Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Clinical Characteristics and Prognosis of Lymphocyte Dominant Exudative Pleural Effusion with Low ADA, Low CEA, Negative Cytology and Negative AFB Smear

항산균 도말 검사, 세포진 검사가 음성이고, ADA와 CEA가 낮은 림프구성 흉막 삼출증의 임상 양상과 예후

  • Kang, Young Ae (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Yoon, Young Soon (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Lee, Sei Won (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Choi, Chang Min (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Kim, Deog Kyeom (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Lee, Hee Seok (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Ko, Dong Seok (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Yoo, Chul Gyu (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Kim, Young Whan (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Han, Sung Koo (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Shim, Young Soo (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine) ;
  • Yim, Jae Joon (Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, and Lung Institute of Medical Research Center, Seoul National University College of Medicine)
  • 강영애 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 윤영순 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 이세원 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 최창민 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 김덕겸 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 이희석 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 고동석 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 유철규 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 김영환 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 한성구 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 심영수 (서울대학교 의과대학 내과학교실 및 폐 연구소) ;
  • 임재준 (서울대학교 의과대학 내과학교실 및 폐 연구소)
  • Received : 2004.07.13
  • Accepted : 2004.12.17
  • Published : 2005.01.30
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Abstract

Background : A pleural effusion is a common medical problem. Despite several diagnostic tests, 15-20% of pleural effusions go undiagnosed. The aim of this study was to evaluate the clinical characteristics and prognosis of a lymphocyte dominant exudative pleural effusion with a low adenosine deaminase (ADA), low carcinoembryonic antigen (CEA), negative cytology and negative acid fast bacilli (AFB) smear. Method : From Jan 2000 to Aug 2001, 43 patients with lymphocyte dominant exudative pleural effusions whose AFB smear and cytologic exam were negative, their pleural fluid ADA level was < 40 IU/L, and their CEA level was < 10 ng/mL were enrolled in this study. A retrospective analysis of the patients' medical records was carried out. Result : Among 31 of the 43 cases (72%), probable underlying diseases causing the pleural effusion were identified: 21cases of malignant diseases, 4 cases of liver cirrhosis, 2 cases of pulmonary tuberculosis, 1 case of end stage renal disease, 1 case of a chylothorax, 1 case of a post-CABG (coronary artery bypass graft) state, 1 case of a pulmonary embolism. No clinically suspected etiology was identified in the remaining 12 cases (28%). Of these 12 pleural effusions, 7 cases spontaneously resolved, 2 effusions resolved with antibiotics, and the other 2 cases were persistent. Conclusion : Lymphocyte dominant exudative pleural effusions with a low ADA, low CEA, negative cytological exam, and negative AFB smear, but without a definite cause might have a benign course and clinicians can observe them with attention.

연구 배경 : 흉수의 항산균 도말과 세포진 검사가 음성이며, 흉수의 ADA 가 40 IU/L 이하, CEA가 10 ng/ml 이하인 림프구성 흉막 삼출증의 임상적 특징과 예후를 살펴보고자 한다. 연구 방법 : 2000년 1월 1일부터 2001년 8월 31일 사이에 서울대학교 병원을 방문한 림프구성 흉막 삼출증 환자들 중 흉수의 항산균 도말과 세포진 검사가 음성이며, 흉수의 ADA가 40 IU/L 이하, CEA가 10 ng/ml 이하인 환자들의 의무 기록을 후향적으로 분석하였다. 연구 결과 : 43명의 림프구성 흉막 삼출증 환자들 중 31예에서 임상적으로 추정되는 흉막 삼출증의 원인 질환이 발견되었는데, 악성 종양이 21예로 가장 많았고, 나머지 12예에서는 흉막 삼출증의 원인을 찾을 수 없었다. 12예 중 7예에서 흉막 삼출증이 자연 관해 되었으며 2예에서는 항생제 치료를 하면서 흉막 삼출증이 소실 되었고, 1예에서는 소량의 흉막 삼출액이 지속되었다. 결 론 : 흉수의 항산균 도말 검사, 세포진 검사가 음성이고 흉수의 ADA 와 CEA 가 낮은, 원인 질환이 뚜렷하지 않은 림프구성 흉막 삼출증은 양호한 예후를 보이므로 임상의는 주기적인 추적 관찰을 통해 주의 깊게 임상 경과를 살펴볼 수 있다.

Keywords

References

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