Diagnostic Significance of Pleural Fluid Lactate Concentrations

胸水中乳酸鹽濃度的診斷意義

蘇義仁(Yih-Ming Su) ； 鄭天寶(Tien-Pao Cheng) ； 溫政諭(Cheng-Yu Wen) ； 葉聰文(Tsung-Wen Yeh) ； 洪芳明(Fang-Ming Hung) ； 高敬為(Ching-Wei Kao)

《胸腔醫學》 18卷4期 (2003/08) Pp. 285-292

摘要

An early diagnosis of empyema is required in order to administer antimicrobial therapy and institute early drainage of the pleural effusion to prevent loculation. The determination of lactate in body fluids has been used mainly for the detection of bacterial infection. The purpose of our study was to investigate the validity of diagnosing of exudates from transudates, and empyema from other exudative diseases, by the determination of pleural fluid lactate and serum lactate.
Ninety-three consecutive samples of pleural fluid from eighty-seven patients were obtained by thoracocentesis and investigated before giving any antimicrobial therapy. Pleural fluid lactate (PFL) and venous blood lactate (BL) were drawn and measured simultaneously. The difference between PFL and BL (PFL-BL) was calculated for each sample. The patients were grouped into five categories based on the final diagnosis: empyema, tuberculous pleurisy, malignant pleural effusion, parapneumonic effusion, and transudative pleural effusion.
Fourteen samples were transudative pleural effusions and seventy-nine samples were exudative pleural effusions. The PFL-BL difference for transudates and exudates (mean ± SD) were 1.47 ± 1.75 and 5.75 ± 10.52, respectively. There was no statistically significant difference between transudates and exudates (P ＞ 0.1).
The mean PFL (± SD) for empyema and other exudative pleural effusions were 39.55 ± 23.26 and 4.64 ± 2.04, respectively. There was a significant difference between empyema and other exudative pleural effusions (P ＜ 0.015). The mean PFL-BL differences (± SD) for empyema and exudative pleural effusion were 35.60 ± 22.60, and 3.29 ± 1.99, respectively. There was a statistically significant difference between empyema and the other exudates (P ＜ 0.015). The mean values (± SD) of BL for empyema and other exudates were 3.95 ± 0.88, and 1.34 ± 0.72, respectively. There was no statistically significant difference between the two groups (P ＞ 0.1).
In conclusion, PFL and PFL-BL differences have no diagnostic value in differentiating exudates and transudates, but they are helpful in differentiating between empyema and other exudates.

關鍵字

胸水乳酸鹽 ； 血液乳酸鹽 ； 胸水和血液乳酸鹽的差

並列摘要

An early diagnosis of empyema is required in order to administer antimicrobial therapy and institute early drainage of the pleural effusion to prevent loculation. The determination of lactate in body fluids has been used mainly for the detection of bacterial infection. The purpose of our study was to investigate the validity of diagnosing of exudates from transudates, and empyema from other exudative diseases, by the determination of pleural fluid lactate and serum lactate.
Ninety-three consecutive samples of pleural fluid from eighty-seven patients were obtained by thoracocentesis and investigated before giving any antimicrobial therapy. Pleural fluid lactate (PFL) and venous blood lactate (BL) were drawn and measured simultaneously. The difference between PFL and BL (PFL-BL) was calculated for each sample. The patients were grouped into five categories based on the final diagnosis: empyema, tuberculous pleurisy, malignant pleural effusion, parapneumonic effusion, and transudative pleural effusion.
Fourteen samples were transudative pleural effusions and seventy-nine samples were exudative pleural effusions. The PFL-BL difference for transudates and exudates (mean ± SD) were 1.47 ± 1.75 and 5.75 ± 10.52, respectively. There was no statistically significant difference between transudates and exudates (P ＞ 0.1).
The mean PFL (± SD) for empyema and other exudative pleural effusions were 39.55 ± 23.26 and 4.64 ± 2.04, respectively. There was a significant difference between empyema and other exudative pleural effusions (P ＜ 0.015). The mean PFL-BL differences (± SD) for empyema and exudative pleural effusion were 35.60 ± 22.60, and 3.29 ± 1.99, respectively. There was a statistically significant difference between empyema and the other exudates (P ＜ 0.015). The mean values (± SD) of BL for empyema and other exudates were 3.95 ± 0.88, and 1.34 ± 0.72, respectively. There was no statistically significant difference between the two groups (P ＞ 0.1).
In conclusion, PFL and PFL-BL differences have no diagnostic value in differentiating exudates and transudates, but they are helpful in differentiating between empyema and other exudates.

並列關鍵字

Pleural fluid lactate ； blood lactate ； lactate difference between pleural fluid and blood