Odeh Majed, Kogan Yana, Sabo Edmond
Department of Internal Medicine A, Bnai Zion Medical Center, Haifa 3104802, Israel.
Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel.
Adv Respir Med. 2025 Aug 5;93(4):29. doi: 10.3390/arm93040029.
: Discrimination between various causes of exudative pleural effusion (PE) remains a major clinical challenge, and to date, definitive biochemical markers for this discrimination remain lacking. An increasing number of studies have reported that serum C-reactive protein (CRPs), pleural fluid CRP (CRPpf), and CRPpf/CRPs ratio (CRPr) are useful for the differential diagnosis of exudative PE; however, their efficacy rate is not similar in these studies. The majority of these studies were conducted on small groups of subjects, and the efficacy of the gradient between CRPs and CRPpf (CRPg-calculated as CRPs-CRPpf) in this differentiation has not been previously investigated. This study aims to evaluate the efficacy rate of CRPs, CRPpf, CRPg, and CRPr in the differential diagnoses of various causes of exudative PE in a relatively large cohort of patients. : The research group included 282 subjects with exudative PE-146 had parapneumonic effusion (PPE), 126 had malignant pleural effusion (MPE), and 10 had tuberculous pleural effusion (TPE). The values are presented as mean ± SD. : The mean CRPs level was significantly higher in the PPE group compared to the MPE group ( < 0.0001) and the TPE group ( < 0.001), and also significantly higher in the TPE group than in the MPE group ( = 0.0009). Similarly, the mean CRPpf level was significantly higher in the PPE group than in the MPE group ( < 0.0001) and the TPE group ( = 0.04), and also significantly higher in the TPE group than in the MPE group ( < 0.0001). The mean CRPg level was significantly higher in the PPE group than in both the MPE group ( < 0.0001) and the TPE group ( < 0.002). The mean CRPr level did not differ significantly among these groups of exudate. : CRPs, CRPpf, and CRPg are effective in the differential diagnosis of exudative PE, while CRPr was not effective in this regard. The main limitation of this study is that the sample size of the TPE group is very small.
鉴别渗出性胸腔积液（PE）的各种病因仍然是一项重大的临床挑战，迄今为止，仍缺乏用于这种鉴别的确定性生化标志物。越来越多的研究报告称，血清C反应蛋白（CRPs）、胸水C反应蛋白（CRPpf）以及CRPpf/CRPs比值（CRPr）可用于渗出性PE的鉴别诊断；然而，这些研究中的有效率并不相同。这些研究大多是在小样本受试者中进行的，此前尚未研究CRPs与CRPpf之间的梯度（CRPg，计算为CRPs - CRPpf）在这种鉴别中的有效性。本研究旨在评估在相对较大的患者队列中，CRPs、CRPpf、CRPg和CRPr在鉴别渗出性PE各种病因中的有效率。研究组包括282例渗出性PE患者，其中146例为类肺炎性胸腔积液（PPE），126例为恶性胸腔积液（MPE），10例为结核性胸膜炎胸腔积液（TPE）。数值以均值±标准差表示。PPE组的平均CRPs水平显著高于MPE组（<0.0001）和TPE组（<0.001），TPE组的平均CRPs水平也显著高于MPE组（=0.0009）。同样，PPE组的平均CRPpf水平显著高于MPE组（<0.0001）和TPE组（=0.04），TPE组的平均CRPpf水平也显著高于MPE组（<0.0001）。PPE组的平均CRPg水平显著高于MPE组（<0.0001）和TPE组（<0.002）。这些渗出液组之间的平均CRPr水平无显著差异。CRPs、CRPpf和CRPg在渗出性PE的鉴别诊断中有效，而CRPr在这方面无效。本研究的主要局限性在于TPE组的样本量非常小。
