Tuberculous Pleurisy Patients Research Articles

The Clinical Experience of Mycobacterial Culture Yield of Pleural Tissue by Pleuroscopic Pleural Biopsy among Tuberculous Pleurisy Patients.

Background and Objectives: Tuberculous pleurisy is a common extrapulmonary TB that poses a health threat. However, diagnosis of TB pleurisy is challenging because of the low positivity rate of pleural effusion mycobacterial culture and difficulty in retrieval of optimal pleural tissue. This study aimed to investigate the efficacy of mycobacterial culture from pleural tissue, obtained by forceps biopsy through medical pleuroscopy, in the diagnosis of TB pleurisy. Materials and Methods: This study retrospectively enrolled 68 TB pleurisy patients. Among them, 46 patients received semi-rigid pleuroscopy from April 2016 to March 2021 in a tertiary hospital. We analyzed the mycobacterial culture from pleural tissue obtained by forceps biopsy. Results: The average age of the study participants was 62.8 years, and 64.7% of them were men. In the pleuroscopic group, the sensitivity of positive Mycobacterium tuberculosis (M. TB) cultures for sputum, pleural effusion, and pleural tissue were 35.7% (15/42), 34.8% (16/46), and 78.3% (18/23), respectively. High sensitivities of M. TB culture from pleural tissue were up to 94.4% and 91.7% when pleural characteristic patterns showed adhesion lesions and both adhesion lesions and presence of micronodules, respectively. Conclusions: M. TB culture from pleural tissue should be considered a routine test when facing unknown pleural effusion during pleuroscopic examination.

Characterization of multiple soluble immune checkpoints in individuals with different Mycobacterium tuberculosis infection status and dynamic changes during anti-tuberculosis treatment

BackgroundImmune checkpoints are crucial for the maintenance of subtle balance between self-tolerance and effector immune responses, but the role of soluble immune checkpoints (sICs) in Mycobacterium tuberculosis (M. tb) infection remains unknown. We assessed the levels of multiple sICs in individuals with distinct M. tb infection status, and their dynamic changes during anti-tuberculosis treatment.MethodsWe enrolled 24 patients with pulmonary tuberculosis, among which 10 patients were diagnosed with tuberculous pleurisy (TBP), 10 individuals with latent tuberculosis infection (LTBI), and 10 healthy volunteers from Wuxi Fifth People’s Hospital and Huashan Hospital between February 2019 and May 2021. Plasma concentrations of thirteen sICs were measured at enrollment and during anti-tuberculosis treatment using luminex-based multiplex assay. sICs levels in tuberculous pleural effusion (TPE) and their relations to laboratory test markers of TPE were also assessed in TBP patients.ResultsThe circulating levels of sPD-1, sPD-L1, sCTLA-4, sBTLA, sGITR, sIDO, sCD28, sCD27 and s4-1BB were upregulated in tuberculosis patients than in healthy controls. A lower sPD-L1 level was found in LTBI individuals than in tuberculosis patients. In TBP patients, the levels of sPD-1, sPD-L2, sCD28, sCD80, sCD27, sTIM-3, sLAG-3, sBTLA, s4-1BB and sIDO increased significantly in TPE than in plasma. In TPE, sBTLA and sLAG-3 correlated positively with the adenosine deaminase level. sIDO and sCD80 correlated positively with the lactate dehydrogenase level and the percentage of lymphocytes in TPE, respectively. Meanwhile, sCD27 correlated negatively with the specific gravity and protein level in TPE. In tuberculosis patients, the circulating levels of sBTLA and sPD-L1 gradually declined during anti-tuberculosis treatment.ConclusionsWe characterized the changing balance of sICs in M. tb infection. And our results revealed the relations of sICs to laboratory test markers and treatment responses in tuberculosis patients, indicating that certain sICs may serve as potential biomarkers for disease surveillance and prognosis of tuberculosis.

