嗜酸细胞性胸腔积液中高浓度嗜酸细胞阳离子蛋白和嗜酸细胞蛋白X

为估价胸水中嗜酸细胞的作用和诊断意义,测定不同病因嗜酸细胞和非嗜酸细胞性胸腔积液患者血清和胸水中的嗜酸细胞阳离子蛋白(ECP)和嗜酸细胞蛋白X.方法92例住院患者(均为成人),其中恶性肿瘤所致胸腔积液(PE)33例、原因不明的渗出性PE21例、心衰引起的漏出性PE 10例、结核性胸膜炎6例、类肺炎PE 和细菌性脓胸各4例、其它病因引起的PE 14例.胸穿获取胸水,同时采集外周静脉血标本.     

嗜酸细胞增多性胸腔积液诊断和病因鉴别诊断

正嗜酸细胞增多性胸腔积液(eosinophilic pleural effusion,EPE)约占渗出性胸腔积液的10%,当胸腔积液中嗜酸粒细胞(EOS)比例超过10%即可诊断本病~([1-2])。EPE的病因复杂,Oba等[2]通过对687例EPE进行Meta分析后指出,最常见的原因是恶性肿瘤(26%),其次是气胸或血胸(13%)和肺炎(12%),同时,肺结核(7%)也占有一定比例,除此     

2014恶性胸腔积液诊断和治疗专家共识要点解读

恶性胸腔积液是一组临床常见综合征,恶性胸膜间皮瘤、肺癌、乳腺癌、淋巴瘤等是导致恶性胸腔积液的常见病因。尽管诊断方法和手段较多,但胸腔积液细胞沉淀中找到恶性细胞或在胸膜活检组织中观察到恶性肿瘤的病理改变仍然是确定恶性胸腔积液诊断的"金标准"。近年来多项研究结果倾向持续胸腔引流作为恶性胸腔积液治疗方法的首选,对多年来胸膜固定术的一线治疗地位提出了挑战。     

细胞核仁组成区嗜银蛋白检测对良恶性胸腔积液的鉴别诊断 …

目的 探讨核仁组成嗜银蛋白检测在良性胸腔积液间皮细胞和恶性胸腔积液癌细胞临别诊断中的价值。方法 对５０例恶怀、３０例良性胸腔积液鹗２的胸腔积液细胞涂片行ＡｇＮＯｒ染色，观察良性胸腔积液间皮细胞和恶性胸积液癌细胞核内的ＡｇＮＯＲ数目和形态。另观察６例临床疑诊恶性胸腔积液而常规脱落细胞检查阴性者胸积液细胞核内的ＡｇＮＯＲ数目和形态。结果 恶性组癌细胞平均每核ＡｇＮＯＲ数显著高于良性组间皮细胞；恶性组癌     

CEA和AgNOR检测对良,恶性胸腔积液鉴别诊断价值的比较

目的：比较癌胚抗原（ＣＥＡ）、细胞核仁组成区嗜银蛋白（ＡｇＮＯＲ）检测在良、恶性胸腔积液鉴别诊断中的作用。方法：检测３０例良性胸腔积液和５０例恶性胸腔积液患者胸积液ＣＥＡ水平，并同时作胸腔积液沉渣细胞涂片行ＡｇＮＯＲ染色，观察良性胸腔积液间皮细胞和恶性胸腔积液癌细胞核内的ＡｇＮＯＲ数目和形态。结果：恶性胸腔积液平均ＣＥＡ水平显著高于良性胸腔积液，恶性胸腔积液癌细胞ＡｇＮＯＲ形态以弥散型为主，且其平     

心源性胸腔积液的X线分析

胸腔积液在临床上较常见，可由多种疾病引起。而各种心血管疾病所致充血性心力衰竭引起的胸腔积液是漏出性胸腔积液最常见的原因［１］。临床上心源性胸腔积液易被误诊为结核性甚至恶性胸腔积液。因此认识心源性胸腔积液的Ｘ线特点对鉴别胸腔积液的病因减少误诊具有重要临...     

