Shinto R A, Light R W
Department of Medicine, Veterans Administration Medical Center, Long Beach, California 90822.
Am J Med. 1990 Mar;88(3):230-4. doi: 10.1016/0002-9343(90)90147-6.
The pleural fluid that accumulates secondary to congestive heart failure is almost always a transudate based upon its level of protein and lactic acid dehydrogenase (LDH). Previous work has suggested that the characteristics of the fluid may change into those of an exudate with diuresis. The purpose of the present study was to determine whether aggressive diuresis does result in this change in pleural fluid characteristics.
Twelve patients with severe congestive heart failure (ejection fraction 23.9 +/- 9.6%) and pleural effusions were studied serially as they underwent diuresis. After an initial thoracentesis was performed, the patients then underwent aggressive diuresis for 12 to 48 hours with one or two follow-up thoracentesis.
The mean weight loss during the study period was 4.5 +/- 2.8 kg. With diuresis the LDH level, LDH ratio, protein level, and protein ratio all increased significantly (p less than 0.05). All 12 patients had transudative pleural effusions at the onset of diuresis. However, despite the increases in the levels of protein and LDH with diuresis, only one patient's pleural fluid attained values compatible with an exudate.
From this study we conclude that it is uncommon for a transudative pleural effusion due to congestive heart failure to develop the characteristics of an exudative pleural effusion with rapid diuresis.
继发于充血性心力衰竭而积聚的胸腔积液，基于其蛋白质和乳酸脱氢酶（LDH）水平，几乎总是漏出液。先前的研究表明，随着利尿，液体的特征可能转变为渗出液。本研究的目的是确定积极利尿是否确实会导致胸腔积液特征的这种变化。
对12例严重充血性心力衰竭（射血分数23.9±9.6%）并伴有胸腔积液的患者在进行利尿治疗时进行了系列研究。在最初进行胸腔穿刺后，患者随后进行12至48小时的积极利尿治疗，并进行一或两次随访胸腔穿刺。
研究期间平均体重减轻4.5±2.8kg。随着利尿，LDH水平、LDH比值、蛋白质水平和蛋白质比值均显著升高（p<0.05）。所有12例患者在利尿开始时均有漏出性胸腔积液。然而，尽管随着利尿蛋白质和LDH水平升高，但只有1例患者的胸腔积液达到了与渗出液相符的值。
从本研究中我们得出结论，因充血性心力衰竭导致的漏出性胸腔积液在快速利尿时转变为渗出性胸腔积液的情况并不常见。