Clinical utility of thoracoscopy in elderly tuberculous pleurisy patients under local anesthesia

IntroductionDiagnosing tuberculous pleurisy is important in Japan because it currently has a moderate tuberculosis prevalence. However, physicians often have difficulty making a diagnosis. It was reported that thoracoscopy under local anesthesia is useful for the diagnosis of tuberculous pleurisy, but there are no reports focusing on elderly patients. MethodsIn this study, the usefulness of thoracoscopy under local anesthesia was evaluated in elderly patients. Among 170 patients who underwent thoracoscopy under local anesthesia at our hospital during 11 years from January 2008 to December 2018, those aged 75 years or older (n = 75) were investigated retrospectively. ResultsA total of 55 patients underwent thoracoscopy under local anesthesia for detailed examination of pleural effusion of unknown cause. Of these, 18 were diagnosed as tuberculous pleurisy. The median age was 82 years (range: 75–92 years). The diagnosis of tuberculous pleurisy was made in 11 patients in whom Mycobacterium tuberculosis was detected and in four patients whose pathological findings indicated epithelioid granuloma accompanied by caseous necrosis. Clinical diagnosis was made in the remaining three patients based on thoracoscopic findings of the pleural cavity and a high level of adenosine deaminase in pleural fluid. No serious complications attributable to the examination were observed in any patient. ConclusionsThoracoscopy under local anesthesia was useful for the diagnosis of tuberculous pleurisy in elderly patients, with useful information being also obtained for the treatment of tuberculosis.

Diagnostic Value of Pleural Effusion Mononuclear Cells Count and Adenosine Deaminase for Tuberculous Pleurisy Patients in China: A Case-Control Study.

Background: The diagnostic value of pleural effusion mononuclear cells count for tuberculous pleurisy (TBP) is unclear. We aimed to evaluate the diagnostic value of pleural effusion mononuclear cells count and its combination with adenosine deaminase (ADA) in TBP patients.Methods: We initially analyzed 296 patients with unknown pleural effusion from the Department of Respiratory Medicine at Provincial People's Hospital during January 2014 to February 2018. Ultimately, 100 tuberculous pleurisy (TBP) patients and 105 non-tuberculous pleurisy (non-TBP) patients with pleural effusion were investigated in the current study. Meanwhile, pleural effusion mononuclear cells count and ADA test were performed to evaluate the diagnostic value for TBP. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR–), accuracy and area under the receiver operating characteristic (ROC) curve (AUC) of pleural effusion mononuclear cells count only and its combination with ADA for TBP diagnosis were investigated.Results: (i) The best cut-off value of pleural effusion mononuclear cells count for TBP diagnosis was 969.6 × 106/L, with the sensitivity, specificity and accuracy of 76, 57, and 66%, respectively. (ii) Combination of pleural effusion mononuclear cells count and ADA test suggested diagnostic value for TBP. Specifically, serial test showed the sensitivity, specificity, accuracy of 65, 90, 78%, respectively, whereas parallel test revealed the sensitivity, specificity, accuracy of 92, 45, 68%, respectively. The sensitivity of parallel test (92%) was significantly higher than pleural effusion mononuclear cells count alone (76%) (X2 = 23.19, p < 0.001). (iii) The area under the ROC of pleural effusion mononuclear cells count and it combined with ADA were 0.66 (95% CI, 0.59–0.72) and 0.83 (95% CI, 0.78–0.89), respectively, with statistically significant difference (Z = 3.46, p < 0.001).Conclusion: This retrospective case-control study demonstrated that pleural effusion mononuclear cells count is relatively useful for TBP diagnosis. Furthermore, the pleural effusion mononuclear cells count in combination with ADA can further improve the diagnostic accuracy of TBP.

Differential expression and predictive value of monocyte scavenger receptor CD163 in populations with different tuberculosis infection statuses

BackgroundMonocytes are the predominant innate immune cells at the early stage of Mycobacterium tuberculosis (M. tb) infection as the host defense against intracellular pathogens. Understanding the profile of different monocyte subpopulations and the dynamics of monocyte-related biomarkers may be useful for the diagnosis and prognosis of tuberculosis.MethodsWe enrolled 129 individuals comprising patients with pulmonary tuberculosis (PTB) (n = 39), tuberculous pleurisy (TBP) (n = 28), malignant pleural effusion (MPE) (n = 21), latent tuberculosis infection (LTBI) (n = 20), and healthy controls (HC) (n = 21). Surface expression of CD14, CD16, and CD163 on monocytes was detected using flow cytometry. In addition, soluble CD163 (sCD163) was determined by enzyme linked immunosorbent assay.ResultsHigher frequency of CD14+CD16+ (15.7% vs 7.8%, P < 0.0001) and CD14−CD16+ (5.3% vs 2.5%, P = 0.0011) monocytes and a decreased percentage of CD14+CD16− (51.0% vs 70.4%, P = 0.0110) cells was observed in PTB patients than in HCs. Moreover, PTB patients displayed a higher frequency of CD163+ cells in CD16+ monocytes than those in the HC group (40.4% vs 11.3%, P < 0.0001). The level of sCD163 was elevated in TBP patients and was higher in pleural effusion than in plasma (2116.0 ng/ml vs 1236.0 ng/ml, P < 0.0001). sCD163 levels in pleural effusion and plasma could be used to distinguish TBP from MPE patients (cut-off values: 1950.0 and 934.7 ng/ml, respectively; AUCs: 0.8418 and 0.8136, respectively). Importantly, plasma sCD163 levels in TBP patients decreased significantly after anti-TB treatment.ConclusionsHigher expression of membrane and soluble CD163 in active tuberculosis patients might provide insights regarding the pathogenesis of tuberculosis, and sCD163 may be a novel biomarker to distinguish TBP from MPE and to predict disease severity.

