Serum and Pleural Fluid Procalcitonin for Discriminating Complicated Non-Purulent from Uncomplicated Parapneumonic Effusions

利用血清與肋膜積液中的降鈣素原來鑑別併發性與非併發性的肺炎肋膜積液

柯仰謦(Yang-Ching Ko) ； 林鉅桓(Chu-Huan Lin) ； 徐武輝(Wu-Huei Hsu) ； 許啓森(Chi-Sen Hsu) ； 戴孟平(Mong-Ping Dai) ； 歐建志(Chien-Chih Ou)

《重症醫學雜誌》 11卷1期 (2010/03) Pp. 8-17

https://doi.org/10.30035/TCCM.201003.0002

摘要

目的：在肺炎肋膜積液中，若是併發性肋膜積液與膿胸，必須利用胸管引流合併藥物治療。我們利用血清或肋膜積液中的降鈣素原來找出肺炎肋膜積液中，須要以胸管引流來治療的患者。
方法：利用回溯性分析法，將30位診斷爲肺炎性肋膜積液患者分爲兩組，其中12位爲併發性肋膜積液，另外18位爲非併發性肋膜積液。在患者接受治療前檢驗血清與肋膜積液中的降鈣素原。另外三種常用的肋膜積液分析值：葡萄糖、酸鹼度與乳酸脫氫酵素，也一併同時檢測。
結果：在比較併發性與非併發性肋膜積液患者血清與肋膜積液中的降鈣素原後，兩者均有統計學上的差異（P=0.002與P=0.006）。且血清與肋膜積液中的降鈣素原有正相關性(r=0.72, P=0.000)。以血清降鈣素原的臨界值0.26ng/mL來診斷併發性肋膜積液，其專一度爲61%，而敏感度爲92%。若以肋膜積液中降鈣素原的臨界值0.5ng/mL來診斷的話，其專一度與敏感度分別爲71%與83%。
結論：血清與肋膜積液中的降鈣素原在併發性肋膜積液與非併發性患者中有顯著差異。兩者可以在傳統的肋膜積液檢查外，做爲診斷併發性肺炎肋膜積液的工具。

關鍵字

降鈣素原 ； 肺炎性肋膜積液 ； 胸管引流

並列摘要

Objective: In parapneumonic effusions (PPE), tube thoracostomy is indicated in complicated parapneumonic effusions (CPPE) and empyema. This study focused on assessing the value of procalcitonin (PCT) in serum and pleural fluid for the identification of patients with PPE that ultimately require chest tube drainage.
Methods: A retrospective clinical study was performed with two different patient groups. A total of thirty patients with PPE were included: twelve of these patients had CPPE, and eighteen had uncomplicated parapneumonic effusions (UPPE). Serum and pleural fluid PCT concentrations were evaluated before treatment. Three classical parameters (pH, glucose and LDH) in the pleural fluid were also assessed.
Results: Serum and pleural fluid PCT concentrations were statistically different between CPPE and UPPE groups (P=0.002 and P=0.006, respectively). A positive and significant correlation was detected between serum and pleural fluid PCT levels (r=0.72, P=0.000). Diagnostic specificity and sensitivity values for serum and pleural fluid PCT in discriminating CPPE from UPPE were 61% and 92%, and 71% and 83% at the 0.26 and 0.50 ng/mL cut-off values, respectively.
Conclusion: Serum and pleural PCT in patients with PPE were significantly different between the CPPE and UPPE. They may both contribute to the identification of CPPE with at least better sensitivity than the use of pH, glucose, or lactate dehydrogenase, but the accuracy of PCT should be further investigated.

並列關鍵字

Procalcitonin ； Parapneumonic pleural effusion ； Thoracostomy tube