Daniil Z D, Zintzaras E, Kiropoulos T, Papaioannou A I, Koutsokera A, Kastanis A, Gourgoulianis K I
Department of Respiratory Medicine, University of Thessaly School of Medicine, Larissa, Greece.
Eur Respir J. 2007 Nov;30(5):957-64. doi: 10.1183/09031936.00126306. Epub 2007 Aug 9.
Pleural effusion is a common complication of various diseases. Conventional methods are not always capable of establishing the cause of pleural effusion, so alternative tests are needed. The aim of this study was to explore means of discriminating between different pleural effusion groups, malignant, parapneumonic and tuberculous, based on the combined function of seven biological markers. Adenosine deaminase (ADA), interferon-gamma, C-reactive protein (CRP), carcinoembryonic antigen, interleukin-6, tumour necrosis factor-alpha and vascular endothelial growth factor concentration levels were measured in pleural fluid from 45 patients with malignant, 15 with parapneumonic and 12 with tuberculous pleural effusion. Receiver operating characteristic curve analysis, multinomial logit modelling and canonical variate analysis were applied to discriminate the pleural effusion groups. The three groups could be discriminated successfully using the measured markers. The most important parameters for discrimination were ADA and CRP concentration levels. An individual with an ADA concentration level of >45 U.L(-1) and a CRP concentration of <4 mg.dL(-1) was more likely to belong to the tuberculous pleural effusion group, whereas one with an ADA concentration level of <40 U.L(-1) and a CRP concentration of >6 mg.dL(-1) was more likely to belong to the parapneumonic pleural effusion group, and one with a CRP concentration of <4 mg.dL(-1) to the malignant pleural effusion group. The combination of adenosine deaminase and C-reactive protein levels might be sufficient for discriminating between the three different groups of exudative pleural effusion: malignant, tuberculous and parapneumonic.
胸腔积液是多种疾病的常见并发症。传统方法并不总是能够确定胸腔积液的病因，因此需要其他检测方法。本研究的目的是基于七种生物标志物的联合作用，探索区分不同胸腔积液组（恶性、肺炎旁和结核性）的方法。对45例恶性胸腔积液患者、15例肺炎旁胸腔积液患者和12例结核性胸腔积液患者的胸腔积液中的腺苷脱氨酶（ADA）、干扰素-γ、C反应蛋白（CRP）、癌胚抗原、白细胞介素-6、肿瘤坏死因子-α和血管内皮生长因子浓度水平进行了测量。应用受试者工作特征曲线分析、多项logit模型和典型变量分析来区分胸腔积液组。使用所测标志物能够成功区分这三组。区分的最重要参数是ADA和CRP浓度水平。ADA浓度水平>45 U.L(-1)且CRP浓度<4 mg.dL(-1)的个体更可能属于结核性胸腔积液组，而ADA浓度水平<40 U.L(-1)且CRP浓度>6 mg.dL(-1)的个体更可能属于肺炎旁胸腔积液组，CRP浓度<4 mg.dL(-1)的个体更可能属于恶性胸腔积液组。腺苷脱氨酶和C反应蛋白水平的联合可能足以区分渗出性胸腔积液的三种不同类型：恶性、结核性和肺炎旁。