High expression of BTLA and B7-H4 on the surface of myeloid dendritic cells has a negative regulatory effect on their anti-tuberculosis immunity activity in pleural tuberculosis patients

To investigate the effects of the surface markers B- and T-lymphocyte attenuator (BTLA) and B7 homologous body 4 (B7-H4) on expression of CD83, and Human Leukocyte Antigen–DR isotype (HLA-DR) that can activate dendritic cells (DCs). Flow cytometry was used to detect the co-expression of BTLA and B7-H4 on myeloid DCs (mDCs) in peripheral blood (PB) and pleural effusions (PE) in 15 volunteers and 20 tuberculous pleurisy (TP) patients. Co-expression of BTLA and B7-H4 (double positive (DP)) mDCs in PB and PE of TP patients were enhanced. The proportion of DP mDC in PB decreased markedly after 2 weeks treatment, but was still greater than in controls. Expression of CD83 and HLA-DR on DP mDCs was higher than on BTLA and B7-H4 double negative (DN) expressing mDCs in PB of different TP groups. Expression of CD83 on DP mDCs in PB and PE of TP patients was greater than that of controls. Expression of HLA-DR on DP mDCs in TP patient PB was lower than in TP PE and controls. In pleural tuberculosis (TB) patients, high expression of BTLA and B7-H4 promoted a high level of CD83 and HLA-DR, which had a negative regulatory effect on mDCs on anti-TB immunity.

CD157 Confers Host Resistance to Mycobacterium tuberculosis via TLR2-CD157-PKCzeta-Induced Reactive Oxygen Species Production.

Recruitment of monocytes to the infection site is critical for host resistance against Mycobacterium tuberculosis CD157 has a crucial role in neutrophil and monocyte transendothelial migration and adhesion, but its role in tuberculosis (TB) is unclear. Here, we show that both mRNA and protein levels of Cd157 are significantly increased during M. tuberculosis infection. Deficiency of Cd157 impaired host response to M. tuberculosis infection by increasing bacterial burden and inflammation in the lung in the murine TB model. In vitro experiments show that the bactericidal ability was compromised in Cd157 knockout (KO) macrophages, which was due to impaired M. tuberculosis-induced reactive oxygen species (ROS) production. We further reveal that CD157 interacts with TLR2 and PKCzeta and facilitates M. tuberculosis-induced ROS production in Cd157 KO macrophages, which resulted in enhanced M. tuberculosis killing. For the clinic aspect, we observe that the expression of CD157 decreases after effective anti-TB chemotherapy. CD157 is specifically increased in pleural fluid in tuberculous pleurisy patients compared to pneumonia and lung cancer patients. Interestingly, the levels of soluble CD157 (sCD157) correlate with human peripheral monocyte-derived macrophage bactericidal activity. Exogenous application of sCD157 could compensate for macrophage bactericidal ability and restore ROS production. In conclusion, we have identified a novel protective immune function of CD157 during M. tuberculosis infection via TLR2-dependent ROS production. Application of sCD157 might be an effective strategy for host-directed therapy against TB in those with insufficient CD157 production.IMPORTANCE Tuberculosis, a chronic bacterial disease caused by Mycobacterium tuberculosis, remains a major global health problem. CD157, a dual-function receptor and β-NAD+-metabolizing ectoenzyme, promotes cell polarization, regulates chemotaxis induced through the high-affinity fMLP receptor, and controls transendothelial migration. The role of CD157 in TB pathogenesis remains unknown. In this study, we find that both mRNA and protein levels of CD157 are significantly increased in TB. Deficiency of CD157 impaired host defense against M. tuberculosis infection both in vivo and in vitro, which is mediated by an interaction among CD157, TLR2, and PKCzeta. This interaction facilitates M. tuberculosis-induced macrophagic ROS production, which enhances macrophage bactericidal activity. Interestingly, the sCD157 level in plasma is reversibly associated with MDM M. tuberculosis killing activity. By uncovering the role of CD157 in pathogenesis of TB for the first time, our work demonstrated that application of soluble CD157 might be an effective strategy for host-directed therapy against TB.

