Dissertation
Dissertation > Medicine, health > Internal Medicine > Respiratory system and chest diseases > Pleura and chest diseases > Hydrothorax

The Study on Multiple-index Joint Inspection in the Diagnosis of the Exudative and the Transudatory Pleural Effusion

Author ZhuHongBin
Tutor SunGengYun
School Anhui Medical University,
Course Diseases of the Respiratory System
Keywords Exudate Transudate Pleutal effusion Multiple indicator Differential diagnosis
CLC R561.3
Type Master's thesis
Year 2011
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Objective:To investigate pleural effusion cholesterol(PE CHOL), pleural effusion cholesterol and serum cholesterol ratio(P/S CHOL),pleural effusion C-reactive protein (PE CRP) and serum-effusion albumin gradient (SEAG); compared with Light standard:pleural effusion protein and serum protein ratio (P/S PRO)、pleural effusion lactate dehydrogenase and serum lactate dehydrogenase ratio(P/S LDH) and pleural effusion lactate dehydrogenase(PE LDH);to explore the value of the multiple-index joint inspection in the diagnosis of the exudative and the transudatory pleural effusion.Methods:The 137 patients with different causes of pleural effusion (93 males,44 females,average 52.1 years old) were divided into exudates group(71 males,23 females, with a total of 94 patients and a mean of 50.1 years) and transudate group(22 males,21 female with a total of 43 patients, and a mean of 54.8 years),diagnostic criteria is based on clinical symptom and related inspection. Various indexes related to pleural effusion can be inspected in parallel by using the OLYMPUS AU400 automatic biochemical analyzer. The receiver operator characteristic (ROC) curve can be obtained by analyzing the data of the statistics.Results:(1) The levels of the exudative pleural effusion (including P/S PRO, P/S LDH, and PE LDH) are apparently higher than that of the transudatory pleural effusion with the results as 0.7±0.1、0.9±0.2、290.7±49.9 IU/L and 0.2±0.1、0.5±0.1、161.1±46.3 IU/L,respectively. The difference was statistics significance (P<0.05). According to the Light’s (P/S PRO>0.5、P/S LDH>0.6、PE LDH>200 IU/L),respectively, the sensitivity and specificity of them were 99% and 81%.(2)The levels of the exudative pleural effusion (including PE CHOL, P/S CHOL, and PE CRP) are apparently higher than that of the transudatory pleural effusion with the results as 2.5±0.6 mmol/L、0.7±0.2、34.9±10.2mg/L and 1.3±0.5 mmol/L、0.3±0.1、11.6±10.1 mg/L, respectively. The difference has statistics significance(P<0.05). According to the ROC curve, the determined diagnostic cutoff points are> 1.52 mmol/L,> 0.32, and> 20 mg/L, respectively. Meanwhile, the sensitivity of them are 93%,98%,93%; the specificity of them are 89%,91%,91% respectively. The area under the curve(AUC) were 0.891, 0.939 and 0.926, respectively. (3) The levels of the exudative pleural effusion (SEAG) are apparently lower than that of the transudatory pleural effusion with the results as 7.3±2.6 g/L and 18.8±7.3 g/L, respectively. The difference has statistics significance(P<0.05). AUC was 0.913. According to the selection of the ROC curve, the determined diagnostic cutoff points is<10 g/L. Meanwhile, the sensitivity and specificity were 81% and 91%, respectively. (4) If one index of the four index is eligible, the sensitivity and specificity related to them are 98% and 86%. If all of them are eligible, the sensitivity and specificity related to them are 89% and 98%.Conclusions:The multiple-index joint inspection has value in the diagnosis of the exudative and the transudatory pleural effusion. Compared with the Light standard, it has similar sensitivity but higher specificity. It can be taken as the supplement of the Light standard.

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