C反应蛋白在胸腔积液鉴别诊断中的价值

Use of pleural fluid C-reactive protein in differential diagnosis of pleural effusions

目的 探讨胸液及血清C -反应蛋白 (CRP)在胸腔积液鉴别诊断中的价值。 方法 前瞻性地对 12 9例不同病因入院的胸腔积液病人检测胸液及血清中CRP的水平。 结果 胸水CRP在良性渗出液组最高 (肺炎组比结核组更高 ) ,恶性渗出液组次之 ,漏出液组最低 ,差异有统计学意义。胸水CRP和血清CRP浓度有中度相关性 ,相关系数r =0 .6 7(P <0 .0 0 1)。若以CRP >2 0mg L为标准 ,则诊断良性胸腔积液的敏感性为 89.1% ,特异性为 10 0 % ,阳性预测值为 10 0 % ,阴性预测值为 88.2 %。 结论 胸水CRP是一个较好的鉴别良恶性胸腔积液的生化指标 ,特别对于鉴别炎症性胸水。

Objective To investigate the use of serumal and pleural fluid C-reactive protien in differential diagnosis of pleural effusions. Methods We studied the usefulness of pleural fluid C-reactive protein measurement in a population of 129 patients with pleural effusion, by means of an immunoturbidimetric method. A comparison of pleural effusion C-reactive protein levels in different subgroups of patients with effusion was made. Results According to present diagnostic criteria, 13 patients were classified as transudates and the mean pleural fluid CRP(2.5±0.8 mg/L, P<0.01) were significantly lower than those in the exudate effusion groups. Among the 116 patients with exudate effusion, 52 patients were caused by neoplastic disease and the pleural fluid CRP mean (7.1±1.3mg/L, P<0.001) were significantly lower than those in exudates from pneumonic effusions (71.7±12.6mg/L,P<0.01) and than those in the exudates from patients with effusion associated with tuberculosis (32.9±10.5 mg/L, P<0.001). There was a correlation between the pleural and serumal C-reactive protein (r=0.67,P<0.001). Pleural fluid CRP>20mg/L had good sensitivity ( 89.1 %), specificity (100%) and predictive value of positivity (100%) in the diagnosis of exudate effusions and higher CRP-levels may prove to be a practical, accurate and rapid method for differentiating pneumonic effusions and effusions associated with tuberculosis from others. Conclusions Quantitative immunoturbidimetric assay of pleural fluid C-reactive protein will be a useful diagnostic method to differentiate pleural effusions with bacterial origin from others.