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KMID : 0948320040040010016
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Konyang Medical Journal
2004 Volume.4 No. 1 p.16 ~ p.20
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Correlation between Degree of Pleural Thickening after Treatment of Tuberculous Pleurisy and Levels of D-dimer in Pleural Fluid before Treatment
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Na Moon-Jun
Son Ji-Woong
Choi Eu-Gene
Lee Won-Young
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Abstract
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Background: Tuberculous pleurisy has been well treated by combination therapy, but pleural thickening occurs as sequelae about 50% of the patients. To reduce residual pleural thickening, steroid or therapeutic thoracentesis have been added to traditional anti-tuberculous chemotherapy, but the effects of the treatment are debating issue. Many authors reported that the adhesion of pleura was derived from the imbalance between clottability and fibrinolytic activity of pleural fluid. We studied the relationship between the levels of D-dimer in pleural fluid and the degree of pleural thickening.
Methods: 16 patients of tuberculous pleurisy and 5 patients of malignant effusion from August, 2002 to August, 2003 were examined the levels of D-dimer in pleural fluid using semiquantitative method of Latex agglutination. Pleural biopsies were performed before treatment in all patients. After treatment for 6 months in tuberculous pleurisy, we measured the extent of pleural thickening by calculating the distance from the lateral chest wall at the level of costophrenic angle in chest X-ray films. We classified the extent of pleural thickening by groups of less (A) and more (B) than 2 mm thickness.
Results: 1) D-dimer levels in the tuberculous pleurisy and malignant effusion were 680.6516.9 ng/ml, 768.2 789.5 ng/ml. D-dimer level in the malignant effusion group was slightly higher than in the tuberculous pleurisy group, but it was not statistically significant (p0.05). 2) Difference of D-dimer levels between the amounts of pleural fluid before treatment were not statistically significant (p0.05). 3) D-dimer levels in the group A and the group B were 761351 ng/ml, 422372 ng/ml. The D-dimer levels in the group of mild pleural thickening (group A) were slightly higher than the group of more severe thickening, but it was not statistically significant (p0.05).
Conclusions: Statistical significant correlation between the levels of D-dimer and the degree of pleural thickening was not found. But, we think that the fibrinolytic system in pleural fluid would contribute to the production of pleural thickening to a certain extent.
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KEYWORD
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Tuberculous pleurisy, Pleural thickening, D-dimer
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