Predictive Risk Factors of Pleural Tuberculoma Occurrence on Patients with Pleural Tuberculosis

Abstract

Background: Pleural tuberculoma (PTM) had been observed more and more frequently on patients with pleural tuberculosis (PT). The occurrence of PTM is not favorable for the treatment outcome of PT. However, its predictive risk factors had not been clarified. This study was to explore the predictive risk factors of PTM occurrence on the patients with PT. Methods: From January 2017 to June 2018, patients diagnosed as PT were enrolled prospectively into the study. All clinical characteristics and pleural changes during the chemotherapy were recorded and adenosine aminase (ADA)、 lactate dehydrogenase (LDH)、glucose and protein of pleural fluid were quantified. Interferon-gamma (IFN- γ)、 transforming growth factor -beta (TGF-β), plasminogen activator inhibitor type-1 (PAI-1) and tissue plasminogen activator (t-PA) of pleural fluid were tested before chemotherapy by enzyme-linked immunosorbent assay (ELISA). Results: A total of 162 patients with PT were enrolled. 82 patients (51.3%, 82/162) developed PTM during chemotherapy. We found the probability of PT to develop PTM reached 99.5% when the patients with pleural thickness, packaged plural effusion, LDH>461.5 IU/L , ADA>62.9 IU/L , GLU<4.75 mmol/L and age>32.5 years old. The probability to develop PTM was as low as 1.4% when these 6 indices were in the opposite trend to the conditions list above. Using tested cytokines in pleural fluid from 76 cases, the probability of PTM if patients satisfied 3 indexes including increased TGF-β(>15.235 μ g/L) , increased PAI-1(>180.720 μ g/L) and decreased t-PA(<2.875 μ g/L ) was 78%, and the probability to develop PTM was only as low as 2.7% when these 3 cytokines were in the opposite trend. Conclusions: Age, pleural thickness, packaged pleural fluid, increased ADA, LDH, TGF-β, PAI-1 and decreased glucose and t-PA might be predictive risk factors of developing PTM for patients with PT, clinicians should take deep consideration if patients had above factors.