[Parameters relating to the development of residual pleural thickening in tuberculous pleurisy]

To identify predictive parameters for the development of residual pleural thickening in tuberculous pleurisy, we investigated 58 tuberculous pleurisy patients retrospectively who could be followed up until their chest roentgenogram no longer changed. The patients were divided into the following three groups according to the final configuration of pleural space: group I costphrenic angle (C-P angle) of the affected side was completely or almost completely recovered (20 cases), group II C-P angle became dull (20 cases), group III pleural thickening of > 2 mm remained in the lateral chest wall above the diaphragmatic dome level (18 cases). Differences of the clinical, chest roentgenographic and laboratory data were compared between these three groups. There were no differences between groups I and II in all of the parameters compared, while there were some differences between groups I and/or II and group III. The mean age of group III (51.1 +/- 18.1 y.o.) was significantly higher than that of group I (40.7 +/- 18.6 y.o.) and group II (34.7 +/- 14.7 y.o.) (p < 0.05 and p < 0.005 respectively). Glucose level in pleural fluid of group III (32 +/- 31 mg/dl) was lower than that of group I (96 +/- 13 mg/dl) and group II (86 +/- 21 mg/dl) (p < 0.001, respectively), while the levels of LDH, TP and ADA in pleural fluid were not different significantly among three groups. BSR (blood sedimentation rate) and CRP (C-reactive protein) were higher in group III (77 +/- 30 mm/hr and 8.5 +/- 4.3 mg/dl) than those in group I (45 +/- 23 mm/hr and 4.1 +/- 5.4 mg/dl) (p < 0.01 and p < 0.05, respectively). The level of albumin in serum was lower and that of globulin was higher, and consequently that of A/G ratio in group III (0.78 +/- 0.17) was lower than that of group I (1.15 +/- 0.16) and group II (1.10 +/- 0.22) (p < 0.001, respectively). It should be emphasized that the level of gamma-globulin was higher in group III irrespective of the presence or absence of accompanying pulmonary tuberculosis. Most patients more than 40 years old with serum A/G ratio less than 0.95 belonged to group III (13/15 (87%)) while most of those with serum A/G ratio more than 0.95 belonged to group I or II (10/11 (91%)). Thus hyper (gamma-) globulinemia and the intensity of inflammatory reaction in the whole body and in the pleural space are the predictive factors for the development of residual pleural thickening in tuberculous pleurisy.