| ObjectiveThe research aimed to study the potential causes of pleural adhesion of tuberculous pleurisyfrom the points of view of pleural Th1/Th2 immunity and clinical manifestations.MethodsThe Pleural effusion levels of IFN-γ,IL-4 are measured by double antibody sandwichELISA in 44 patients with TB and 22 patients with malignant effusions. The tuberculouseffusions are divided into loculated and free-flowing groups by imagine studies as well asdivided into "＜1month" and "＞1month" groups according to the course of disease. As a result, patients with TB are divided into 4 groups: loculated or free-flowing effusions in＜1month ofcourse of disease, loculated or free-flowing effusions in＞1month of course of disease. ThePleural fluid levels of IFN-γ,IL-4 are compared between different groups.The occurrence rates of symptoms such as fever, night sweat, chest ache, and dyspnea arealso studied, while the cell counts, concentrations of protein and LDH of effusions in all groupsare studied too.ResultsThe mean levels of IFN-γin the tuberculous effusions(1238.7pg/ml) are significantlyhigher than in the malignant effusions(87.8pg/ml)(P＜0.01), while those of IL-4 in these twogroups are similar(55.96pg/ml in tuberculous effusions, 53.68pg/ml in malignant effusions, P＞0.05).The mean levels of IFN-γin cases of TB in the course of disease less than 1month(1536.14pg/ml) are significantly higher than those in the course of disease longer than 1month(766.35pg/ml, P＜0.01), while those of IL-4 in these two groups are similar(53.33pg/ml vs60.14pg/ml, P＞0.05). The mean levels of IFN-γin cases of TB which developed loculated effusions in less than1 month of the course of disease(1961.91pg/ml) are significantly higher than those in thefree-flowing group of the same course(1140.79pg/ml)(P＜0.01), however, the differencedisappeared after one month of the course of disease. Moreover, there are no differences of IL-4in all groups.The mean occurrence age and occurrence rate of fever in the TB cases are significantlylarger than in the Malignant cases (36.8years vs 62.7years, P＜0.01).The Pleural fluid levels of cell count, protein and LDH are similar in the TB and theMalignant groups. Moreover, there are no differences of all these parameters in the loculated andfree-flowing groups of TB cases, either.The occurrence rates of symptoms such as fever, night sweat, chest ache, and dyspnea areall similar in all TB cases. The occurrence rates of pleural adhesion is 58.82％in cases morethan 1 month and 48.15％in cases less than 1 month, but the difference is not statisticallysignificant.ConclusionThe Th1 immunity response is enhanced in tuberculous effusions, especially in the earlystage of disease. However, too intensive Th1 response may lead to adhesion of pleura.The enhanced Th1 immunity response seems to become normal dynamically with the cureof the disease, while the Th2 immunity response seems no significant change during the processof disease.The Pleural fluid level of IFN-γseems to be a good parameter for the differentiatingdiagnosis between tuberculous and malignant effusions.The Th1 immunity response is so intensive in the early stage of the disease that it mayeasily cause adhesion of pleura, therefore, early treatment is very important.The occurrence age may help in the differentiating diagnosis between tuberculous andmalignant effusions: Tuberculous effusions mainly happened in young people while malignanteffusions in old people. The occurrence of fever may also help: Patients with fever point to TB, otherwise, malignant effusions.The occurrence rates of symptoms such as fever, night sweat, chest ache, and dyspnea are all similar in the loculated and free-flowing groups of TB cases, so did the Pleural fluid levels ofcell count, protein and LDH. Therefore, it would be unadvisable to predict pleural adhesion fromthe point of view of clinical manifestations. However, delay of treatment may cause pleuraladhesion.
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