Scheurich J W, Keuer S P, Graham D Y
Department of Medicine, Ben Taub General Hospital, Baylor College of Medicine, Houston, Tex.
South Med J. 1989 Dec;82(12):1487-91.
Pleural fluid analysis is often the initial diagnostic test used to determine the cause of a pleural effusion. We prospectively studied 33 consecutive patients with pleural effusions to determine whether the fluid arose from a transudative or an exudative process. Clinical judgment by an internist before thoracentesis and both serum and pleural fluid protein and lactic dehydrogenase levels (commonly referred to as "Light's criteria") were compared to the patient's final diagnosis. The internist correctly classified 15 of 17 exudative processes and all 16 transudative processes; the presence of any one of Light's three criteria correctly classified 15 of 17 exudative processes, whereas the absence of all three criteria correctly classified 14 of 16 transudative processes. Clinical judgment and Light's criteria are comparable in their ability to predict whether an exudative or transudative process was responsible for the effusion. Both methods are associated with errors, though of different kinds; these errors occurred infrequently. Recognizing the limitations of these methods will permit the most accurate effusion categorization.
胸腔积液分析通常是用于确定胸腔积液病因的初始诊断性检查。我们前瞻性地研究了33例连续的胸腔积液患者，以确定积液是由漏出性还是渗出性过程引起的。将内科医生在胸腔穿刺术前的临床判断以及血清和胸腔积液的蛋白及乳酸脱氢酶水平（通常称为“Light标准”）与患者的最终诊断进行比较。内科医生正确分类了17例渗出性过程中的15例以及所有16例漏出性过程；Light三项标准中任何一项的存在正确分类了17例渗出性过程中的15例，而三项标准均不存在则正确分类了16例漏出性过程中的14例。临床判断和Light标准在预测渗出性或漏出性过程是否导致积液方面能力相当。两种方法都存在误差，不过是不同类型的误差；这些误差很少发生。认识到这些方法的局限性将有助于进行最准确的积液分类。
