Salomaa E R, Viander M, Saaresranta T, Terho E O
Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital, Finland.
Chest. 1998 Sep;114(3):723-30. doi: 10.1378/chest.114.3.723.
The aim of this study was to determine the role of complement components in pleural effusion measured with novel markers of complement activation, to assess which pathway of activation is predominant in different diseases, and to find out whether the analysis of complement components and their activation products could help in diagnostic procedure differentiating the etiologies of pleural effusion.
The study population consisted of 71 patients who had pleural effusion secondary to tuberculosis (n=23), rheumatic disease (n=10), or malignancy (n=38).
Complement components and their activation products, including the soluble terminal complex SC5b-9, were measured in plasma and pleural fluid.
In all patients with rheumatic pleurisy, pleural fluid SC5b-9 was higher than 2 AU/mL and in all patients with malignant pleural fluid it was lower than 2 AU/mL. The mean level of SC5b-9 in rheumatic pleural effusion was also significantly higher than in tuberculosis. In addition, the concentrations of pleural fluid C3 and C4 were significantly lower and the ratio C4d/C4 was significantly higher in rheumatic compared with tuberculous or malignant pleurisy. In plasma, both SC5b-9 and C1s-C1r-C1INH-complexes were significantly higher in rheumatic subjects than in other patients. In stepwise multinominal logistic regression analyses, the most significant predictors for rheumatic pleural fluid were high pleural fluid SC5b-9 and low C4.
These observations indicate that the complement cascade is activated through both the classic and the alternative pathways in rheumatic pleurisy. Determinations of SC5b-9 and C4d/C4 in pleural fluid were the best variables differentiating rheumatic, tuberculous, and malignant effusions.
本研究旨在通过补体激活的新型标志物确定补体成分在胸腔积液中的作用，评估不同疾病中哪种激活途径占主导地位，并探究补体成分及其激活产物的分析是否有助于鉴别胸腔积液病因的诊断程序。
研究人群包括71例继发于肺结核（n = 23）、风湿性疾病（n = 10）或恶性肿瘤（n = 38）的胸腔积液患者。
在血浆和胸腔积液中测量补体成分及其激活产物，包括可溶性终末复合物SC5b - 9。
在所有风湿性胸膜炎患者中，胸腔积液SC5b - 9高于2 AU/mL，而在所有恶性胸腔积液患者中，其低于2 AU/mL。风湿性胸腔积液中SC5b - 9的平均水平也显著高于肺结核患者。此外，与结核性或恶性胸膜炎相比，风湿性胸膜炎患者胸腔积液中C3和C4的浓度显著降低，C4d/C4比值显著升高。在血浆中，风湿性疾病患者的SC5b - 9和C1s - C1r - C1INH复合物均显著高于其他患者。在逐步多项逻辑回归分析中，风湿性胸腔积液的最显著预测指标是胸腔积液中SC5b - 9高和C4低。
这些观察结果表明，在风湿性胸膜炎中补体级联反应通过经典途径和替代途径均被激活。胸腔积液中SC5b - 9和C4d/C4的测定是区分风湿性、结核性和恶性胸腔积液的最佳变量。