Significance of T-cell dot test and combined detection of adenosine deaminase in tuberculous pleurisy at different ages

Objective To analyze the clinical value of combined detection of tuberculous T cell enzyme-linked immuno spot assay (T-SPOT.TB) and adenosine deaminase (ADA) in tuberculous pleurisy patients of different ages. Methods From February 2014 to February 2018, three hundred and thirty-six patients with pleural effusion were admitted to Hebei Thoracic Hospital.Among them, two hundred and fifty five cases were diagnosed as tuberculous pleurisy and 81 cases were diagnosed as non-tuberculous pleurisy.The patients were divided into two groups according to their age.The younger group (214 cases) was 16-59 years old and the older group (122 cases) was over 60 years old.The sensitivity and specificity of T-SPOT.TB combined with ADA in the diagnosis of tuberculous pleurisy were compared between the two groups. Results The sensitivity and specificity of T-SPOT.TB were 85.5% (153/179) and 71.4% (25/35) in the young and middle-aged group, 73.7% (56/76) and 58.7% (27/46) in the old group, respectively.The sensitivity of the young and middle-aged group was significantly higher than that of the old group (χ2=4.990, P=0.045). The sensitivity and specificity of T-SPOT.TB combined with ADA were 98.9% (177/179) and 94.3% (33/35) in the young and middle-aged group, 96.1% (73/76) and 89.1% (41/46) in the elderly group, respectively.There was no significant difference in sensitivity and specificity between the two groups (χ2=0.256, P=0.393、χ2=0.655, P=0.218). Conclusion The diagnostic efficacy of T-SPOT.TB combined with ADA in patients with tuberculous pleurisy at different ages has been improved, especially for those who can not tolerate pleural biopsy and elderly patients. Key words: Tuberculous pleurisy; T cell enzyme-linked immuno-spot assay; Adenosine deaminase; Age

Clinical study on central venous catheter drainage and intrapleural injection of urokinase in the treatment of tuberculous pleurisy

Objective To observe the therapeutic effect of central venous catheter drainage and intrapleural injection of urokinase on tuberculous pleurisy patients. Methods 60 hospitalized patients with tuberculous pleurisy were selected, and they were divided into two groupsby simple random grouping method.Both two groups received 3HRZE/6HR anti-tuberculosis treatment.30 patients in the observation group were treated with central venous catheter drainage and intrapleural injection of urokinase.30 patients in the control group were treated with conventional pleurocentesis.The duration of pleural effussion drainage, incidence of pleural thickening, hospitalization time and expense, and the adverse reaction rate were observed during treatment. Results In the observation group, the curative effect at 1 week was 46.7%, the duration of pleural effussion drainage was (20.5±6.7)days, the incidence rate of pleural thickening was 26.7%, the hospitalization time was (9.4±2.7)days, the hospitalization expense was (6 675.4±1 818.4)RMB, the incidence rate of adverse reaction was 3.3%.In the control group, the curative effect at 1 week was 20.0%, the duration of pleural effussion drainage was (25.1±7.7)days, the incidence rate of pleural thickening was 46.7%, the hospitalization time was (10.3±2.8)days, the hospitalization expense was (7 508.9±1 692.1)RMB, the incidence rate of adverse reaction was 20.0%.There were statistically significant differences between the two groups in the curative effect at 1 week(χ2=4.800, P=0.028), duration of pleural effussion drainage (t=2.484, P=0.016), incidence of pleural thickening (t=4.444, P=0.035) and incidence rate of adverse reaction (χ2=4.043, P=0.044). No statistically significant differences were observed between the two groups in hospitalization time(t=1.270, P=0.209) and expense(t=1.838, P=0.071). Conclusion In comparison to conventional pleurocentesis, the treatment of central venous catheter drainage and intrapleural injection of urokinase for tuberculous pleurisy is markedly efective, it is safe and worthy of popularizing in clinical application. Key words: Pleurisy; Tuberculosis, pleural; Central venous catheter drainage; Urokinase

