天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (6): 531-534.

• 临床研究 • 上一篇    下一篇

不同病因胸腔积液经细管引流前后性质变化特点

马晖 1，2，李月川 2，任珉 3，于书雨 2，张永祥 2，贾玮 2，吴琦 1△   

  1. 1天津医科大学总医院（邮编300052）；2天津市胸科医院呼吸与危重症医学科；3天津市心血管病研究所
  • 收稿日期:2019-11-27 修回日期:2020-04-07 出版日期:2020-06-15 发布日期:2020-06-15
  • 通讯作者: 马晖 E-mail:mahuitj@126.com

The characteristics of the pleural effusion collected before and after catheter drainage in patients with different etiologies

MA Hui1, 2, LI Yue-chuan2，REN Min3, YU Shu-yu2, ZHANG Yong-xiang2, JIA Wei2, WU Qi1△   

  1. 1 Tianjin Medical University General Hospital, Tianjin 300052, China; 2 Department of Respiratory and Critical Care,
    Tianjin Chest Hospital; 3 Tianjin Institute of Cardiovascular Diseases
  • Received:2019-11-27 Revised:2020-04-07 Published:2020-06-15 Online:2020-06-15

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摘要： 摘要：目的 分析不同病因的患者胸腔积液（胸液）引流前后性质及细胞学变化特点。方法 收集天津市胸科 医院呼吸与危重症医学科一病区2016年4月—2017年12月179例中、大量胸液患者资料，根据胸液病理及理化等特 点将其分为结胸组37例、恶性组87例、炎症组39例和心衰组16例。经胸腔置细管引流500~1 000 mL胸液，于引流 前及引流24 h后分别留取标本4 mL，对白蛋白、乳酸脱氢酶（LDH）、白细胞、单核细胞、多核细胞及间皮细胞变化特 点进行统计学分析。结果 结胸组、炎症组、恶性组胸液引流前后基本仍为渗出液。心衰组引流后5例（83.33%）渗 出液变为漏出液。引流前，恶性组、炎症组、心衰组患者胸液白细胞计数均低于结胸组；引流后，该3组仍低于结胸 组，且炎症组、心衰组低于恶性组（P＜0.05）；恶性组引流后白细胞升高（P＜0.05）。引流前，恶性组、炎症组、心衰组 胸液单核细胞计数低于结胸组；引流后，炎症组、心衰组仍低于结胸组；恶性组引流后升高（P＜0.05）。4组患者引流 前、引流后组间，且各组引流前后多核细胞计数差异均无统计学意义（P＞0.05）。引流前，恶性组胸液间皮细胞计数 高于其他3组；引流后，恶性组间皮细胞计数下降，但仍最高（P＜0.05）。结论 慢性充血性心力衰竭伴胸液者引流 前后性质变化较大。肺癌所致恶性胸液者引流前后细胞成分变化较大。对于胸液性质及病理结果的可靠性需结合 标本送检时间谨慎判读。

关键词: 胸腔积液, 引流术, 结核, 胸膜, 胸腔积液, 恶性, 肺炎, 旁积液, 漏出液

Abstract: Abstract: Objective To investigate the characteristics and cytological changes of pleural effusion (PE) before and after drainage in patients with different causes. Methods From April 2016 to December 2017, data of 179 patients with moderate and massive PE were collected from the Pulmonary and Critical Care Medicine of Tianjin Chest Hospital. According to the pathological and physicochemical characteristics of pleural effusion, the patients were divided into tuberculous pleural effusion (TPE) grouop (n=37), malignant effusion (MPE) group (n=87), parapneumonic effusion (PPE) group (n=39) and chronic heart failure caused pleural effusion (CHFPE) group (n=16). The pleural effusion (500-1 000 mL) was drained with a tube through the pleural cavity. Before and after 24 hours of drainage, 4 mL of pleural samples were collected to analyze the changes of albumin, lactic dehydrogenase (LDH), white blood cells, monocytes, multinucleated cells and mesothelial cells. Results The PPE, MPE and TPE groups showed exudate before and after drainage. In CHFPE group, exudate became transudate after drainage in 5 cases (83.33%). Before drainage, the leukocyte counts of pleural fluid were lower in the MPE, PPE, and CHFPE groups than those in the TPE group. After drainage, the leukocyte counts of pleural fluid were still lower in the three groups than those in the TPE group, and the PPE and CHFPE groups were lower than those in the MPE group (P＜0.05). Leukocytes of pleural fluid increased after drainage in the MPE group (P＜0.05). Before drainage, the monocyte counts were lower in the MPE, PPE, and CHFPE groups than those in the TPE group. After drainage, the monocyte counts were still lower in the PPE and CHFPE groups than those in the TPE group, and which was increased after drainage in the MPE group (P＜0.05). There were no significant differences in multinucleated cell counts before and after drainage between the four groups (P＞0.05). Before drainage, the mesothelial cell counts of pleural fluid was higher in the MPE group than those of the other three groups. After drainage, the mesothelial cell count of pleural fluid was still the highest in MPE group (P＜0.05), and the mesothelial cell count decreased after drainage in the MPE group (P＜0.05). Conclusion The characteristics of pleural effusion changed greatly before and after drainage in patients with CHFPE. The cellular composition changed greatly before and after pleural effusion drainage in patients with MPE. The reliability of PE and pathological results should be carefully interpreted in combination with the time of specimen examination.

Key words: pleural effusion, drainage, tuberculosis, pleura, pleural effusion, malignancy, pneumonia, para effusion,
transudate