Limthongkul S, Charoenlap P, Nuchprayoon C, Songkhla Y N
Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 1990 Aug;73(8):429-32.
The relationships between pleural fluid pH and PO2 to pleural fluid PO2, amylase, protein, glucose, white cell count were examined in 110 cases of tuberculous and 140 cases of malignant pleural effusions. Pleural fluid amylase concentrations of 200 or more units/ml indicated malignant effusions rather than tuberculous effusions with a specificity of 92.7 per cent and sensitivity of 27.1 per cent. There was evidence which suggested that the increasing pleural fluid amylase concentrations were due to the excessive leakage of serum amylase into the pleural cavity secondary to the break-down of capillaries by tuberculosis and malignancy as well as the production of amylase by tumor cells invading the pleura. The decreasing pleural fluid pH and increasing pleural fluid PCO2 had a significant linear relationship with decreasing fluid PO2, increasing pleural fluid protein and decreasing fluid glucose. These indicated a leakage of serum protein into the pleural cavity and the over-utilization of glucose relative to the transport defect of low pleural fluid glucose concentrations in the acidotic fluid of tuberculous and malignant effusions. No relationship between pleural fluid pH and PCO2 to pleural fluid and white cell count was found in the present study.
对110例结核性胸腔积液患者和140例恶性胸腔积液患者的胸水pH值、胸水PO2与胸水PO2、淀粉酶、蛋白质、葡萄糖、白细胞计数之间的关系进行了研究。胸水淀粉酶浓度达到或超过200单位/毫升提示为恶性胸腔积液而非结核性胸腔积液，其特异性为92.7%，敏感性为27.1%。有证据表明，胸水淀粉酶浓度升高是由于结核和恶性肿瘤导致毛细血管破裂，血清淀粉酶过多漏入胸腔，以及肿瘤细胞侵犯胸膜产生淀粉酶所致。胸水pH值降低和胸水PCO2升高与胸水PO2降低、胸水蛋白质升高和胸水葡萄糖降低呈显著线性关系。这些表明血清蛋白漏入胸腔，以及在结核性和恶性胸水的酸性液体中，相对于低胸水葡萄糖浓度的转运缺陷，葡萄糖过度利用。在本研究中未发现胸水pH值和PCO2与胸水及白细胞计数之间存在关联。