Clinical Investigation of Tuberculous Pleurisy Patients Who Underwent Thoracoscopy Under Local Anesthesia at Our Hospital

Clinical Investigation of Tuberculous Pleurisy Patients Who Underwent Thoracoscopy Under Local Anesthesia at Our Hospital

СРАВНИТЕЛЬНАЯ ХАРАКТЕРИСТИКА ТУБЕРКУЛЕЗНОГО ПЛЕВРИТА В ЗАВИСИМОСТИ ОТ ВИЧ-СТАТУСА БОЛЬНЫХ

Goal of the study: to study specific manifestations of tuberculous pleurisy in HIV patients, to evaluate the efficiency of video-assisted thoracoscopy when diagnosing tuberculous pleurisy in case of different HIV status of the patients. Materials and methods: 241 tuberculous pleurisy patients were examined. 88 – HIV positive (group 1), 153 – HIV negative (group 2). Average CD4 count in group 1 made 189 cells/mcl. The following parameters were compared in those groups: clinical and X-ray manifestations, microbiological, cytologic and biochemical rates in blood and effluent. 77 patients with isolated pleurisy (of them 33 HIV positive) had video-assisted thoracoscopy with biopsy for diagnostic purposes. The data of histological examination of pleura, obtained through video-assisted thoracoscopy and autopsy have been presented. Results: tuberculous pleurisy with concurrent HIV infection is characterized by frequent occurrence of hemorrhagic effusion, scarce cellular sediment of effluent, expressed reduction of glucose level and increase of thymol test rates in effluent. Regardless of HIV status the frequency of tuberculous mycobacteria detection through microscopy and culture is low and does not exceed 10%. Histological testing of specimens obtained through video-assisted thoracoscopy allowed proving tuberculosis in all patients thus differentiating tuberculous changes from metastases. Thus video-assisted thoracoscopy can be recommended for diagnostics of difficult cases of tuberculous pleurisy regardless of HIV status. From morphological point of view tuberculous pleurisy was characterized by specific granulomas which were presented by lymphoid and epithelioid cells with Pirogov-Langhans cells with minor caseous necrosis in the center (9.1%) or its complete absence (90.9%).

Treatment of free-flowing tuberculous pleurisy with intrapleural urokinase.

Patients with loculated tuberculous pleurisy (TBP) treated with urokinase suffer less from residual pleural thickening (RPT) than those treated with simple drainage. However, the role of intrapleural urokinase in free-flowing TBP patients remains unclear. A total of 318 patients with presumed TBP were screened. The final 171 patients who participated in the study were randomly allocated to the urokinase group (n = 86) and the control group (n = 85). Personalised doses of urokinase were infused via a catheter. This procedure was repeated every 24 h until the volume of pleural fluid obtained was less than 50 ml after three injections. Changes in lung function and pleural thickening were recorded and compared between both groups periodically for 24 weeks. Seven patients (9.1%) had restrictive functional sequelae in the control group, while no patient in the urokinase group suffered from sequelae (P < 0.05). The incidence of RPT (⩾10 mm) was 0 for the urokinase group and 9.1% for the control group (P < 0.05). A lower percentage of patients treated with intrapleural urokinase had blunted costophrenic angle than controls (5.1% vs.19.5%, P < 0.05). Patients with free-flowing TBP treated with urokinase suffered less from RPT than those treated with drainage.

Diagnostic value of adenosine deaminase(ADA)for the tuberculous pleural effusion

Objective To investigate the value of adenosine deaminase(ADA)for the diagnosis of tuberculous pleural effusion. Methods A retrospective analysis was made of 324 cases of tuberculous pleural effusion patients which were effective treated and 68 cases were diagnosed of malignant pleural effusion.By drawing receiver operating characteristic curve, the best threshold of diagnosing of tuberculous pleural effusion was determined,and the distribution characteristics of ADA in tuberculous pleural effusion were analyzed. Results When the ADA was set at 19.5U/ L it was good for identifying tuberculous empyema and tuberculous pleurisy.The activity of ADA in group of different gender did not have significant difference(Z=-0.572,P= 0.283).The activity of ADA had significant difference between tuberculous empyema with tuberculous pleurisy patients(Z=-2.317,P= 0.01),and the same as in group of different ages between less than or equal to 45 years old with the others(Z=-2.387,P= 0.008).The activity of ADA had significant difference between tuberculous empyema and tuberculous pleurisy patients of younger than 45 years old(Z=-2.740,P= 0.003),but not in the group of less than or equal to 45 years old(Z=-0.267,P = 0.390). Conclusion The activity of ADA is good for identifying diagnosis of tuberculous pleural effusion and malignant pleural effusion,especially in tuberculous empyema and less than or equal to 45 years old patients.The standard of diagnosis and the nature of the tuberculous pleural effusion may affect the cut-off value of ADA. Key words: Pleural Effusion; Tuberculous,Pleural; Adenosine Deaminase; Diagnosis

