Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Etiology and Characteristics of Massive Pleural Effusions Investigated at One University Hospital in Korea

대량 흉수의 원인과 성상-국내 한 대학병원의 경험

  • Park, Song Ree (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Kim, Jee Hyun (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Ha, Na Rae (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Lee, Jae Hyung (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Kim, Sang Heon (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Sohn, Jang Won (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Yoon, Ho Joo (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Shin, Dong Ho (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Park, Sung Soo (Department of Internal Medicine, College of Medicine, Hanyang University) ;
  • Kim, Tae Hyung (Department of Internal Medicine, College of Medicine, Hanyang University)
  • 박송리 (한양대학교 의과대학 내과학교실 호흡기내과) ;
  • 김지현 (한양대학교 의과대학 내과학교실 호흡기내과) ;
  • 하나래 (한양대학교 의과대학 내과학교실 호흡기내과) ;
  • 이재형 (한양대학교 의과대학 내과학교실 호흡기내과) ;
  • 김상헌 (한양대학교 의과대학 내과학교실 호흡기내과) ;
  • 손장원 (한양대학교 의과대학 내과학교실 호흡기내과) ;
  • 윤호주 (한양대학교 의과대학 내과학교실 호흡기내과) ;
  • 신동호 (한양대학교 의과대학 내과학교실 호흡기내과) ;
  • 박성수 (한양대학교 의과대학 내과학교실 호흡기내과) ;
  • 김태형 (한양대학교 의과대학 내과학교실 호흡기내과)
  • Received : 2006.09.29
  • Accepted : 2006.11.15
  • Published : 2006.11.30
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Abstract

Background: Differential diagnosis is very important in patients with pleural effusions. A few studies on the etiologies of massive pleural effusions have been reported, but these were conducted in different decades and locations. In the present study, the etiologic spectrum of massive pleural effusions in Korea, were evaluated through an investigation at one university hospital. Methods: Retrospective chart reviews were performed in patients having undergone thoracentesis between July 2002 and July 2005. Pleural effusions were deemed to be massive if they occurred in two thirds or more of one hemithorax. The etiologies of massive pleural effusions, pleural fluid findings, serum laboratory findings, and sputum and pleural fluid cytologies were compared. Results: Of 298 pleural effusions cases, 41 (13.8%) had massive pleural effusions. The most frequent causes of massive pleural effusions were malignancy (19; 46.3%) followed by tuberculosis (15; 36.6%), parapneumonic effusion (4; 9.8%) and transudate (3; 7.3%). Compared with massive benign effusions, patients with massive malignant pleural effusions were more likely to have lower adenosine deaminase (ADA) activity, a higher amylase level and higher RBC count in their pleural fluids. Also, compared with non-tuberculosis effusions, patients with massive tuberculous pleural effusions were more likely to have lower RBC and neutrophil counts, but a higher lymphocyte count, adenosine deaminase (ADA) activity and protein level. Conclusion: The most common etiologies of massive pleural effusions in Korea are malignancy and tuberculosis. A high ADA content favors a tuberculous condition, while bloody effusions with a relatively lower ADA content. favors malignancy. The proportion of tuberculosis in massive pleural effusions was higher than in previous reports.

연구배경: 대량 흉수의 가장 흔한 원인은 악성으로 알려졌으나 이에 대한 보고가 많지 않고, 지역 및 시대에 따라 다른 분포를 보였다. 저자들은 결핵의 유병율이 높은 국내에서 대량 흉수의 원인 질환의 분포를 알아보고, 원인 질환 감별을 위한 흉수의 분석지표에 대해 알아보기 위해 연구를 시행하였다. 방 법: 2002년 7월부터 2005년 7월까지 한양대학교 구리병원에 입원하여 흉수 천자를 시행하였던 298명 환자를 대상으로 후향적 조사를 시행하였다. 대량 흉수는 흉부단순촬영에서 일측 흉곽의 2/3 이상을 차지한 경우로 정의하였고 각 환자에서 혈청 생화학 검사, 흉수 천자 소견을 비교하였다. 결 과: 전체 298명의 흉수 예 중 대량 흉수는 41예, 13.8% 이었다. 대량 흉수의 원인으로는 악성 흉수가 19예(46.3%)로 가장 많았고 결핵 15예(36.6%), 부폐렴성 흉막염 및 농흉 4예(9.8%), 여출성 흉수 3예(7.3%) 순이었다. 대량 흉수 중 악성 흉수(n=19)와 양성 흉수군(n=22)의 비교 시 악성 흉수에서 ADA가 낮고(30.5 vs 86.2;p=0.017), amylase 수치가 높았다(349.0 vs 39.2;p=0.031). 흉수 적혈구는 악성 흉수 군에서 높은 경향을 보였다(95,406 vs 22,105;p=0.052). 결 론: 국내에서 대량 흉수의 원인으로는 악성 외에도 결핵에 의한 경우가 많았으며, ADA가 낮은 혈성 흉수는 악성을, ADA가 높은 림프구성 흉수는 결핵의 가능성을 고려해 볼 수 있겠다.

Keywords

References

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