Etiology And Diagnosis Analysis For 241 Cases Of Pleural Effusion

BackgroundPleural effusion was a common disease of respiratory system. It was a kind of disease that liquid abnormally accumulates in the pleural space. Pleural effusion was due to the lesions of systemic multiple-organ-system and lung, or local lesion of the pleura, which destroyed the dynamic balance of pleural filtration, and absorption of balance. It was not only a common clinical disease in the clinical experiences, but also the clinical manifestations that many diseases are associated with. There are many kinds of etiologies of pleural effusion which involves many different clinical departments, and it is also one of the most common symptoms of respiratory system.During the clinical experience, we should determine the presence of pleural effusion depending on clinical manifestations, physical examinations, X-ray, CT scan, MRI and PET imaging examinations for the first step. Secondly we should make a comprehensive analysis of clinical manifestation, laboratory examination and pathological examination to make the definite etiology of pleural effusion. Accurate etiologic diagnosis plays great role in the treatment of pleural effusion. Therefore, the etiology and diagnostic analysis occupies an important position in the clinical experiences. Pleural effusion is classically divided into two categories, namely exudates and transudates, and Light criterion is currently the universal diagnostic standard.The differential diagnosis of pleural effusion had always been a matter which clinical physicians seriously concern on. The differential diagnosis of benign pleural effusion and malignant pleural effusion had a great significant value in the clinical treatment and prognosis evaluation, especially the differential diagnosis of malignant pleural effusion and tuberculosis pleurisy. Making the right etiology as soon as possible was very important to identify the effective treatment. At the same time it also had a significant value to shorten the patients' hospital stay, reduce the patients' economical burden. Therefore the cause of pleural effusion and diagnostic analysis had a significant clinical value. ObjectiveWith the analysis of clinical data of 241 cases of patients of pleural effusion in the first affiliated hospital of Zhengzhou University, including age, sex, clinical manifestations, biochemical test of blood and effusion, histopathological examination methods and complications of medical thoracoscopy, we aimed to explore the causes of pleural effusion and clinical characteristics, to assess the value of the biochemical indicators in the diagnosis and differential diagnosis of pleural effusion, to take a further step to improve the level of diagnosis and differential diagnosis of pleural effusion. To learn the role of medical thoracoscopy in clinical practice process, and evaluate its diagnostic value of pleural effusion. MethodsRetrospectively analysis of the clinical information, lab results, imaging and pathological data of 241 patients with pleural effusion from respiratory department of the first affiliated hospital of Zhengzhou university from June 2014 to June 2015 were made. Of which there were 144 males, and 97 females, ageing 17-87 years old, and the median age was 58-year-old, and an analysis of the etiologies of all of the patients was conducted. For all the patients with malignant pleural effusion and tuberculosis pleurisy, we analyzed clinical manifestations, locations of pleural effusion, the nature of exudates and transudates, hemorrhagic and non-hemorrhagic, biochemical test, including chloridum, LDH, ALP, CRP, ADA, and the differences of CEA level between serum and pleural effusion. The pathological types and the methods of acquiring biopsy of patients with malignant pleural effusion caused by primary lung cancer were also analyzed in the research. Finally we carried out a statistical analysis on the complications of the medical thoracoscopy to evaluate its value in the process of clinical practice and operation. Results1. 135 cases of all the 241 cases of patients with pleural effusion were benign pleural effusion, in which 69 cases were tuberculosis pleurisy(accounting for 51.11%), and 106 cases were malignant pleural effusions, in which 93 cases were primary lung cancer(accounting for 87.74%). Tuberculosis pleurisy were the main causes of the age?40-year-old group,accounting for 70.18%(40/57). On the contrary, malignant pleural effusions were the main causes for patients aged 41-60 year-old group and age >60-year-old with the proportion respectively for 53.62%(37/69) and 55.65%( 64/115).2. The main complaints of patients with Malignant pleural effusion were cough, dyspnea, fatigue; on the contrary, fever, cough, chest pain, dyspnea were the main clinical manifestations for the patients with tuberculosis pleurisy.3. There were differences in the etiologies of unilateral and bilateral pleural effusion. For the unilateral pleural effusion, malignant pleural effusion accounts for 47.40%,with tuberculosis pleurisy accounting for 37.57%. For the bilateral pleural effusion, malignant pleural effusion accounts for 35.29%,with tuberculosis pleurisy accounting for 5.89%.4. Malignant pleural effusion and tuberculosis pleurisy are the main causes of exudates pleural effusion. The detection rate of malignant tumor is obviously higher in the exudates and hemorrhagic pleural effusion than that in the transudates and non- hemorrhagic pleural effusion.5. The chloride and LDH levels have no significant difference between the patients with malignant pleural effusion and tuberculosis pleurisy. And the level of glucose and ALP of pleural fluid is much higher of patients with malignant pleural effusion than that of tuberculosis pleurisy. The level of CRP and ADA of pleural fluid of patients with tuberculosis pleurisy is significantly higher than that of malignant pleural effusion.6. The level of CEA of the pleural fluid of malignant pleural effusion increased obviously more than that of the serum. Both the level of CEA of pleural fluid and serum were significantly higher than that of patients with tuberculosis pleurisy.7. The leading etiology of malignant pleural effusion was primary lung cancer, and 81.72% of the cases were diagnosed as adenocarcinoma in pathological type.8. Multiple biopsy methods could improve the sensitivity and specificity of the diagnosis of malignant pleural effusion. Medical thoracoscopy has a accuracy of 95.56% in the diagnosis of pleural effusion resulted from primary lung cancer.9. The complications of medical thoracoscopy were mild, and it was a safe means of minimally invasive examination. ConclusionMalignant pleural effusion and tuberculosis pleurisy are still the main etiologies of pleural effusion.The detection of several kinds of biomarkers in the serum and pleural effusion, is of great value for diagnosis. Medical thoracoscopy is a safe, efficient and minimally invasive diagnosis technology which is of great clinical significance for the diagnosis of pleural effusions.