Clinical and pathological differences between polymorphonuclear-rich and lymphocyte-rich tuberculous pleural effusion
OBJECTIVE: Analysis of the occurrence factors and disease characteristics of tuberculous (TB) pleural effusion (TPE) dominated by neutrophils. METHODS: We retrospectively analyzed the clinical data of 304 patients with two types of TB pleurisy. The clinical, laboratory, and pathological features of...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2020-01-01
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| Series: | Annals of Thoracic Medicine |
| Subjects: | |
| Online Access: | http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2020;volume=15;issue=2;spage=76;epage=83;aulast=Zhao |
| _version_ | 1818600387579478016 |
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| author | Tingting Zhao Bing Chen Yurong Xu Yiqing Qu |
| author_facet | Tingting Zhao Bing Chen Yurong Xu Yiqing Qu |
| author_sort | Tingting Zhao |
| collection | DOAJ |
| description | OBJECTIVE: Analysis of the occurrence factors and disease characteristics of tuberculous (TB) pleural effusion (TPE) dominated by neutrophils.
METHODS: We retrospectively analyzed the clinical data of 304 patients with two types of TB pleurisy. The clinical, laboratory, and pathological features of TB pleurisy separately dominated by lymphocytes and neutrophils were analyzed.
RESULTS: Neutrophil-predominant effusion was observed in 33 (10.9%) patients. The patients with TPE with polymorphonuclear leukocytes (PMNLs) had higher fever rates and higher decortication rates than those with lymphocyte-predominant TPE. Otherwise, they had lower chest distress rates and lower positive rates of pulmonary TB and lower biopsy tissue culture-positive rates than patients with lymphocyte-predominant TPE. PMNL TPE patients had higher lactic acid dehydrogenase (LDH) (1297 vs. 410 U/l,P < 0.001) and adenosine deaminase (ADA) levels (54.1 vs. 42.9 U/l, P = 0.043) and lower pleural fluid glucose (1.92 vs. 4.70 mmol/L,P < 0.001) and protein (47.4 vs. 48.4 g/L, P = 0.024) levels than that of lymphocyte-predominant TPE. Otherwise, they had lower blood ALB levels and higher C-reactive protein levels than lymphocyte-predominant TPE. Finally, PMNL TPE patients had lower rates of granuloma formation (27.2% vs. 75.2%,P < 0.001) and pleural nodules than patients with lymphocyte-predominant TPE and more frequent findings of pus, caseous exudate, and necrosis.
CONCLUSION: The TB pleurisy patients dominated by neutrophils show strong inflammatory reactions and higher ADA levels in pleural effusion. These findings can significantly improve the positive rate of Mycobacterium tuberculosis in neutrophil-predominant TPE under thoracoscopy. |
| first_indexed | 2024-12-16T12:34:41Z |
| format | Article |
| id | doaj.art-a6d14cf3e7f2462faf8f4ecb4d0a5f6a |
| institution | Directory Open Access Journal |
| issn | 1817-1737 1998-3557 |
| language | English |
| last_indexed | 2024-12-16T12:34:41Z |
| publishDate | 2020-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Thoracic Medicine |
| spelling | doaj.art-a6d14cf3e7f2462faf8f4ecb4d0a5f6a2022-12-21T22:31:36ZengWolters Kluwer Medknow PublicationsAnnals of Thoracic Medicine1817-17371998-35572020-01-01152768310.4103/atm.ATM_15_20Clinical and pathological differences between polymorphonuclear-rich and lymphocyte-rich tuberculous pleural effusionTingting ZhaoBing ChenYurong XuYiqing QuOBJECTIVE: Analysis of the occurrence factors and disease characteristics of tuberculous (TB) pleural effusion (TPE) dominated by neutrophils. METHODS: We retrospectively analyzed the clinical data of 304 patients with two types of TB pleurisy. The clinical, laboratory, and pathological features of TB pleurisy separately dominated by lymphocytes and neutrophils were analyzed. RESULTS: Neutrophil-predominant effusion was observed in 33 (10.9%) patients. The patients with TPE with polymorphonuclear leukocytes (PMNLs) had higher fever rates and higher decortication rates than those with lymphocyte-predominant TPE. Otherwise, they had lower chest distress rates and lower positive rates of pulmonary TB and lower biopsy tissue culture-positive rates than patients with lymphocyte-predominant TPE. PMNL TPE patients had higher lactic acid dehydrogenase (LDH) (1297 vs. 410 U/l,P < 0.001) and adenosine deaminase (ADA) levels (54.1 vs. 42.9 U/l, P = 0.043) and lower pleural fluid glucose (1.92 vs. 4.70 mmol/L,P < 0.001) and protein (47.4 vs. 48.4 g/L, P = 0.024) levels than that of lymphocyte-predominant TPE. Otherwise, they had lower blood ALB levels and higher C-reactive protein levels than lymphocyte-predominant TPE. Finally, PMNL TPE patients had lower rates of granuloma formation (27.2% vs. 75.2%,P < 0.001) and pleural nodules than patients with lymphocyte-predominant TPE and more frequent findings of pus, caseous exudate, and necrosis. CONCLUSION: The TB pleurisy patients dominated by neutrophils show strong inflammatory reactions and higher ADA levels in pleural effusion. These findings can significantly improve the positive rate of Mycobacterium tuberculosis in neutrophil-predominant TPE under thoracoscopy.http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2020;volume=15;issue=2;spage=76;epage=83;aulast=Zhaoadenosine deaminaselactate dehydrogenasethoracoscopytuberculous granulomatuberculous pleural effusions |
| spellingShingle | Tingting Zhao Bing Chen Yurong Xu Yiqing Qu Clinical and pathological differences between polymorphonuclear-rich and lymphocyte-rich tuberculous pleural effusion Annals of Thoracic Medicine adenosine deaminase lactate dehydrogenase thoracoscopy tuberculous granuloma tuberculous pleural effusions |
| title | Clinical and pathological differences between polymorphonuclear-rich and lymphocyte-rich tuberculous pleural effusion |
| title_full | Clinical and pathological differences between polymorphonuclear-rich and lymphocyte-rich tuberculous pleural effusion |
| title_fullStr | Clinical and pathological differences between polymorphonuclear-rich and lymphocyte-rich tuberculous pleural effusion |
| title_full_unstemmed | Clinical and pathological differences between polymorphonuclear-rich and lymphocyte-rich tuberculous pleural effusion |
| title_short | Clinical and pathological differences between polymorphonuclear-rich and lymphocyte-rich tuberculous pleural effusion |
| title_sort | clinical and pathological differences between polymorphonuclear rich and lymphocyte rich tuberculous pleural effusion |
| topic | adenosine deaminase lactate dehydrogenase thoracoscopy tuberculous granuloma tuberculous pleural effusions |
| url | http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2020;volume=15;issue=2;spage=76;epage=83;aulast=Zhao |
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