[Residual pleural thickening in tuberculous pleuritis. Associated factors]]

Macrophage M1/M2 ratio as a predictor of pleural thickening in patients with tuberculous pleurisy

We evaluated the association between macrophage polarization and the development of pleural thickening in patients with tuberculous pleurisy. Patients with tuberculous pleurisy admitted to our hospital between October 2018 and March 2019 were prospectively recruited. Pleural fluid samples were obtained before treatment for detection of adenosine deaminase (ADA) and macrophage phenotype (M1: CD14+ CD86+; M2: CD14+ CD163+). Peripheral blood samples were subjected to interferon gamma release assay (IGRA). All subjects were administered standard anti-tuberculosis regimen (2HREZ/4HR); high-resolution CT was performed to determine pleural thickening (thickness>2mm) after completion of treatment. Pleural effusion in patients with thickened pleura had significantly more M1 but fewer M2 macrophages, and higher ADA level, as compared to those with normal pleura (P<0.05). No significant between-group difference was observed with respect to IGRA. In receiver operating characteristic (ROC) curve analysis, the optimal cut-off level of M1/M2 ratio for predicting pleural thickening was 1.149 (area under the curve: 0.842; sensitivity: 88.6%; specificity: 69.2%; positive predictive value: 86.3%; negative predictive value: 81.7%). M1/M2 ratio in the pleural fluid is a promising marker for predicting the development of pleural thickening in patients with tuberculous pleurisy. Macrophage-mediated immune response may play an important role in the pathogenesis of tuberculous pleurisy.

Percentage reduction of pleural effusion as a simple predictor of pleural scarring in tuberculous pleuritis

OBJECTIVE

The aim of the present study was to evaluate the utility of serum and pleural fluid biomarkers for predicting residual pleural scarring (RPS) in tuberculous pleuritis.

METHODOLOGY

A retrospective study of patients with pleural tuberculosis was performed. Demographic data, clinical parameters, haematological indices, serum and pleural fluid biochemistry and pleural effusion area were assessed for correlation with the extent of RPS.

RESULTS

RPS was found in 41.4% of the 70 cases evaluated, with significant pleural scarring being present in 7.1%. It was more common in males (odds ratio 5.55). Among the variables studied, only the percentage reduction of the effusion after 2 weeks of treatment was found to independently predict the extent of RPS (r=-0.502, P<0.001).

CONCLUSION

RPS was more common in males and the percentage reduction in pleural effusion on CXR after 2 weeks of treatment was found to be a useful predictor of RPS.

[Pleural thickening and tuberculous effusion: searching for predictive data]

Tuberculosis is a very common disease usualy related to bad social-economic conditions and sometimes with associated pleural effusion. Pleural sequelae are referred by some authors as a consequence that may interfere with lung function provoking respiratory failure in some critical situations. Some experts try to find clinical and biochemical parameters in order to detect possibilities that could predict future pleural thickening and necessity of closer vigilance to avoid lung function disability. This study is based on the post-treatment roentgenological pleural findings and their correlation with the initial pleural fluid biochemical data, the volume of the effusions and time of patients complains.