Application of the clinical care path of health education as the core for patients with tuberculous pleurisy

Objective To explore the application effect of the clinical care path of health education as the core for the patients with tuberculous pleurisy. Methods 76 cases of tuberculous pleurisy patients were divided into observation group and control group, 38 cases in each group. Patients in observation group were nursed by the clinical care path of health education as the core, while in the control group were received routine nursing. The results of two groups were compared and analyzed. Results The awareness of health knowledge and nursing satisfaction were significantly higher than those of the control group(P<0.05). The compliance of taking medicine was higher than that of the control group(P<0.05). Conclusions The clinical care path of health education as the core could improve the compliance of treatment and nursing satisfaction in the patients with tuberculous pleurisy. Key words: Tuberculous pleurisy; Clinical care path; Health education

Hyaluronic Acid Concentration in Pleural Fluid: Diagnostic Aid for Tuberculous Pleurisy

BackgroundA high concentration of hyaluronic acid in pleural fluid is suggestive of malignant mesothelioma. However, a relatively high concentration of hyaluronic acid was also seen in the pleural fluid of patients with benign inflammatory diseases. To show the utility of measuring hyaluronic acid levels in pleural fluid to diagnose tuberculous pleurisy, we compared the clinical features and levels of hyaluronic acid in the pleural fluid of patients with and without tuberculous pleurisy.MethodsWe enrolled 27 patients with infective pleurisy admitted at Teikyo University Hospital from January 2010 to December 2013. Ten patients were diagnosed with tuberculous pleurisy, and 17 with non-tuberculous pleurisy. We reviewed the clinical features and data of all 27 patients and compared the two groups. We analyzed and compared the concentration of hyaluronic acid and adenosine deaminase in their pleural fluid.ResultsPatients with tuberculous pleurisy tended to have significantly higher concentrations of hyaluronic acid and adenosine deaminase in their pleural fluid (tuberculous pleurisy patients vs. other infective pleurisy patients: hyaluronic acid (× 103 ng/mL); 42.9 ± 23.3 vs. 16.8 ± 17.9, P = 0.003, adenosine deaminase (IU/L); 89.7 ± 33.3 vs. 74.0 ± 90.9, P = 0.032). Receiver operating characteristic analysis revealed no significant difference in the area under the curve of hyaluronic acid and adenosine deaminase volumes in pleural fluid, suggesting their equivalent value as major diagnostic tools for tuberculosis pleurisy.ConclusionsHyaluronic acid concentration in pleural fluid can be a valuable tool for the diagnosis of tuberculous pleurisy.

The influence of health education on self-care ability of patients with tuberculous pleurisy

Objective To explore the effects of health education on patients with tuberculous pleurisy.Methods In our hospital from 2012 December to 2013 July 60 cases of tuberculous pleurisy patients were randomly divided into the observation group and the control group, 30 cases in each group , the control group was received routine nursing care , the observation group was strengthened health education based on the control group .Awareness of health knowledge , treatment compliance , self-care ability , life quality and nursing satisfaction were compared between two groups.Results Health knowledge score , treatment compliance , efficacy, overall self-care ability score were higher than those in the control group , the hospitalization time was shorter than that in the control group with statistical significance （ P〈0.05） .Life quality in physical function , role function, social function in the observation group were higher than those in the control group , nursing satisfaction in the observation group was higher than that in the control group with statistical significance （ P〈0.05 ） .Conclusions 〈br〉 Health education is beneficial to improve the treatment compliance and self -care ability of patients with tuberculous pleurisy and improve their life quality .. Key words: Health education; Tuberculous pleurisy; Self-care ability; Life quality

Changes of Th17 cells, Treg cells and Th17/Treg cell-associated cytokines in patients with tubercu-lous pleurisy and significance of the changes

