目的:探讨高龄结核性胸腔积液在临床上的鉴别诊断方法。方法:35例高龄胸腔积液患者抽出胸腔积液进行常规、生化、细菌学、腺苷脱氨酶(ADA)、癌胚抗原(CEA)、乳酸脱氢酶(LDH)、抗酸杆菌、细胞学等检查,部分患者行纤维支气管镜及胸膜活检。结果:27例胸膜活检为结核改变,占77.14%;6例纤维支气管镜找到抗酸杆菌,占17.14%。痰检查抗酸杆菌2例,占5.71%。35例均确诊为结核性胸膜炎。误诊为癌性PE者24例,心、肾功能衰竭6例,胶原性疾病3例,化脓性胸膜炎2例。结论:病理学和病原学诊断是胸腔积液的确诊手段,胸膜活检操作简单实用,创伤较小,阳性率高,适合于基层医院对高龄胸腔积液患者开展。 Objective: To investigate the clinical differential diagnosis of tuberculous pleural effusion in elderly patients. Methods: Thirty - five patients with advanced pleural effusion were treated with routine pleiotropic fluid, bacteriology, adenosine deaminase (ADA), carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH), acid - fast bacilli Learn and other tests, some patients underwent bronchoscopy and pleural biopsy. Results: Pleural biopsy in 27 cases was changed to tuberculosis, accounting for 77.14%. In 6 cases, acid-fast bacilli were found in 6 cases, accounting for 17.14%. Sputum check acid bacilli in 2 cases, accounting for 5.71%. 35 cases were diagnosed as tuberculous pleurisy. 24 cases misdiagnosed as cancerous PE, 6 cases of heart and renal failure, 3 cases of collagen disease and 2 cases of suppurative pleurisy. Conclusion: Pathological and etiological diagnosis is the diagnostic method of pleural effusion. The operation of pleural biopsy is simple and practical, with less trauma and high positive rate. It is suitable for primary hospital for patients with advanced pleural effusion.