Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Tuberculous Pleurisy : Clinical Characteristics of Primary and Reactivation Disease

결핵성 흉막염에서 초감염 결핵과 재발성 결핵의 임상 양상

  • Hong, Koo Hyun (Department of Internal Medicine, College of Medicine, Dankook University) ;
  • Lim, Sang Soo (Department of Internal Medicine, College of Medicine, Dankook University) ;
  • Shin, Jae Min (Department of Internal Medicine, College of Medicine, Dankook University) ;
  • Park, Jae Seuk (Department of Internal Medicine, College of Medicine, Dankook University)
  • 홍구현 (단국대학교 의과대학 내과학교실) ;
  • 임상수 (단국대학교 의과대학 내과학교실) ;
  • 신재민 (단국대학교 의과대학 내과학교실) ;
  • 박재석 (단국대학교 의과대학 내과학교실)
  • Received : 2006.10.13
  • Accepted : 2006.12.11
  • Published : 2006.12.30
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Abstract

Backgroud: Traditionally, tuberculous pleurisy has been known to largely develop as primary tuberculosis. However, as the incidence of tuberculosis decrease, recent studies have shown reactivation tuberculosis has become the main cause of tuberculous pleurisy. Methods: 141 cases of tuberculous pleurisy, between January 2003 and February 2006, at the Dankook university hospital. were retrospectively studied. The patients were divided into primary and reactivation tuberculosis. based on the history and radiological characteristics, and the clinical, radiological characteristics at the time of diagnosis and residual pleural thickening after 6 month of chemotherapy were compared between the two groups. Results: 1. Of the 141 tuberculous pleurisy cases, in 135 it was possible to differentiate between primary and reactivation tuberculosis. 2. Of the 135 tuberculous pleurisy cases, 38 (28%) showed a primary tuberculosis pattern, and 98 (72%) showed a reactivation tuberculosis pattern. 3. There were no significant differences between primary and reactivation tuberculosis in relation to age, sex, duration of symptom, amount of pleural effusion, pleural fluid WBC, lymphocyte count, and level of protein, LDH and ADA at the time of diagnosis 4. 124 patients were followed for 6 months after diagnosis of tuberculous pleurisy, and there was no significant difference in the residual pleural thickening between primary and reactivation tuberculosis. Conclusion: In South Korea, a reactivation disease is currently a more common cause of tuberculous pleurisy than a primary disease. There was no difference in the clinical characteristics between primary and reactivation tuberculosis.

연구배경: 결핵성 흉막염은 대부분 초감염 결핵의 형태로 발생하는 것으로 알려져 왔다. 그러나 최근 결핵환자가 감소함에 따라 초감염 결핵보다 재발성 결핵으로 결핵성 흉막염이 발생하는 경향이 늘고 있다. 대상 및 방법: 2003년 1월부터 2006년 2월까지 단국대학교병원에서 결핵성 흉막염으로 진단받은 환자들의 과거력과 방사선 소견에 따라 초감염 결핵과 재발성 결핵으로 분류하고 두 군 사이에 임상 소견, 방사선 소견, 그리고 6 개월 동안 항결핵 약물치료 후 잔여 흉막비후에 있어서 차이가 있는지 알아보았다. 결 과: 1. 결핵성 흉막염 환자 141명 중에서 135명에서 초감염 결핵과 재발성 결핵의 구분이 가능하였는데 초감염 결핵의 소견을 보인 환자는 38명(28%), 재발성 결핵의 소견을 보인 환자는 97명(72%)으로 재발성 결핵의 소견을 보이는 환자가 더 많았다. 2. 초감염과 재발성 결핵 환자 사이에서 성별, 나이, 증상의 발현 시작부터 흉수검사까지의 기간, 진단 시의 흉수의 양, 흉수 총백혈구수, 림프구수, LDH, ADA 수치에 있어서 유의한 차이가 없었다. 3. 6개월 이상 추적관찰이 가능하였던 124명의 환자들의 잔여 흉막비후의 정도에 있어서 초감염 결핵과 재발성 결핵 사이에 차이가 없었다. 결 론: 결핵성 흉막염 환자 중에서 초감염 결핵보다 재발성 결핵의 소견을 보이는 환자가 더 많았으며 두 군 사이에 임상 소견, 방사선 소견, 흉수 소견에서 유의한 차이가 없었으며, 6 개월 치료 후의 잔여 흉막비후의 정도에 있어서도 유의한 차이가 없었다.

Keywords

References

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