鉴别淋巴瘤相关积液的诊断陷阱。

Diagnostic pitfalls of discriminating lymphoma-associated effusions.

作者信息

Chen Hung-Jen, Huang Kuo-Yang, Tseng Guan-Chin, Chen Li-Hsiou, Bai Li-Yuan, Liang Shinn-Jye, Tu Chih-Yen, Light Richard W

机构信息

From the Division of Pulmonary and Critical Care Medicine (H-JC, K-YH, S-JL, C-YT); Department of Internal Medicine (H-JC, K-YH, L-YB, S-JL, C-YT); Department of Pathology (G-CT); Division of Hematology and Oncology (L-YB), China Medical University Hospital; Department of Respiratory Therapy (H-JC, S-JL), China Medical University; Department of Internal Medicine (L-HC), Buddhist Tzu-Chi General Hospital, Taichung, Taiwan; and Division of Allergy, Pulmonary and Critical Care Medicine (RWL), Vanderbilt University Medical Center, Nashville, Tennessee, USA.

出版信息

Medicine (Baltimore). 2015 May;94(17):e800. doi: 10.1097/MD.0000000000000800.

DOI:10.1097/MD.0000000000000800

PMID:25929933

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4603050/

Abstract

High serum lactate dehydrogenase (LDH) level, immunologic defects, enlarged mediastinal lymph nodes, and frequent hydration and diuresis in lymphoma patients may affect the development of pleural effusion (PE). The study was to assess the clinical utility of "Light criteria" and the "recommended algorithm for investigating PEs" in patients with lymphoma.The characteristics of 126 PEs of lymphoma patients who underwent diagnostic thoracentesis between January 1, 2003, and April 30, 2012, were reviewed. Using Light criteria, 29 (23%) PEs were incorrectly classified. The sensitivity for exudates in Light criteria was 88% and the specificity was only 44%. In 32 transudates, PE LDH correlated with blood LDH concentration (P < 0.001, r = 0.66). Nine transudates were misclassified as exudates (50%; 9/18) just due to PE LDH more than two-thirds the upper limits. Among the 56 bilateral PEs, 33 (59%) were exudates. Ten (63%) polymorphonuclear (PMN)-predominant exudative PEs were malignant. Infective PEs were often mononuclear (67%) rather than PMN predominant.When a patient has lymphoma with either unilateral or bilateral PE, thoracentesis for microbiological testing and cytology is imperative. Carefully clinical correlation in addition to the result from Light criteria and differential cell count is essential for prompt management.

摘要

淋巴瘤患者血清乳酸脱氢酶（LDH）水平升高、免疫缺陷、纵隔淋巴结肿大以及频繁补液和利尿可能会影响胸腔积液（PE）的发生。本研究旨在评估“Light标准”和“胸腔积液调查推荐算法”在淋巴瘤患者中的临床应用价值。回顾了2003年1月1日至2012年4月30日期间接受诊断性胸腔穿刺术的126例淋巴瘤患者胸腔积液的特征。根据Light标准，29例（23%）胸腔积液被错误分类。Light标准对渗出液的敏感性为88%，特异性仅为44%。在32例漏出液中，胸腔积液LDH与血液LDH浓度相关（P<0.001，r=0.66）。9例漏出液仅因胸腔积液LDH超过上限的三分之二而被误诊为渗出液（50%；9/18）。在56例双侧胸腔积液中，33例（59%）为渗出液。10例（63%）以多形核白细胞（PMN）为主的渗出性胸腔积液为恶性。感染性胸腔积液通常以单核细胞为主（67%），而非以PMN为主。当患者患有淋巴瘤并伴有单侧或双侧胸腔积液时，必须进行胸腔穿刺术以进行微生物检测和细胞学检查。除了Light标准和细胞分类计数结果外，仔细的临床相关性分析对于及时处理至关重要。