PLEVRAL SIVILARDA TRANSÜDA- EKSÜDA AYRIMINDA LİGHT KRİTERLERİ, PROTEİN GRADİYENTİ, ALBUMİN GRADİYENTİNİN VE KOMBİNASYONLARININ TANISAL DEĞERİ

Yıl 2012, Cilt: 26 Sayı: 2, 107 - 116, 01.10.2012

A. Kadri Çırak Serpil Tekgül Semra Bilaçeroğlu Berna Kömürcüoğlu Seher Kurtul Sönmez Emel Özden

Öz

Çalışmanın amacı; plevral efüzyonların transudaeksuda ayırımında Light kriterleri, albumin gradienti ve protein gradientinin ayrı ayrı ve kombine kullanıldığında tanısal verimliliklerini araştırmaktır. Bu amaçla, 87 plevral sıvılı olgu değerlendirildi. Eş zamanlı olarak alınan serum ve plevral sıvıda total protein, albumin, laktik dehidrogenaz (LDH) düzeyleri ölçüldü. Light kriterleri, albumin gradienti, protein gradienti, Light kriterleri + albumin gradienti ve Light kriterleri + protein gradienti hesaplamaları yapıldı. Light kriterleri, eksuda olgularının tamamını doğru sınıflandırdı ancak, transuda olgularını saptamada duyarlılığı düşük bulundu. Transuda-eksuda ayırımında Light kriterleri, albumin gradienti ve protein gradientinin sırasıyla duyarlılıkları: %100, %82.3, %90.1, özgüllükleri: %58.3, %97.2, %83.3 ve doğruluk oranları: %82.7, %88.5, %87.3 olarak saptandı. Transuda vasfında sıvısı olan 15 olgu, Light kriterlerine göre yanlış eksuda olarak nitelendirildi ve bu hastalar diüretik tedavisi almaktaydı. Klinik olarak transuda düşünülen ve diüretik tedavisi görmüş plevral sıvılı olgularda, Light kriterleri ile uyumsuz sonuç alındığında, ek olarak protein gradienti ya da albumin gradienti ile değerlendirmeyle özgüllük ve doğruluk oranlarında artış izlendi. Özgüllük ve doğruluk oranı, Light kriterleri-albumin gradienti kombine kullanımında, Light kriterleri-protein gradienti kombine kullanımına göre anlamlı olarak yüksek bulundu. Sonuç olarak, özellikle diüretik kullanan plevral sıvılı olgularda transuda-eksuda ayrımında Light kriterleriyle birlikte albumin gradientinin kullanılmasının tanıya katkıda bulunabileceği kanısına vardık.

Anahtar Kelimeler

Plevral sıvı, ekuda, transuda, Light Kriterleri, albumin gradienti, protein gradienti

DIAGNOSTIC VALUE OF PLEURAL LIGHT'S CRITERIA, THE PROTEIN GRADIENT, AND THE ALBUMIN GRADIENT ALONE OR IN COMBINATION IN DIFFERENTIATION OF EXUDATES AND TRANSUDATES

Öz

To determine the diagnostic efficacy of Light's criteria, the albumin gradient, and the protein gradient, alone or in combination, in the differentiation of pleural transudates and exudates. Eighty-seven patients with pleural effusions, 51 (59%) of which were exudative and 36 (41%) of which were transudative, were assessed between January 2006 and February 2007. Of these patients, 71 (81.6%) were males and 16 (18.4%) were females. Total protein, albumin, and lactate dehydrogenase (LDH) levels were measured in the serum and pleural effusion samples were concurrently obtained. Calculations for Light's criteria, the albumin gradient, the protein gradient, Light's criteria and the albumin gradient, and Light's criteria and the protein gradient were performed. Light's criteria classified all of the exudates correctly; however, the sensitivity in determining transudates was low. The sensitivities of Light's criteria, the albumin gradient, and the protein gradient in the differentiation of transudates and exudates were 100%, 82.3%, and 90.1%, respectively; the corresponding specificities were 58.3%, 97.2%, and 83.3%, respectively; and the corresponding accuracies were 82.7%, 88.5%, and 87.3%, respectively. Fifteen cases of transudates were incorrectly classified as exudates by Light's criteria and were treated with diuretics. An increase in specificity and accuracy occurred by the additional assessment of the protein or albumin gradient when inconsistent results were obtained by Light's criteria in cases with pleural effusion clinically suspected to be a transudate and treated with diuretics. The specificity and accuracy were significantly higher with the combined use of Light's criteria and the albumin gradient compared to the combined use of Light's criteria and the protein gradient. The combined use of the Light's criteria and albumin gradient may contribute to differentiation of transudates and exudates in patients particularly those treated with diuretics.

Anahtar Kelimeler

Pleural effusions, exudate, transudate, Light criteria, albumin gradient, protein gradient

Kaynakça

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