Adelman M, Albelda S M, Gottlieb J, Haponik E F
Am J Med. 1984 Nov;77(5):915-20. doi: 10.1016/0002-9343(84)90542-4.
It has been stated that pleural fluid eosinophilia (defined as greater than 10 percent eosinophils in the pleural white cell differential count) is not helpful in the diagnosis of exudative effusions. By review of the recent literature, it was found that pleural fluid eosinophilia was associated most often with idiopathic effusions or with air previously introduced into the pleural space. Also, a high proportion of "idiopathic" and benign asbestos effusions were characterized by pleural fluid eosinophilia, a previously unrecognized phenomenon. The diagnostic utility of finding eosinophils in the pleural space was assessed from its impact on prior probabilities of disease. Estimates of pretest likelihoods of malignant versus nonmalignant pleural effusions and the prevalence of eosinophilia in effusions of known cause were obtained from extensive literature review. These were modified by using Bayes' rule to estimate the revised probability of disease in the presence of an eosinophilic effusion. The presence of pleural fluid eosinophilia considerably reduced the probability of malignancy or tuberculosis and increased the likelihood of an underlying benign disorder. Pleural fluid eosinophilia is a useful finding that can aid in the diagnosis of an exudative pleural effusion.
有人指出，胸腔积液嗜酸性粒细胞增多（定义为胸腔白细胞分类计数中嗜酸性粒细胞大于10%）对渗出性胸腔积液的诊断并无帮助。通过回顾近期文献发现，胸腔积液嗜酸性粒细胞增多最常与特发性胸腔积液或先前进入胸腔的空气有关。此外，高比例的“特发性”和良性石棉性胸腔积液的特征是胸腔积液嗜酸性粒细胞增多，这是一种先前未被认识的现象。通过其对疾病先验概率的影响来评估在胸腔积液中发现嗜酸性粒细胞的诊断效用。通过广泛的文献回顾，获得了恶性与非恶性胸腔积液的预测试验可能性估计值以及已知病因的胸腔积液中嗜酸性粒细胞增多的患病率。利用贝叶斯法则对这些估计值进行修正，以估计嗜酸性胸腔积液存在时疾病的修正概率。胸腔积液嗜酸性粒细胞增多显著降低了恶性肿瘤或结核病的概率，并增加了潜在良性疾病的可能性。胸腔积液嗜酸性粒细胞增多是一项有用的发现，有助于渗出性胸腔积液的诊断。