调节性T细胞及其在结核性及恶性胸腔积液中的研究进展

胸腔积液是常见的内科疾病,肺、胸膜和肺外疾病均可引起,其病因以渗出性胸膜炎最为常见,渗出性胸腔积液最常见的病因是结核性胸膜炎和恶性胸腔积液。结核性胸膜炎是由于胸膜下结核杆菌感染诱发严重的迟发型超敏反应而引起,恶性胸腔积液由恶性肿瘤胸膜转移或恶性胸膜间皮瘤引起,     

结核性和癌性胸腔积液鉴别诊断研究近况

胸腔积液的病因诊断,特别是结核性与癌性胸腔积液的鉴别相当困难,现就国内外的鉴别诊断检验指标综述如下。1 心钠素测定恶性肿瘤细胞心钻素含量明显高于正常组织,可以分泌心钠素至胸腔积液中。董良全等报道,采用放射免疫法直接测定血清及胸腔积液心钠素浓度,检测30例结核性胸腔积液,26例癌性胸腔积液患者的血清和胸腔积液中的心钠素(ANP)水平,认为以ANP≥110 ng/L为界值,对恶性胸腔积液诊断的敏感性及特异性分别为81％和100％。以胸腔积液与血清ANP水平之比值≥0.5为界值,对恶性胸腔积液诊断的敏感性及特异性分别为88％和80％。     

血清及胸液C-反应蛋白对胸腔积液病因诊断的研究

目的探讨血清及胸液C-反应蛋白(CRP)对类肺炎性胸腔积液、结核性胸腔积液和癌性胸腔积液的价值。方法选取胸腔积液患者80例,其中类肺炎性胸腔积液35例,结核性胸腔积液13例,恶性胸腔积液32例,比较所有患者血清和胸液中CRP的测量值。结果类肺炎性胸腔积液血清及胸液中CRP含量显著高于结核性胸腔积液,差异有统计学意义(P0.05);结核性胸腔积液血清及胸液中CRP含量显著高于癌性胸腔积液,差异有统计学意义(P0.05)。结论血清和胸液中CRP对胸腔积液病因诊断具有一定的临床价值;可以作为良恶性胸腔积液鉴别诊断的参考指标。     

血清及胸腔积液CEA检测联合细胞染色体分析在老年患者恶性胸腔积液诊断中的应用

目的 探讨血清及胸腔积液癌胚抗原（CEA）检测联合细胞染色体分析在老年患者恶性胸腔积液诊断中的应用价值.方法 收集不明原因胸腔积液老年患者48例,按组织病理学诊断结果分为恶性胸腔积液组28例和良性胸腔积液组20例.检测两组患者血清、胸腔积液中的CEA,并对其胸腔积液中的细胞染色体进行分析.结果 单纯采用细胞染色体分析确诊恶性胸腔积液的灵敏度为61％、特异度为95％,血清及胸腔积液CEA检测联合细胞染色体分析确诊恶性胸腔积液的灵敏度为86％、特异度为100％,两者相比,P均＜0.05.结论 血清及胸腔积液中CEA的检测对诊断恶性胸腔积液具有一定价值,尤其胸腔积液CEA,联合细胞染色体分析对诊断恶性胸腔积液的灵敏度和特异度升高.     

Case of tuberculous pleurisy with eosinophilic pleural effusion and hematological eosinophilia

A 30-year-old man suffered from a chest-pain on his left side and was also having a low-grade fever though he actually neglected these symptoms for a while. Later, he was referred to our hospital due to the detection of chest abnormal shadows through the mass examination of chest X-ray taken on 18th October, 2005. His chest X-ray showed bilateral pleural effusion and it was confirmed that the right pleural effusion was encapsulated by his chest CT. The patient's hematological examination performed during his initial visit, showed an increased level of WBC with blood eosinophilia. He also had a puncture of pleural effusion at the time of admission to the center. Moreover, pleural effusion on both sides was exudative and elevations of ADA and eosinophil count as well were traced. In the patient's right pleural effusion, mycobacterium tuberculosis direct (MTD) test was positive. As there were no findings suggesting collagen disease, malignancy, parasite infection, and other complications, he was diagnosed as tuberculous pleurisy with eosinophilic pleural effusion and blood eosinophilia. He was treated with four antitubercular agents, namely, INH, RFP, EB and PZA. As the result, his pleural effusion and blood eosinophil counts were decreased along with an improvement in inflammatory reaction. The most common conditions associated with eosinophilic pleural effusion are described as malignancy, collagen disease, paragonimiasis, drug induced pleurisy, asbestosis, pneumothorax, and trauma, while there are only a few reports about such eosinophilic pleural effusion caused by tuberculous pleurisy. In this case, he also showed blood eosinophilia. Based on these findings, we finally came to the conclusion that the case is a very rare and significantly unique case of eosinophilic pleurisy with blood eosinophilia.     

