누출성 흉수 대 삼출성 흉수
Transudates vs. Exudates Pleural Effusion
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참고문헌
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초록
누출성 흉수와 삼출성 흉수의 감별에 Light’s criteria가 가장 중요하며 누출성 병변은 기저 질환의 치료가 중요하고, 삼출성 병변은 흉수의 모양, 세포수, 세포 분획, 미생물, 세포 검사, 당 농도, pH, 지질 분석, ADA 수치, 흉막 생검을 통하여 원인 질환의 감별과 치료에 이용한다.
Abstract
Pleural effusions are common and of highly diverse etiologies. These effusions can form based on disease of the pleural membranes themselves or of thoracic or abdominal organs. In initial approach, these effusions can be separated as exudates or transudates with Light's criteria. Exudative pleural effusions meet at least one of the following criteria, whereas transudative effusions meet none: pleural fluid protein-to-serum protein ratio of more than 0.5, pleural fluid lactate dehydrogenase (LDH)-to-serum LDH ratio of more than 0.6, and pleural fluid LDH more than two thirds of the upper normal limit for serum. If a patient appears to have clinically a transudative effusion, additional tests can be assessed to verify its transudative etiology. Congestive heart failure and cirrhosis are responsible for almost all transudative pleural effusions. However, it has been determined that the patient has an exudative pleural effusion, one should attempt to determine which of the diseases, remembering that pneumonia, malignancy, and tuberculosis account for the great majority of all exudative pleural effusions. In all patients with undiagnosed exudative pleural effusions, the appearance of the fluid should be noted, and the pleural fluid protein and LDH levels, glucose level, differential cell count, and microbiologic and cytologic studies should be obtained. In selected patients, other tests on the pleural fluid, such as pH, amylase level, antinuclear antibody level, rheumatoid factor level, adenosine deaminase, lipid analysis, and so forth, may be of value. (Korean J Med 2011;81:135-142)
참고문헌 (32)
- Albertine KH, "No evidence for mesothelial cell contact across the costal pleural space of sheep", J Appl Physiol, 70, pp.123~134 (1991)
- Murray JF, "The Normal Lung. 2nd ed" (1986), WB Saunders
- Broaddus VC, "Physiology: fluid and solute exchange in normal physiological states. In Textbook of Pleural Diseases", pp.43~48 (2008), Hodder Arnold
- Leckie WJ, "Albumin turnover in pleural effusions", Clin Sci, 29, pp.339~352 (1965)
- Broaddus VC, "Clearance of lung edema into the pleural space of volume-loaded, anesthetized sheep", J Appl Physiol, 68, pp.2623~2630 (1990)
- Broaddus VC, "Transudative pleural effusions. In Pleural Diseases (European Respiratory Monograph)", pp.157~176 (2002), ERS Journals, Ltd
- Light RW, "Pleural Diseases. 5th ed" (2007), Lippincott Williams & Wilkins
- Lee HK, "Clinical features of tapped pleural effusion in four Busan University Hospitals", Tuber Respir Dis, 65(Sup 1), pp.53~ (2008)
- Romero-Candeira S, "Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart f", Am J Med, 110, pp.681~686 (2001)
- Light RW, "Pleural effusions: the diagnostic separation of transudates and exudates", Ann Intern Med, 77, pp.507~513 (1972)
- Valdés L, "Cholesterol: a useful parameter for distinguishing between pleural exudates and transudates", Chest, 99, pp.1097~1102 (1991)
- Costa M, "Measurement of pleural fluid cholesterol and lactate dehydrogenase: a simple and accurate set of indicators for separating exudates from transudates", Chest, 108, pp.1260~1263 (1995)
- Roth BJ, "The serum-effusion albumin gradient in the evaluation of pleural effusions", Chest, 98, pp.546~549 (1990)
- Meisel S, "Pleural fluid to serum bilirubin concentration ratio for the separation of transudates from exudates", Chest, 98, pp.141~144 (1990)
- Garcia-Pachon E, "Pleural fluid to serum cholinesterase ratio for the separation of transudates and exudates", Chest, 110, pp.97~101 (1996)
- Romero S, "Evaluation of different criteria for the separation of pleural transudates from exudates", Chest, 104, pp.339~404 (1993)
- Burgess LJ, "Comparative analysis of the biochemical parameters used to distinguish between pleural transudates and exudates", Chest, 107, pp.1604~1609 (1995)
- Porcel JM, "Biomarkers of heart failure in pleural fluid", Chest, 136, pp.671~677 (2009)
- Heffner JE, "A meta-analysis derivation of continuous likelihood ratios for diagnosing pleural fluid exudates", Am J Respir Crit Care Med, 167, pp.1591~1599 (2003)
- Peterman TA, "Evaluating pleural effusions: a two-stage laboratory approach", JAMA, 252, pp.1051~1053 (1984)
- Light RW, "Cells in pleural fluid: their value in differential diagnosis", Arch Intern Med, 132, pp.854~860 (1973)
- Noppen M, "Volume and cellular content of normal pleural fluid in humans examined by pleural lavage", Am J Respir Crit Care Med, 162, pp.1023~1026 (2000)
- Romero Candeira S, "Biochemical and cytologic characteristics of pleural effusions secondary to pulmonary embolism", Chest, 121, pp.465~469 (2002)
- Kalomenidis I, "Eosinophilic pleural effusions", Curr Opin Pulm Med, 9, pp.254~260 (2003)
- Light RW, "Parapneumonic effusions", Am J Med, 69, pp.507~512 (1980)
- Ferrer JS, "Evolution of idiopathic pleural effusion: a prospective, long-term follow-up study", Chest, 109, pp.1508~1513 (1996)
- Villena V, "Interferon gamma levels in pleural fluid for the diagnosis of tuberculosis", Am J Med, 115, pp.365~370 (2003)
- Su WJ, "Recent advances in the molecular diagnosis of tuberculosis", J Microbiol Immunol Infect, 35, pp.209~214 (2002)
- Cronin P, "The role of multidetector computed tomography angiography for the diagnosis of pulmonary embolism", Semin Nucl Med, 38, pp.418~431 (2008)
- Maskell NA, "Standard pleural biopsy versus CT-guided cutting-needle biopsy for diagnosis of malignant disease in pleural effusions: a randomized controlled trial", Lancet, 361, pp.1326~1330 (2003)
- Casal RF, "Medical thoracoscopy", Curr Opin Pulm Med, 15, pp.313~320 (2009)
- Ryan CJ, "The outcome of patients with pleural effusion of indeterminate cause at thoracotomy", Mayo Clin Proc, 56, pp.145~149 (1981)