Eid Alain A, Keddissi Jean I, Samaha Michel, Tawk Maroun M, Kimmell Kristopher, Kinasewitz Gary T
Departments of Pulmonary and Critical Care Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
Chest. 2002 Nov;122(5):1518-23. doi: 10.1378/chest.122.5.1518.
Pleural effusions due to congestive heart failure (CHF) typically are transudates, but an occasional patient with CHF is found to have an exudate in the absence of an apparent cause other than CHF. We sought to determine the incidence and clinical significance of such exudative effusions.
Patients with CHF and effusions seen during the 7-year period from January 1994 through December 2000 were identified from their hospital discharge diagnoses and radiographs, while those who had undergone thoracentesis were identified from a review of the laboratory logs. The presenting symptoms and clinical course were determined from a review of the medical records. The effect of RBC contamination on pleural fluid lactate dehydrogenase (LDH) levels was determined by measuring the LDH activity of mock pleural fluid containing known amounts of RBC.
Seven hundred seventy patients had CHF with an effusion, but only 175 patients underwent a thoracentesis. In this select group, 86 patients had transudates and 89 had exudates. A noncardiac cause for the exudate was readily identified in 59 patients by hospital discharge, and 7 more patients had an etiology found during follow-up. Eleven of the remaining 23 patients had undergone coronary artery bypass graft (CABG) surgery > or = 1 year prior to presentation, and 50% of the effusions in patients who had undergone CABG surgery were exudates. Thus, CHF-related exudates were identified in only 12 patients, and in 4 of these patients the exudates could be explained by RBC contamination of the pleural fluid. The clinical presentation of patients with CHF-associated exudates was similar to that of CHF patients with transudates.
In most patients who have CHF and an exudative effusion, there is a noncardiac cause for the pleural effusion. The high frequency of exudates in patients with a history of CABG indicates a persistent impairment in lymphatic clearance from the pleural cavity. Exudative effusions due solely to CHF are rare.
充血性心力衰竭（CHF）所致胸腔积液通常为漏出液，但偶尔会发现CHF患者在无CHF以外明显病因的情况下出现渗出液。我们试图确定此类渗出性胸腔积液的发生率及临床意义。
从1994年1月至2000年12月这7年期间因CHF和胸腔积液住院的患者出院诊断及X线片记录中进行筛选，同时通过查阅实验室日志确定接受胸腔穿刺术的患者。通过查阅病历确定患者的首发症状及临床病程。通过测量含已知量红细胞的模拟胸腔积液的乳酸脱氢酶（LDH）活性，确定红细胞污染对胸腔积液LDH水平的影响。
770例患者患有CHF并伴有胸腔积液，但仅175例患者接受了胸腔穿刺术。在这一特定组中，86例患者为漏出液，89例为渗出液。出院时在59例患者中很容易确定渗出液的非心脏病因，另外7例患者在随访期间发现病因。其余23例患者中有11例在就诊前≥1年接受过冠状动脉旁路移植术（CABG），接受CABG手术患者的胸腔积液中有50%为渗出液。因此，仅在12例患者中确定为CHF相关渗出液，其中4例患者的渗出液可由胸腔积液的红细胞污染来解释。CHF相关渗出液患者的临床表现与CHF漏出液患者相似。
在大多数患有CHF和渗出性胸腔积液的患者中，胸腔积液存在非心脏病因。有CABG病史患者渗出液的高发生率表明胸腔淋巴清除持续受损。仅由CHF引起的渗出性胸腔积液很少见。
