Plevra sıvılarının eksüda-transüda ayrımında light kriterleri, albümin gradienti, alkalen fosfataz, total kolesterol, total bilirübin ve ürik asit ölçümlerinin karşılaştırmalı analizi

Amaç: Plevral sıvıların tanısında, transüda ve eksuda olarak ayırım yapmak ilk basamağı oluşturmaktadır. Transüda-eksuda ayrımında Light kriterlerinin, albumin gradienti, ALP, total kolesterol, total bilirübin ve ürik asit ölçümlerinin değerini araştırmak amaçladı. Gereç ve Yöntem: Çalışmaya 53 hasta alındı. 18'i transüda (yaş ortalaması 61.44±11.81), 351 eksuda (yaş.oıt. 40.49±17.44) olarak sınıflandırıldı. Bulgular: Plevra total proteini, plevra/serum (p/s) total protein oranı, plevra LDH'ı, p/s LDH oranı, s-p albumin gradienti, plevra ALP'ı, plevra total kolesterolü, p/s total kolesterol oranı, p/s total bilirübin oranı, plevra ürik asit ortalamaları transüdalı hastalarda sırasıyla 1.94±0.80, 0.29±0.10, 1 18.83±100, 0.36±0.22, 2.I7±O.81, 20.50± 14.23, 30.61 ±19.69, 0.16±0.11, 0.43±0.27, 6.40± 1.92; eksudalı hastalarda ise sırasıyla 5.09±0.63, 0.73±0.08, 541.03±401, 3.09±2.77, 0.55±0.28, 55.17±17.33, 88.40±24.80, 0.59±0.14, 0.87±0.41, 4.73±1.44 olarak bulundu. Her iki grupta "Student-t Testi" kullanılarak yapılan karşılaştırmalarda yukarıdaki tüm değerler için tansüda-eksuda ayrımında anlamlı sonuçlar elde edildi. Ayrıca sensitivite ve spesifite ölçümleri sırasıyla p/s total protein 0.52 oranı için % 100-% 100 (eksuda tanısında), p/s LDH 0.61 oranı için %100-%89 (eksuda tanısında), s-p albumin gradienti 1.2'de %94-%100 (transüda tanısında), plevra ALP'ı 42 değerinde %77-%95 (eksuda tanısında), plevra total kolesterolü 64 değerinde %9l-%95 (eksuda tanısında), p/s total kolesterol 0.33 oranı için %97-%84 (eksuda tanısında), p/s total bilirübin 0.61 oranı için %77-%89 (eksuda tanısında), plevra ürik asiti 5.5 değeri için %55-%78 (transüda tanısında) olarak tespit edildi. Sonuç: Bulgularımız Light kriterleri, albumin gradienti, ALP, total kolesterol, total bilirübin ve ürik asit ölçümlerinin transüdaeksuda ayrımında tanısal değerleri olduğunu göstermektedir. Bununla birlikte. Light kriterleri bu ayrımda en anlamlı yöntem olmaya devam etmektedir.

Comparative analysis of light's criteria, albumin gradient, alkaline phosphatase, total cholesterol, total bilirubin and uric acid measurements for differentiation of pleural exudates from transudates

Aim: The differentiation of pleural effusions as being either transudate or exucjate is the first step in the diagnosis of pleural effusions. Material and method: Fifty three patients with pleural effusions were included in the study which was made to evaluate the values of Light's criteria, albumin gradient, alkaline phosphatase(ALP), total cholesterol, total bilirübin and uric acid analysis to discriminate exudates from transudates. Eightteen cases (mean age 61.44±11.81) were grouped as transudates and 35 cases (mean age 40.49±17.44) as exudates. Results: Mean pleural fluid total protein, mean pleura/serum (P/S) total protein ratio, mean pleura LDH, mean p/s LDH ratio, meanalbumin gradient, mean pleura ALP, mean pleura total cholesterol, mean p/s total cholesterol ratio, mean p/s total bilirubin ratio, mean pleura uric acid were measured 1.94±0.80 g/dL, 0.29±0.10, 118.83±100 U/L, 0.36±0.22, 2.17±0.81 g/dL, 20.50±14.23, 3O.'61±19.69 mg/dL, 0.16±0.11, 0.43±0.27, 6.40±1.92 mg/dLin patients with transudates, respectively; 5.09±0.63 g/dL, 0.73±0.08, 541.03±401 U/L, 3.09±2.77, 0.55±0.28 g/dL, 55.17± 17.33, 88.40±24.80 mg/dL, 0.59±0.14, 0.87±0.41, 4.73± 1.44 mg/dLin patients with exudates, respectively. Significant values for above measurements were found in compared transudates and exudates groups by employing "Student-t Test"(p<0.01). Sensitivity and Specificity: P/S total protein ratio for diagnosis of exudates effusions were % 100-% 100(cut-off: 0.52),P/S LDH ratio for exudates were % 100-%89 (cut-off: 0.61), S-P albumin gradient for diagnosis of transudates were %94-% 100 (cut-off: 1.2),pleura ALP for exudates were %77-%95 (cut-off: 42),pleura total cholesterol for exudates were %91 -%95 (cut-off: 64), P/S total cholesterol ratio for exudates were %97-%84 (cut-off: 0.33), P/S total bilirubin ratio for exudates were %77-%89 (cut-off: 0.61), pleura uric acid for transudates were %55-%78 (cut-off: 5.5),respectively. Conclusion: Our findings indicate that measurements of Light's criteria, albumin gradient, ALP, total cholesterol, total bilirubin and uric acid in pleural fluid become of diagnostic value in differential diagnosis of transudates and exudates. However, Light's criteria remain the best method of separating transudates from exudates.

Kaynakça

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Kaynak Göster

Solunum
  • ISSN: 1302-4922
  • Yayın Aralığı: Yılda 0 Sayı
  • Başlangıç: 2018

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