Abstract
Background : Residual pleural thickening (RPT) is the most common complication of tuberculous pleurisy (TP), despite adequate anti-tuberculous chemotherapy. At the conclusion of treatment, 43-50% of patients present RPT, with its incidence varying according to the time of evaluation. To assess the spontaneous resolution of RPT, the RPT at the completion of treatment was compared with that at the final follow-up. The factors related to the development of RPT after the completion of treatment were also studied. Methods : The medical records of sixty four patients, diagnosed with TP between March 2001 and June 2003, were retrospectively. The RPT was measured at the completion of treatment and at the time of the final follow-up and the degree and frequency of RPT compared between the two measurements. Each time, the patients were divided into two groups: those with and without RPT. The clinical characteristics and the radiographic and pleural fluid findings of the two groups were compared. Results : Thirty six (56%) and 27 patients had RPT at the completion of treatment and at the time of the final follow-up, respectively (median follow up period: 8 months). Spontaneous resolution of the RPT was found in 9 patients (24%), and had decrease below 10mm in 15 (42%) during the follow-up period after treatment. The patients were initially divided into two groups: 36 and 27 patients with and without RPT, respectively. There was no predicting factor of RPT, with the exception of the presence of CRP, between the two groups. The patients were also separated into two groups at the time of final visit: 27 and 37 patients with and without RPT, respectively. The patients with RPT were found to have a lower total WBC count in pleural fluid. Conclusion : 57% of patients with RPT were found to have spontaneous resolution of the residual pleural thickening after completion of the chemotherapy. The time of evaluation for RPT and its predicting factors were decided after adequate follow-up, irrespective of the completion of treatment.
연구배경 : 결핵성 흉막염은 치료 이후 약 43 - 50%에서 잔여 흉막비후가 남으며 최근 치료 종결 이후에도 잔여 흉막비후의 자연흡수가 있을 수 있다. 저자들은 결핵성 흉막염에서 치료 종결 시점과 이후 마지막 추적 관찰시점까지 흉막 비후 정도를 추적 관찰하여 자연 흡수정도를 알아보고 이에 따라 흉막비후의 예측인자를 알아보고자 하였다. 방 법 : 2001년 3월부터 2003년 6월까지결핵성흉막염으로 진단받고 외래 추적 관찰이 이루어진 환자 64명을 대상으로 후향적으로 분석하였다. 결 과 : 투약 종료 시에 2mm이상의 잔여 흉막비후를 보이는 경우는 56%, 마지막 관찰시점(관찰기간중앙값 8개월)에서 42%로 9례가 관찰기간 중 자연 흡수되어 흉막비후가 소실됐으며, 15 례에서 10mm 미만으로 감소하는 소견을 보였다. 투약 종료 시에 흉막비후가 남아있던 36례 중 92%가 마지막 추적시까지 흉막비후가 완전히 또는 부분적으로 자연흡수되는 소견을 보였으며, 흉막비후의 감소는 유의한 차이를 보였다(p=0.00). 투약 종료 시에 잔여 흉막비후의 예측인자는 높은 CRP였고 최종 관찰시점에서는 흉수 내 낮은 총 백혈구치이었다. 결 론 : 결핵성 흉막염은 치료종결 후에도 자연흡수가 이루어지며 이는 흉막비후의 유무를 진단하는데 있어 치료종결시점이 아닌 추적 관찰이 이루어진 후에 판단하고, 그에 따른 예측인자를 분석하는 시도가 필요하리라 생각된다.