Zablockis Rolandas, Nargela Remigijus
Clinic of Pulmonology and Allergology, Vilnius University, Santariskiu 2, Lithuania.
Medicina (Kaunas). 2002;38(12):1171-8.
The study included 200 patients with pleural effusion. Pleural effusions were transudative in 48 (24%) and exudative in 152 (76%) of cases. Congestive cardiac failure (14.5%), nephrotic syndrome (5.5%), and liver cirrhosis (2.5%) were the most common etiological diagnoses of transudate cases. Malignant effusion (16.5%), pneumonia (13%), pleural empyema (9%), tuberculosis (6%), and pulmonary embolism (5.5%) were the most common etiological diagnoses of exudative cases. Thirty-two (16%) cases of exudative pleural effusions were of undertermined etiology. Polymorphonuclear leucocytes predominated in 48 patients with exudative pleural effusions. The most common etiological diagnoses were pneumonia (41.67%), pleural empyema (39.59%) and pulmonary embolism (10.42%). Lymphocytes in pleural fluid were predominant in 63 patients, with malignant (6.34%), tuberculous pleurisy (19.02%), pulmonary embolism (6.34%), trauma (6.34%), and (46.11%) cases in patients with pleural exudate undertermined etiology. Eosinophyls were predominant in 16 (8%) patients with exudative pleural effusions. The most common etiology of eosinophilic pleural fluid were pneumonia (37.5%), malignant pleural effusion (25%), pulmonary embolism (12.5%), pyopneumothorax (6.25%) and trauma 6.25%. From 16 patients with eosinophilic pleural exudate, in 31% cases air, in 12.5% blood in pleural fluid were determined and in 12.5% cases previous pleural puncture was performed. Pleural fluid eosinophilia is most commonly associated with the presence of air or blood in the pleural fluid (correalation index 0.82). Malignant pleural effusions were determined in 33 patients. Malignant cells in pleural fluid were identified in 25 cases. The diagnostic sensitivity of pleural fluid cytology for malignant pleural effusions were 76%. Hemoragic pleuritis was determined in 18 and hemothorax in 4 patients. Etiology of hemothorax were trauma (75%) and coaguliopathia (25%). Most common etiological diagnoses of hemoragic pleuritis were neoplasia (33.3%), pulmonary embolism (16.65%), trauma (16.65%), pneumonia (11.11%), and congestive cardiac failure (11.11%). Diagnostic sensitivity and specifity of hemoragic pleuritis is low, 58% and 45% respectively.
该研究纳入了200例胸腔积液患者。48例（24%）为漏出液，152例（76%）为渗出液。充血性心力衰竭（14.5%）、肾病综合征（5.5%）和肝硬化（2.5%）是漏出液病例最常见的病因诊断。恶性胸腔积液（16.5%）、肺炎（13%）、胸膜脓胸（9%）、肺结核（6%）和肺栓塞（5.5%）是渗出液病例最常见的病因诊断。32例（16%）渗出性胸腔积液病因不明。48例渗出性胸腔积液患者以多形核白细胞为主。最常见的病因诊断为肺炎（41.67%）、胸膜脓胸（39.59%）和肺栓塞（10.42%）。63例患者胸腔积液中淋巴细胞为主，病因不明的胸腔积液患者中，恶性（6.34%）、结核性胸膜炎（19.02%）、肺栓塞（6.34%）、创伤（6.34%）及（46.11%）。16例（8%）渗出性胸腔积液患者以嗜酸性粒细胞为主。嗜酸性胸腔积液最常见的病因是肺炎（37.5%）、恶性胸腔积液（25%）、肺栓塞（12.5%）、脓气胸（6.25%）和创伤（6.25%）。16例嗜酸性胸腔渗出液患者中，31%的病例胸腔积液中有气体，12.5%有血液，12.5%的病例曾行胸腔穿刺。胸腔积液嗜酸性粒细胞增多最常与胸腔积液中存在气体或血液有关（相关指数0.82）。33例患者诊断为恶性胸腔积液。25例胸腔积液中发现恶性细胞。胸腔积液细胞学对恶性胸腔积液的诊断敏感性为76%。18例诊断为出血性胸膜炎，4例为血胸。血胸的病因是创伤（75%）和凝血障碍（25%）。出血性胸膜炎最常见的病因诊断为肿瘤（33.3%）、肺栓塞（16.65%）、创伤（16.65%）、肺炎（11.11%）和充血性心力衰竭（11.11%）。出血性胸膜炎的诊断敏感性和特异性较低，分别为58%和45%。
