Klech H, Rona G, Knoth E, Kummer F, Bayer P M
2. Medizinische Abteilung, Wilhelminenspital, Wien, Osterreich.
Klin Wochenschr. 1988 Apr 15;66(8):346-50. doi: 10.1007/BF01735792.
Polymorphonuclear (PMN) granulocyte derived neutrophil elastase (NE) is rapidly antagonized by alpha 1-proteinase inhibitor (alpha 1 PI) in vivo. To determine the clinical value of elastase alpha 1-proteinase inhibitor complexes (E-alpha 1 PI) in pleural effusions, fluid samples of 99 patients were examined. Fifty-six had malignant effusions, 30 had non-malignant exudates (pleural protein above 3 g/dl) mainly of inflammatory origin, and 13 patients had low protein transudates (below 3 g/dl) due to congestive heart failure. Nonmalignant exudates showed significantly higher (P less than 0.001) concentrations of E-alpha 1 PI compared with malignant effusions or low protein transudates (P less than 0.001). Malignant exudates secondary to lung cancer were characterized by higher (P less than 0.001) median pleural E-alpha 1 PI concentrations compared to malignant exudates due to primarily extrathoracic malignancies. Total pleural leukocyte counts and pleural neutrophil counts were performed in 68 effusions. By this means no clear-cut differentiation between malignant and nonmalignant exudates seems possible except for marked empyema. In conclusion, E-alpha 1 PI complexes in pleural fluid may better reflect the stage of inflammation of pleural effusions rather than mere pleural leukocyte counts. Low levels of E-alpha 1 PI complexes (less than 75 ng/ml) in pleural exudates with protein values above 3 g/dl are characteristic of malignant exudates. Determination of E-alpha 1 PI in pleural exudates may serve as a sensitive marker of inflammation and useful adjunct to pleural cytology in aspects of differential diagnosis of pleural effusions.
多形核（PMN）粒细胞衍生的中性粒细胞弹性蛋白酶（NE）在体内会迅速被α1-蛋白酶抑制剂（α1 PI）拮抗。为了确定弹性蛋白酶α1-蛋白酶抑制剂复合物（E-α1 PI）在胸腔积液中的临床价值，对99例患者的液体样本进行了检查。56例有恶性胸腔积液，30例有主要为炎症性起源的非恶性渗出液（胸腔蛋白高于3 g/dl），13例因充血性心力衰竭有低蛋白漏出液（低于3 g/dl）。与恶性胸腔积液或低蛋白漏出液相比，非恶性渗出液中E-α1 PI的浓度显著更高（P<0.001）。与主要源于胸外恶性肿瘤的恶性渗出液相比，肺癌继发的恶性渗出液的胸腔E-α1 PI中位数浓度更高（P<0.001）。对68例胸腔积液进行了总胸腔白细胞计数和胸腔中性粒细胞计数。通过这种方法，除了明显的脓胸外，似乎无法在恶性和非恶性渗出液之间进行明确区分。总之，胸腔积液中的E-α1 PI复合物可能更好地反映胸腔积液的炎症阶段，而不仅仅是胸腔白细胞计数。蛋白值高于3 g/dl的胸腔渗出液中E-α1 PI复合物水平低（低于75 ng/ml）是恶性渗出液的特征。测定胸腔渗出液中的E-α1 PI可作为炎症的敏感标志物，在胸腔积液的鉴别诊断方面是胸腔细胞学的有用辅助手段。
