MALİGN VE BENİGN PLEVRAL EFÜZYONLARIN AYRIMINDA PLEVRAL VE SERUM C-REAKTİF PROTEİN, ADENOZİN DEZAMİNAZ VE LAKTİK DEHİDROGENAZ DÜZEYLERİNİN TANISAL DEĞERİ

Öz

Plevral sıvıların malign-benign ayrımında serum ve plevral sıvı C-reaktif protein (CRP), adenozin deaminaz (ADA) ve laktik dehidrogenaz (LDH) düzeylerinin rolü araştırılmıştır. Mart 2006 - Haziran 2007 döneminde hastanemize başvuran 103 plevral sıvılı olgu çalışmaya dahil edildi. Tüm olgulardan, hastaneye ilk başvuruları sırasında plevral sıvı ve serum örnekleri alındı. Benign-malign plevral sıvılı olgular arasında, serum ve plevral sıvı CRP, ADA, LDH düzeyleri ile plevral sıvı/serum CRP, ADA, LDH oranları karşılaştırıldı. Sitolojik değerlendirmeye göre plevral sıvıların 75'i benign, 28'i malign sitolojide idi. Benign sitoloji olarak gruplanan olguların 29'u tüberküloz plörezi, 16'sı nonspesifik plörezi, 13'ü ampiyem-parapnömonik plörezi ve 17'si de KKY'ne ba ğlı plörezili idi. Plevral sıvı ve serum CRP, ADA düzeylerinin ve ayrıca plevral sıvı/ serum CRP, ADA ve LDH oranlarının malignbenign plörezi ayrımında bir katkısı görülmedi. Sadece serum LDH düzeyi malign plörezi olgularında ROC analizi ile istatiksel açıdan anlamlı olarak yüksek idi (p:0.018). Ek olarak uygulanan lojistik regresyon analizinde de, serum LDH düzeyi malign plörezili olgularda istatistiki açıdan anlamlı olarak yüksek saptandı (p:0.006) Malign-benign plevral sıvı ayrımında serum LDH düzeyinin katkısı olabileceği sonucuna varılmıştır.

Anahtar Kelimeler

• Plevral sıvı, CRP, ADA, LDH, malign, benign

DIAGNOSTIC VALUES OF PLEURAL FLUID, AND SERUM C-REACTIVE PROTEIN, ADENOSINE DEAMINASE, AND LACTATE DEHYDROGENASE LEVELS AND PLEURAL FLUID/SERUM RATIOS IN THE DIFFERENTIATION OF MALIGNANT FROM BENIGN PLEURAL EFFUSIONS

Öz

The aim o f the present study was to investigate the roles of serum and pleural fluid C-reactive protein (CRP), adenosine deaminase (ADA), and lactate dehydrogenase (LDH) levels in the differentiation of malignant from benign pleural effusions. Totally, 103 patients with pleural effusions admitted to the hospital between March 2006 and June 2007 were enrolled in the study. Pleural fluid and serum samples were obtained from all cases upon admission to the hospital. Serum and pleural fluid CRP, ADA, and LDH levels and pleural fluid/serum CRP, ADA, and LDH ratios were compared between the groups with benign and malignant pleural effusions. Cytologic assessment revealed that pleural fluids were benign and malignant in 75 and 28 cases, respectively. Of the cases with benign cytology, 29 were tuberculous pleurisy, 16 were non-specific pleurisy, 13 were empyema/parapneumonic pleurisy, and 17 were pleurisy associated with congestive heart failure (CHF). There were no contributions of pleural fluid and serum CRP and ADA levels, and pleural fluid/serum CRP, ADA, and LDH ratios in the differentiation of malignant from benign pleurisy. Only the serum LDH level was significantly higher based on the receiver operating characteristics (ROC) analysis in cases with malignant pleurisy (p=0.018). Logistic regression analysis also established that the serum LDH level was significantly higher in cases with malignant pleurisy (p=0.006). It was concluded that serum LDH level can have a contribution in the differentiation of malignant from benign pleural effusions.

Anahtar Kelimeler

• Pleyral effusion, CRP, ADA, LDH, malignant, benign

Kaynakça

1. 1. Hassan T, Al-Alawi M, Chotirmal SH, McElvaney NG. Pleural fluid analysis: standstill or a work in progress? Pulmonary Medicine 2012; doi:10.1155/2012/716235.
2. 2. Light RW. Pleural effusion. N Eng J Med 2002; 346(25): 1971-7.
3. 3. Light RW, MacGregor MI, Luchsinger PC, Ball WC. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 1972; 77: 507-13.
4. 4. Light RW. Clinical manifestations and useful tests. In: Light RW (Ed). Pleural disease. Baltimore: Williams & Wilkins. 1995: 36-74.
5. 5. Rakha EA, Patil S, Abdulla K, Abdulkader M, Chaudry Z, Soomro IN. The sensitivity of cytologic evaluation of pleural fluid in the diagnosis of malignant mesothelioma. Diagnostic Cytopathology 2010; 38(12): 874-9.
6. 6. Ernam D, Atalay F, Hasanoglu HC, Kaptan O. Role of biochemical tests in the diagnosis of exudative plevral effusions. Clinical Biochemistry 2005; 38: 19-23.
7. 7. Lossos IS, Breuer R, Intrator O, Sonenblick M. Differential diagnosis of pleural effusion by lactate dehydrogenase isoenyzme analysis. Chest 1997;111: 648-51.
8. 8. Cobben NA, van Belle AF, Pennings HJ, et al. Diagnostic value ol lactate dehydrogenase isoenzyme pattern in pleural effusions. Br J Chem Clin Biochem 1997: 35: 523-8.

9. 9. Piras MA. Gakis C, Budroni M. Andreoni G. Adenosine deaminase activity in pleural effusions: an aid to differential diagnosis. Br Med J 1978; 2: 1751-2.
10. 10. Ak G, Alatas F, Metintas M, et al. Tüberkülozlu olgular›n genel özellikleri. Toraks Dergisi 2002; 3(1): 45-51.
11. 11. Y›lmaz Turay U, Y›ld›r›m Z. Turkoz Y, et al. Use of pleural fluid C-reactive protein in diagnosis of pleural effusions. Respir Med 2000; 94: 432-5.
12. 12. Garc›´a-Pachon E, Llorca I. Diagnostic value of C-reactive protein in exudative pleural effusions. Eur J Intern Med 2002; 13: 246-9.
13. 13. Kiropoulos TS, Kostikas K, Oikonomidi S, et al. Acute phase markers for the differentiation of infectious and malignant pleural effusions. Respir Med 2007; 101: 910-8.
14. 14. Porcel JM, Vives M, Cao G, Bielsa S, RuizGonza´lez A, Mart›´nez-Iribarren A, Esquerda A. Biomarkers of infection for the differential diagnosis of pleural effusions Eur Respir J 2009; 34: 1383-9.
15. 15. Daniil ZD, Zintzaras E, Kiropoulos T, et al. Discrimination of exudative pleural effusions based on multiple biological parameters. Eur Respir J 2007; 30: 957-64.