THE SERUM-EFFUSION ALBUMIN GRADIENT IN THE EVALUATION OF PLEURAL EFFUSIONS
THE SERUM-EFFUSION ALBUMIN GRADIENT IN THE EVALUATION OF PLEURAL EFFUSIONS
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DOI：
10.1378/chest.98.3.546
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发表时间：
1990-09-01
期刊：
影响因子：
9.6
通讯作者：
CRAGUN, WH
中科院分区：
文献类型：
--
作者：
ROTH, BJ;OMEARA, TF;CRAGUN, WH
本研究的目的是比较血清-渗出液白蛋白梯度（血清白蛋白水平减去胸腔积液白蛋白水平）与Light的传统标准（胸腔积液/血清总蛋白比> 0.5，胸腔积液/血清LDH比> 0.6，胸腔积液LDH > 200 U/L），以识别渗出性胸腔积液。研究设计包括前瞻性测量一所军事教学医院住院病房的胸腔积液患者的血清-渗出液白蛋白梯度和Light标准。连续59例胸腔积液患者接受诊断性或治疗性胸腔穿刺术，其中可以确定积液的病因。测量血清和胸腔积液的化学成分，以确定血清-积液白蛋白梯度和Light标准。使用1.2 g/dl或更低的白蛋白梯度指示渗出液，大于1.2 g/dl指示漏出液，59例患者中的57例（41例渗出液; 18例漏出液）被正确分类。两名恶性积液患者被错误分类为有漏出液。尽管Light的标准正确识别了渗出物，但5例充血性心力衰竭患者被错误分类为渗出物。其中4例患者既往接受过利尿剂治疗，所有患者对进一步利尿剂治疗均有临床反应。我们的结论是，尽管Light的渗出液标准非常敏感，但1.2 g/dl或更低的白蛋白梯度往往更具特异性，特别是在慢性充血性心力衰竭的情况下。
The objective of the study was to compare the serum-effusion albumin gradient (serum albumin level minus pleural effusion albumin level) to Light''s traditional criteria (pleural fluid/serum total protein ratio > 0.5, pleural fluid/serum LDH ratio > 0.6, and pleural fluid LDH > 200 U/L) for identifying exudative pleural effusions. The design included prospective measurement of the serum-effusion albumin gradient and Light''s criteria in patients with pleural effusions in an inpatient ward in a military teaching hospital. Fifty-nine consecutive patients with pleural effusions who were undergoing diagnostic or therapeutic thoracentesis in whom the etiology of the effusion could be determined were studied. Serum and pleural effusion fluid chemistries were measured in order to determine both the serum-effusion albumin gradient and Light''s criteria. Using an albumin gradient of 1.2 g/dl or less to indicate exudates and greater than 1.2 g/dl to indicate transudates, 57 of the 59 patients (41 exudates; 18 transudates) were correctly classified. Two patients with malignant effusions were misclassified as having transudates. Although Light''s criteria correctly identified of the exudates, five patients with congestive heart failure were misclassified as exudates. Four of these patients had had previous diuretic therapy, and all had a clinical response to further diuretic therapy. We conclude that although Light''s criteria for exudates are very sensitive, an albumin gradient of 1.2 g/dl or less tends to be more specific, especially in cases of chronic congestive heart failure.