Eosinophilic pleural effusion in adults at Srinagarind Hospital

The presence of pleural eosinophilia remains a controversy in etiology and prognosis. We conducted this study to evaluate the etiology of eosinophilic pleural effusion and to define the factors that determine malignancy in eosinophilic pleural effusion. Between 1 August 1994 and 1 July 2000, 50 patients were diagnosed with eosinophilic pleural effusion; 35 men and 15 women averaging 56.4 years of age. Most (96%) had exudative pleural effusion. Malignancy was the most common (46%) established cause followed by tuberculosis (10%), parapneumonic effusion (8%), and empyema thoracis (2%). We encountered only one case of pneumothorax and parasitic pleural effusion (from Strongyloides stercoralis). Unknown causes constituted 22% of cases. The etiology of those who had previously undergone thoracocentesis did not differ from those having their first thoracocentesis. Patients with malignant pleural effusion had significant longer duration of clinical symptoms (> or = 1 month) and weight loss than benign pleural effusion. The median duration of symptoms in benign pleural effusion was 14 days. Fever was more characteristic in patients with benign than in those with malignant pleural effusion. The percentage of eosinophils in pleural fluid and blood did not differ between the two groups. Pleural fluid eosinophils in malignant vs benign pleural effusion were 26.6% (range 10% to 63%), and 30.6% (range 10% to 93%), respectively. We concluded that, pleural eosinophilia did not indicate benign conditions which would spontaneously resolve. Malignant pleural effusion should be considered especially in areas malignancy is prevalent.     

Eosinophilic pleural effusion related to taking valproic acid

Eosinophilic pleural effusions have multiple aetiologies. We report on the case of a 40-year-old man who experienced an eosinophilic pleural effusion with blood hypereosinophilia that occurred nine weeks after a treatment with valproic acid was introduced. Usual aetiologies of eosinophilic pleural effusion were excluded. Once valproic acid was discontinued, both pleural effusion and blood eosinophilia decreased rapidly. The persistence of a residual pleural effusion required the introduction of oral corticosteroids, which resulted in the effusion disappearing completely and rapidly. Valproic acid is a rare cause of eosinophilic pleural effusion. The effusion usually regresses when treatment is discontinued but short-term oral corticotherapy may be necessary in order to heal the patient.     

Progressive systemic sclerosis-polymyositis overlap syndrome with eosinophilic pleural effusion

Pleural fluid rarely occurs in patients with progressive systemic sclerosis (PSS) or polymyositis (PM) with no lesions in the pulmonary area. Pleural fluids in patients with autoimmune diseases are mostly dominated by monocytes and lymphocytes but very rarely contain increased eosinophils. We report a 55-year-old male with PSS-PM overlap syndrome and eosinophilic pleural effusion. Air invasion into the pleural cavity and the antituberculous therapy could be ruled out as causes for the patient's eosinophilic pleural effusion, because the differential eosinophil count was already as high as 19% from the first thoracentesis before the start of antituberculous therapy. Infections and malignant tumor also were unlikely causes based upon the negative pleural fluid results and the negative pleural biopsy findings, except for nonspecific inflammation. After the administration of corticosteroid, the pleural effusion decreased promptly, with normalization of serum creatine phosphokinase and C-reactive protein concentrations.     

Eosinophilic pleural effusion

Eosinophilic pleural effusion accounts for 5 to 10% of all clear liquid pleurisies. Its pathogenic significance is unclear and its relation to the causative diagnosis of pleural eosinophilia is diversely evaluated. In this study, 86 cases of eosinophilic pleural effusion observed at the Ariana Pneumophthisiology Hospital over a 5-year period are reviewed. At first aspiration, the proportion of pleural fluid eosinophils varied from 12% to 85% (54% on average). Blood eosinophilia was present in 60% of the patients. The main cause of effusion was tuberculosis (39.6%, but many other diseases were observed; despite numerous investigations, no cause could be found in 23.2% of the cases. The discovery of a pleural eosinophilia has an impact on the probable cause of the pleurisy, and this can be determined by applying Bayes' rule. The probability of tuberculous being the cause falls from 70.3% for clear liquid pleurisies generally to 44.6% for eosinophilic pleurisy. The probability of cancer as a cause falls from 4.5% to 0.66%; whereas that of "idiopathic" pleurisy rises from 13.5% to 59.56%. These findings are concordant with Adelman's conclusions. In other words, the finding of a pleural eosinophilia decreases the probability of tuberculous or malignant pleural effusion and increases the probability of benign or "idiopathic" effusion. Clinicians confronted with an eosinophilic pleural effusion should be particularly careful and accurate since this diagnosis may spare the patient an unnecessary exploratory thoracotomy and an unwarranted antituberculous treatment.     