Objective To investigate the significance of Th 17 cells, Treg cells and Th17/Treg cell-associated cytokines in the development of tuberculous pleurisy through detecting the expressions of Th 17 cells and Treg cells （CD4＋CD25＋Foxp3＋） in CD4＋T cells, analyzing concentrations of IL-17, IL-23, IL-6＆nbsp;and TGF-βin serum of patients with tuberculous pleurisy and healthy controls and measuring levels of IL -17, IL-23, IL-6 and TGF-βin hydrothorax of patients with tuberculous pleurisy .Methods Flow cytometry was used to detect expressions of Th 17 and Treg cells in peripheral blood of patients with tuberculous pleurisy and healthy controls.ELISA method was performed for quantitative detection of concentrations of IL -17, IL-23, IL-6 and TGF-βin serum and hydrothorax .Differences and correlations between the above measured data were analyzed by the statistical software SPSS 17.0.Results Compared with the healthy control group , the expressions of Th17 cells in peripheral blood of the patients were significantly increased （1.02%±0.20%vs.0.89%±0.13%, P=0.002〈0.05）, while the expressions of Treg cells were significantly decreased （4.64%±0.77%vs.5.10%±0.90%, P=0.000〈0.05）.Correspondingly, the ratio of Th17/Treg cells （0.25±0.07） in the patients were significantly higher than that in the healthy controls （0.17±0.05, P=0.000〈0.05）.Concentrations of IL-17, IL-23 and IL-6 in peripheral blood and in hydrothorax of the pa-tients were （17.49±3.94） ng/L, （90.42±23.06） ng/L, （4.54±1.02） ng/L and （26.13±5.98） ng/L, （122.26±31.71） ng/L, （5.31±0.74） ng/L respectively, which were remarkably higher than the levels of IL-17 （14.45±3.81） ng/L, IL-23 （77.55±20.26） ng/L and IL-6 （4.26±0.91） ng/L in control group. In tuberculous pleurisy group , concentrations of IL-17, IL-23 and IL-6 in hydrothorax were significantly higher than those in peripheral blood with P values of 0.000, 0.000 and 0.003.There was no difference be-tween IL-6 levels in peripheral blood from patients and IL-6 levels in peripheral blood from the healthy con-trols, P=0.274.In comparison with the control group , TGF-βlevels in peripheral blood and in hydrothorax of the patients were significantly decreased （3.95 ng/L±0.79 ng/L, 3.12 ng/L±0.77 ng/L vs.3.32 ng/L ±0.80 ng/L） .In tuberculous pleurisy patients , the expression of Th17 cells in peripheral blood was nega-tively correlated with Treg cells in peripheral blood （r=-0.684, P=0.000〈0.05）, but was positively relat-ed to the levels of IL-17, IL-23 and IL-6 （r=0.479, 0.441, 0.326, P=0.013, 0.015, 0.017）.TGF-βlevel had significantly positive correlations with Treg cells in the peripheral blood of the patients （r=0.297, P=0.024）, but no significant correlation with Th17 cells was found （r=0.091, P=0.659）.Conclusion Th17/Treg cell-associated cytokines might regulate the expressions of Th 17 and Treg cells and inflammatory reaction.Changes of Th17 cells, Treg cells and related cytokines might be important immunopathological mechanisms for tuberculous pleurisy . Key words: Th17 cell; Treg cell; Tuberculous pleurisy; Flow cytometry; Cytokine

Asymptomatic primary tuberculous pleurisy with intense 18-fluorodeoxyglucose uptake mimicking malignant mesothelioma

BackgroundThe pathogenesis of primary tuberculous pleurisy is a delayed-type hypersensitivity immunogenic reaction to a few mycobacterial antigens entering the pleural space rather than direct tissue destruction by mycobacterial proliferation. Although it has been shown that pulmonary tuberculosis induces 18-fluorodeoxyglucose (FDG) uptake in active lesions, little is known about the application of FDG positron emission/computed tomography (FDG PET/CT) to the management of primary tuberculous pleurisy.Case presentationWe report a case of asymptomatic primary tuberculous pleurisy presenting with diffuse nodular pleural thickening without distinct pleural effusion and parenchymal lung lesions mimicking malignant mesothelioma. An initial FDG PET/CT scan demonstrated multiple lesions of intense FDG uptake in the right pleura and thoracoscopic biopsy of pleural tissue revealed caseous granulomatous inflammation. The patient received antituberculous therapy for 6 months, with clearly decreased positive signals on a repeated FDG PET/CT scan.ConclusionFDG PET/CT imaging may be useful for evaluating disease activity in tuberculous pleurisy patients with an unknown time of onset.

