ISSN:
1432-1440
Keywords:
Pleural effusions
;
Neutrophil elastase
;
α1-Proteinase inhibitor complexes
;
Leukocyte counts
;
Differential diagnosis
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Summary Polymorphonuclear (PMN) granulocyte derived neutrophil elastase (NE) is rapidly antagonized by α1-proteinase inhibitor (α1 PI) in vivo. To determine the clinical value of elastase α1-proteinase inhibitor complexes (E-α1 PI) in pleural effusions, fluid samples of 99 patients were examined. Fifty-six had malignant effusions, 30 had nonmalignant exudates (pleural protein above 3 g/dl) mainly of inflammatory origin, and 13 patients had low protein transudates (below 3 g/dl) due to congestive heart failure. Nonmalignant exudates showed significantly higher (P〈0.001) concentrations of E-α1 PI compared with malignant effusions or low protein transudates (P〈0.001). Malignant exudates secondary to lung cancer were characterized by higher (P〈0.001) median pleural E-α1 PI concentrations compared to malignant exudates due to primarily extrathoracic malignancies. Total pleural leukocyte counts and pleural neutrophil counts were performed in 68 effusions. By this means no clear-cut differentiation between malignant and nonmalignant exudates seems possible except for marked empyema. In conclusion, E-α1 PI complexes in pleural fluid may better reflect the stage of inflammation of pleural effusions rather than mere pleural leukocyte counts. Low levels of E-α1 PI complexes (〈75 ng/ml) in pleural exudates with protein values above 3 g/dl are characteristic of malignant exudates. Determination of E-α1 PI in pleural exudates may serve as a sensitive marker of inflammation and useful adjunct to pleural cytology in aspects of differential diagnosis of pleural effusions.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01735792
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