Eosinophilic pleural effusions

Eosinophilic pleural effusions, defined as a pleural effusion that contains at least 10% eosinophils, may be caused by almost every condition that can cause pleural disease. Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of blood or air in the pleural space, infections, and malignancy. Drug-induced pleural effusions, pleural effusions accompanying pulmonary embolism, and benign asbestos pleural effusions are also among the common causes of eosinophilic pleural effusion. No etiology is found in as many as one third of patients. Because studies evaluating different diagnostic approaches with eosinophilic pleural effusions are lacking, the authors suggest that certain noninvasive and invasive diagnostic tools must be used based on the patient's clinical characteristics.     

A case of toxocariasis with eosinophilic pleural effusion

A 76-year-old man admitted for general malaise with fever was found in clinical examination on admission to have eosinophilic pleural effusion, peripheral eosinophilia, and a slightly elevated inflammatory reaction. Immunological examination, including microplate ELISA, showed a high titer of specific antibody against Toxocara canis in both the serum and pleural effusion. We started treatment using albendazole, and found inflammatory findings and serum IgE were ameliorated. Parasitic disease is an important consideration in the differential diagnosis of eosinophilic pleural effusion, and serology is useful in screening for this.     

Eosinophilic pleural effusion by dirofilariasis]

A 44-year-old man visited our hospital because of right chest pain. Pleural effusion in the right lung was detected on a chest radiograph. A chest CT scan demonstrated no abnormal lesions in either lung field, but passive atelectasis due to the pleural effusion was present. Since many eosinophils were found in the exudative pleural effusion, a parasitic infection was suspected. An enzyme-linked immunosorbent assay test led to a diagnosis of eosinophilic pleural effusion by dirofilariasis. Pleural effusion disappeared spontaneously and the level of anti-Dirofilaria immitis antibody decreased. Continued careful observation is necessary in such cases.     

A case of sparganosis with eosinophilic pleural effusion]

A 61 year-old man was admitted to our hospital complaining of exertional dyspnea and presented with left pleural effusion. Laboratory findings showed peripheral eosinophilia and a slightly elevated inflammatory reaction. Chest X-ray film and CT revealed left pleural effusion, but there were no particular abnormal findings on the lung fields. Pleural effusion was exudative, yellowish and contained numerous eosinophils. His detailed medical history showed that he had eaten uncooked snakes, which led us to suspect parasite diseases. Multiple-dot ELISA method was performed to detect specific anti-parasite antibody. The patient was diagnosed with sparganosis after the detection of a highly positive reaction against Spirometra erinacei-europaei in both serum and pleural effusion. Parasite disease is an important consideration on differential diagnosis of eosinophilic pleural effusion, and multiple-dot ELISA method might be helpful for screening it.     

A case of post-traumatic bilateral eosinophilic pleural effusion]

A 58-year-old man was admitted to our hospital with chest pain caused by chest trauma. After admission, his chest pain decreased and he was discharged. Later, he was admitted again with a high fever and dyspnea. Laboratory findings on second admission showed a leukocyte count of 7,900/microliter (9% eosinophils) and a C-reactive protein of 17.0 mg/dl. Chest radiography and chest CT scanning on second admission showed moderate bilateral pleural effusion. Close examination showed an increase of eosinophils in the pleural effusion (14% of total cell counts on the right and 27% of total cell counts on the left) that was exudate. Post-traumatic bilateral eosinophilic pleural effusion was diagnosed. The patient was treated with antibiotic therapy and his condition improved. A chest CT scan afterwards showed improvement of the bilateral pleural effusion. The eosinophil count in the peripheral blood was 1% at chest trauma, 15% in the hospital to the max and decreased to 3% with the decrease of pleural effusion. Post-traumatic eosinophilic pleural effusion may be accompanied with inflammatory findings, and the mechanism is guessed by immunological reaction.