0,5.0)	Z=0.776	0.438

观察指标	USPB组(31例)	MTPB组(31例)	统计检验值	P值
病理诊断[例(构成比,%)]			χ²=2.018	0.402
结核病	23(74.2)	20(64.5)
慢性炎症	7(22.6)	11(35.5)
骨骼肌组织	1(3.2)	0(0.0)
取材[例(成功率,%)]	30(96.8)	31(100.0)	χ²=1.016	1.000
壁层胸膜<3mm	9(69.2)^a	6(60.0)^b	χ²=0.212	0.685
壁层胸膜≥3mm	14(77.8)^c	14(66.7)^d	χ²=0.591	0.479
并发症[例(发生率,%)]
皮下气肿	2(6.5)	11(35.5)	χ²=7.784	0.011
疼痛	2(6.5)	18(58.1)	χ²=18.895	0.000
皮下血肿	3(9.7)	0(0.0)	χ²=3.153	0.238
医源性气胸	0(0.0)	3(9.7)	χ²=3.153	0.238
住院天数[d,M(Q₁,Q₃)]	8(7,9)	11(8,12)	Z=3.851	0.000