Application of pleural fluid combined with serum indicators in the diagnosis of various types of pleural effusion

Abstract

Objective To explore the clinical value of pleural fluid combined with serum indicators for the diagnosis of tuberculous, malignant and nonspecific inflammatory pleural. Methods The complete medical records of 408 cases enrolled in this research were analyzed. Patients were divided into tuberculous pleural effusion group (tuberculosis group, n=200) , malignant pleural effusion group (carcinoma group, n=64) and parapneumonia pleural effusion group (inflammatory group, n=144). The general clinical characteristics and related indicators of patients were analyzed, and multiple linear regression model was established. Results The tuberculous pleural effusion was mainly seen in the people under 50 years old (76.00%) with more females than males (0.56∶1). There were 196 patients (98.00%) with chest pain in tuberculosis group. The malignant and inflammatory pleural effusion were mainly seen in the people over 50 years old (75.00% and 72.22%) with more males than females (1.67∶1 and 1.77∶ 1). There were only 24 patients (37.50%) in carcinoma group and 24 patients (16.67%) in inflammatory group with chest pain. Among 3 groups, the serum procalitonin (PCT) increased obviously in inflammatory group, the pleural effusion carcinoembr yonicantigen (CEA) and lactate dehydrogenase (LDH) increased obviously in carcinoma group, and the serum erythrocyte sedimentation rate (ESR) and pleural effusion adenosine deaminase (ADA) increased obviously in tuberculosis group. Their differences had statistical significances (F=5.327, 21.442, 10.497, 4.687 and 7.562, P all<0.05). Multiple linear regression analysis indicated that pleural effusion ADA, CEA and serum PCT had diagnostic value to tuberculosis pleural fluid (t=3.595, -2.267 and -2.164, P all <0.05); pleural effusion CEA, LDH and ADA had diagnostic value to malignant pleural effusion (t=7.258, 5.464 and -4.119, P all < 0.01); serum PCT, pleural effusion LDH and CEA had diagnostic value to inflammatory pleural effusion (t=3.388, -4.624 and -2.164, P all<0.01). Conclusions The increase of serum PCT and pleural effusion CEA is helpful to eliminate tuberculous pleural fluid. High levels of pleural effusion CEA, LDH and low level of pleural effusion ADA are helpful to diagnose malignant pleural fluid. High level of pleural effusion CEA and low levels of pleural effusion LDH and CEA are helpful to diagnose inflammatory pleural fluid. Key words: Pleural effusion; Diagnosis; Multiple linear regression