Immune Response to Mycobacterium tuberculosis Infection in the Parietal Pleura of Patients with Tuberculous Pleurisy

The T lymphocyte-mediated immune response to Mycobacterium tuberculosis infection in the parietal pleura of patients with tuberculous pleurisy is unknown. The aim of this study was to investigate the immune response in the parietal pleura of tuberculous pleurisy compared with nonspecific pleuritis. We have measured the numbers of inflammatory cells particularly T-cell subsets (Th1/Th2/Th17/Treg cells) in biopsies of parietal pleura obtained from 14 subjects with proven tuberculous pleurisy compared with a control group of 12 subjects with nonspecific pleuritis. The number of CD3+, CD4+ and CCR4+ cells and the expression of RORC2 mRNA were significantly increased in the tuberculous pleurisy patients compared with the nonspecific pleuritis subjects. The number of toluidine blue+ cells, tryptase+ cells and GATA-3+ cells was significantly decreased in the parietal pleura of patients with tuberculous pleurisy compared with the control group of nonspecific pleuritis subjects. Logistic regression with receiver operator characteristic (ROC) analysis for the three single markers was performed and showed a better performance for GATA-3 with a sensitivity of 75%, a specificity of 100% and an AUC of 0.88. There was no significant difference between the two groups of subjects in the number of CD8, CD68, neutrophil elastase, interferon (IFN)-γ, STAT4, T-bet, CCR5, CXCR3, CRTH2, STAT6 and FOXP3 positive cells. Elevated CD3, CD4, CCR4 and Th17 cells and decreased mast cells and GATA-3+ cells in the parietal pleura distinguish patients with untreated tuberculous pleurisy from those with nonspecific pleuritis.

Parameters relating to the development of residual pleural thickening in tuberculous pleurisy

To identify predictive parameters for the development of residual pleural thickening in tuberculous pleurisy, we investigated 58 tuberculous pleurisy patients retrospectively who could be followed up until their chest roentgenogram no longer changed. The patients were divided into the following three groups according to the final configuration of pleural space: group I costphrenic angle (C-P angle) of the affected side was completely or almost completely recovered (20 cases), group II C-P angle became dull (20 cases), group III pleural thickening of > 2 mm remained in the lateral chest wall above the diaphragmatic dome level (18 cases). Differences of the clinical, chest roentgenographic and laboratory data were compared between these three groups. There were no differences between groups I and II in all of the parameters compared, while there were some differences between groups I and/or II and group III. The mean age of group III (51.1 +/- 18.1 y.o.) was significantly higher than that of group I (40.7 +/- 18.6 y.o.) and group II (34.7 +/- 14.7 y.o.) (p < 0.05 and p < 0.005 respectively). Glucose level in pleural fluid of group III (32 +/- 31 mg/dl) was lower than that of group I (96 +/- 13 mg/dl) and group II (86 +/- 21 mg/dl) (p < 0.001, respectively), while the levels of LDH, TP and ADA in pleural fluid were not different significantly among three groups. BSR (blood sedimentation rate) and CRP (C-reactive protein) were higher in group III (77 +/- 30 mm/hr and 8.5 +/- 4.3 mg/dl) than those in group I (45 +/- 23 mm/hr and 4.1 +/- 5.4 mg/dl) (p < 0.01 and p < 0.05, respectively). The level of albumin in serum was lower and that of globulin was higher, and consequently that of A/G ratio in group III (0.78 +/- 0.17) was lower than that of group I (1.15 +/- 0.16) and group II (1.10 +/- 0.22) (p < 0.001, respectively). It should be emphasized that the level of gamma-globulin was higher in group III irrespective of the presence or absence of accompanying pulmonary tuberculosis. Most patients more than 40 years old with serum A/G ratio less than 0.95 belonged to group III (13/15 (87%)) while most of those with serum A/G ratio more than 0.95 belonged to group I or II (10/11 (91%)). Thus hyper (gamma-) globulinemia and the intensity of inflammatory reaction in the whole body and in the pleural space are the predictive factors for the development of residual pleural thickening in tuberculous pleurisy.