Walker Steven, Maskell Nick
Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
Curr Opin Pulm Med. 2017 Jul;23(4):339-345. doi: 10.1097/MCP.0000000000000388.
Historically, pleural effusions have been attributed to a single cause. There is growing recognition that a substantial proportion of pleural effusions may have more than one underlying cause. The purpose of this review is to summarise recent findings regarding the diagnosis and treatment of effusions secondary to more than one aetiology.
A recent prospective study identified that 30% of pleural effusions had more than one underlying aetiology. With a rising prevalence of cardiovascular and malignant disease, the incidence of the complex pleural patient is increasing. The use of biomarkers, including pro-B-type natriuretic peptide, have been suggested as a way of identifying contributing disease process.
Understanding that there are potentially concurrent causes to a pleural effusion is vital in establishing the diagnoses of multiple underlying aetiologies. New diagnostic pathways, with increasing use of biomarkers, will be required to identify the complex pleural effusion. Further studies on whether the targeting of separate aetiologies improves outcomes will help develop future management strategies.
过去，胸腔积液一直被认为是由单一原因引起的。现在越来越多的人认识到，相当一部分胸腔积液可能有不止一个潜在病因。本综述的目的是总结关于多种病因所致胸腔积液诊断和治疗的最新研究结果。
最近一项前瞻性研究发现，30%的胸腔积液有不止一个潜在病因。随着心血管疾病和恶性疾病患病率的上升，复杂胸腔疾病患者的发病率也在增加。有人建议使用包括前B型利钠肽在内的生物标志物来识别相关疾病过程。
认识到胸腔积液可能存在多种并发病因对于诊断多种潜在病因至关重要。需要新的诊断途径，并增加生物标志物的使用，以识别复杂的胸腔积液。关于针对不同病因进行治疗是否能改善治疗效果的进一步研究，将有助于制定未来的管理策略。
