Botana-Rial M, Casado-Rey P, Leiro-Fernández V, Andrade-Olivié Ma, Represas-Represas C, Fernández-Villar A
Unit of lnterventional Bronchopleural Pathology, Pneumology Department, Group of Investigation in Respiratory and Infectious Diseases (GIERI), Spain.
Clin Lab. 2011;57(5-6):373-8.
Procalcitonin (PCT) and C-reactive protein (CRP) measurements in pleural fluid and plasma have been proposed to facilitate differential diagnosis of pleural effusion (PE). The primary aim of this study was to evaluate the usefulness of these measurements when differentiating between benign (BPE) and malignant pleural effusion (MPE).
We prospectively studied 100 patients with the specific diagnosis of exudative PE. We analyzed the demographic data and the usual biochemical studies in PE. CRP and PCT were measured in pleural fluid and plasma before starting treatment.
The CRP levels in pleural fluid were higher in patients with BPE than in patients with MPE [33.1 mg/L (16.8 to 52.1) vs. 11.8 (5.1 to 22); p = 0.001], as were the plasma CRP levels [68.4 mg/L (26.1 to 119.1) vs. 30.2 (11.7 to 64.8); p = 0.007]. No differences in PCT levels were detected between the two patient populations. The AUC derived from the ROC curve analysis for plasma CRP and pleural fluid CRP were 0.667 (CI 95%: 0.551 - 0.782) and 0.752 (CI 95%: 0.653 - 0.852), respectively. Plasma CRP levels > or = 35.5 mg/L exhibited 71% sensitivity and 56% specificity in discriminating between BPE and MPE. Pleural fluid CRP levels > or = 16.7 mg/L had 75% sensitivity and 68% specificity in the diagnosis of BPE.
CRP levels in the pleural fluid and plasma were higher in patients with BPE, particulary infectious PE. However, the measurement of CRP and PCT is not a useful parameter for discriminating between BPE and MPE and does not provide useful information in clinical practice.
有人提出通过检测胸腔积液和血浆中的降钙素原（PCT）和C反应蛋白（CRP）来辅助胸腔积液（PE）的鉴别诊断。本研究的主要目的是评估这些检测指标在鉴别良性胸腔积液（BPE）和恶性胸腔积液（MPE）时的有效性。
我们对100例确诊为渗出性PE的患者进行了前瞻性研究。分析了PE患者的人口统计学数据及常规生化检查结果。在开始治疗前检测胸腔积液和血浆中的CRP和PCT。
BPE患者胸腔积液中的CRP水平高于MPE患者[33.1mg/L（16.8至52.1）vs.11.8（5.1至22）；p = 0.001]，血浆CRP水平也是如此[68.4mg/L（26.1至119.1）vs.30.2（11.7至64.8）；p = 0.007]。两组患者的PCT水平未检测到差异。血浆CRP和胸腔积液CRP的ROC曲线分析得出的AUC分别为0.667（95%CI：0.551 - 0.782）和0.752（95%CI：0.653 - 0.852）。血浆CRP水平≥35.5mg/L在鉴别BPE和MPE时的敏感性为71%，特异性为56%。胸腔积液CRP水平≥16.7mg/L诊断BPE的敏感性为75%，特异性为68%。
BPE患者，尤其是感染性PE患者，胸腔积液和血浆中的CRP水平较高。然而，检测CRP和PCT并非鉴别BPE和MPE的有用参数，在临床实践中无法提供有用信息。
