Pleurisy

Purpose: Tuberculous pleurisy has been well treated by combination therapy. But, pleural thickening is shown in half of the patients after treatment is completed. To reduce the prevalence of pleural thickening, steroid or therapeutic thoracentesis was been added to traditional antituberculous chemotherapy. But, the effects has not been conformed yet. According to many reports, the adhesion of pleura is derived by imbalance between clottability and fibrinolytic activity of pleural fluid. So we measured the levels of D-dimer and degrees of fibrosis in the pleural biopsy using Messon-Trichrome stain before treatment, and measured pleural thickeness reviewed on chest X-ray after treatment. And we compared the levels of D-dimer and degree of fibrosis with extent of pleural thickening.

Methods: 16 patients were diagnosed tuberculous pleurisy. The levels of D-dimer in pleural fluid were examined using ELISA, semi-quantitative method and was also conducted pleural biopsy before treatment. The biopsy materials were stained with Messon-Trichrome and classified by 3 grades(mild, moderate, severe). After treatment, we measured the thickeness of pleura at the level of costophrenic angle on chest X-ray. The extent of pleural thickening was classified into 2 groups by the pleural thickenss. Group A was defined thickeness over 2mm and group B was below 2mm.

Results: 1. The D-dimer levels in Group A(n=9) and Group B(n=7) were 490.7 [+ or -] 307.4 and 873.1 [+ or -] 597.3. Respectively D-dimer levels is slightly higher in Group B than in group A. But, the results didn't show any stastically insignificance.(P [is greater than] 0.05)

2. The D-dimer levels divided into 3 grades(mild, moderate, severe) of pleural fluid before treatment were 1636.5 [+ or -] 583.3, 530.3 [+ or -] 260.5, and 588.8 [+ or -] 423.7. The d-dimer levels was the lowest in severe fibrotic group. But, the results of extent of pleural thickening after treatment were stastically insignificance.(p [is greater than] 0.05)

3. Ther was no relation between the degree of pleural fibrosis before treatment and extent of pleural thickening after treatment.

Conclusion. There is no significant relationship between levels of D-dimer and degree of pleural fibrosis, and extent of pleural thickening.

Clinical Implications: We might think that fibrinolytic system would contribute to the production of pleural thickening to a certain extent.

M S Baek, MD; B R Yun, MD; J O Ann, MD; Y C Kim, MD; Moon Jun Na, MD(*) and D U Kang, MD. Internal Medicine, Eul-Ji Medical College Hospital, Tae Jon, Korea, Republic of and Pathology, Eul-Ji Medical College Hospital, Tae Jon, Korea, Republic of.

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