Fikret KANAT, Faruk ÖZER, Oktay İMECİK, Abdülcelil KALEM

Transüda-eksüde ayrımında plevral sıvı psödokolinesteraz düzeyinin tanısal değeri

Bu çalışmaya, Selçuk Üniversitesi Tıp Fakültesi Göğüs Hastalıkları ile İç Hastalıkları Anabilim Dalı'nda 1999-2000 yılları arasında yatırılarak tetkik edilen plörezili 80 olgu ve kontrol grubu olarak seçilen 30 sağlıklı birey alındı. Plörezili olgular tanılarına göre transüda ve eksüda olmak üzere iki grupta incelendi. Transüda ve eksüda gruplarında ortalama pleüra sıvısı psödokolinesteraz düzeyleri arasında istatistiksel olarak anlamlı fark bulundu (p< 0.001). Ortalama plevral sıvı/serum psödokolinesteraz oranı da gruplar arasında istatistiksel olarak anlamlı farklılık göstermekteydi (p< 0.001). Eksüdatif sıvıların ayırt edilmesinde plevral sıvı psödokolinesteraz düzeyinin sensitivitesi ve spesifisitesi %100 olarak saptandı. Plevral sıvı/serum psödokolinesteraz oranının sensitivite ve spesifisitesi ise sırasıyla %90 ve %87 idi. Sonuç olarak, pleural sıuılann transüdaeksüda ayrımında pleyral sıvı psödokolinesteraz düzeyi ve plevral sıvı/serum psödokolinesteraz oranının, tanışal değeri yüksek ve kullanılabilir bir parametre olduğu kanısına varıldı.

Diagnostic of efficiency pseudocholinesterase level in discrimination of transudates-exudates

In this study, 80 cases with pleural effusion hospitalized at the departments of Chest Diseases and Internal Medicine in the Medical School of Selçuk University, and 30 healthy people as control group were studied. Regarding to the diagnosis, pleural fluids were classified into two roups as follows; transudates and exudates. Difference between the mean pleural pseud ocholinesterase levels of transudates and exudates was statistically significant (p< 0.001). Similar significance was also obtained in the mean pleural fluid/serum pseudocholinesterase ratios of the groups (p< 0.001). In determination of exudative fluids both sensitivity and spesificity of the pleural fluid pseudocholinesterase level was 100%. Sensitivity and spesificity of the pleural fluid/serum pseudocholinesterase ratio were 90 and 87%, respectively. We have concluded that pleural pseudocholinesterase level and pleural fluid/serum pseudocholinesterase ratio can be used as a parameter with high diagnostic efficiency in discrimination of pleural effusions as exudates and transudates.

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1. Sahn SA. The pleura. Am Rev Respir Dis 19BB; 138: 184-234.
2. Light RW.Diagnostic principles in pleural disease. Eur Respir J 1997; 10:476-81.
3. Storey DD, Dines DE, Coles DT. Pleural effusions: A diagnostic dilemma? JAMA 1976; 106: 1209-14.
4. Light RW, MacGregor MI, Luchsinger PC, et al. Pleural effusions: The diagnostic separation of transudates and exudates, Ann Intern Med l972; 77:507-13.
5. Roth BJ. Evaluating pleural fluid. Chest 1996; 110: 7.
6. Burgess LJ, Maritz FJ, Taljaard JJF. Comparative analysis of the biochemical parameters used to distinguish between pleural exudates and transudates. Chest 1995; 107: 1604-9.
7. Valdes L, Pose A, Saurez J, et al. Cholesterol: A useful parameter for distinguishing between pleural transudates and exudates. Chest 1991; 99: 1097-102.
8. Romero S, Candela A, Martin C, et al. Evaluation of different criteria for the separation of pleural transudates from exudates. Chest 1993; 104: 399-404.
9. Hamm H, Brohan U, Bohmer R, et al. Cholesterol in the pleural effusions: A diagnostic aid. Chest 1987; 92: 296-302.
10. Roth BJ, O'mera TF, Crogun WH. The serum-effusion albumin gradient in the evaluation of pleural effusions. Chest 1990; 98:546-9.
11. Meisel S, Shamisso K. Pleural fluid to serum bilirubin concentration ratio for the separation of transudates and exudates. Chest 1990; 98: 141-4.
12. Imecik O, Özer F, Gök M. Plevra sıvılarında kolesterol tayininin transüda-eksüda ayırımındaki yeri. Tüberküloz veToraks 1992; 40:21-6.
13. Uzun K, Vural H, Özer F, et al. Diagnostic value of uric acid to differentiate transudates and exudates, Clin Chem Lab Med 2000; 38: 661-5.
14. Imecik O, Ozer F. Diagnostic value of sialic acid in malignant pleural effusions. Chest 1992; 102: 1819-22.
15. Gazguez I, Parcel JM, Vives M. Comparative analysis of Light's criteria and other biochemical parameters for distinguishing from exudates. Respir Med 1998; 92: 762-5.
16. Taylor P. The cholinesterases. J Biol Chem 1991; 266: 4025-8,
17. Jbila O, Hemile Y, Talesa V, et al. Acetylcholinesterase and butrylcholinesterase expansion in adult rat tissues and during development Eur J Biochem 1994; 225: 115-24.
18. Kutty K, Huang S, Kean KT. Pseudocholinesterase in obesity: Hyperchaloric diet induced changes experimental obece mice. Experientia 1981; 37:1141-2.
19. Kutty KM, Redheendran R, Murphy D. Serum cholines-terase: Function in lipoprotein metabolism. Experientia 1977; 33: 420-3.
20. Garcia-Pachon E, Padllla-Navas I, Sanchez JF, et al. Pleural fluid to serum cholinesterase ratio for the separation of transudates and exudates. Chest 1996; 110: 97-101.
21. Romero S, Martinez A, Hernandez L, et al. Light's criteria revisited: Consistency and comparison with new proposed alternative criteria for seperating pleural transudates and exudates. Respiration 2000; 67: 18-23.
22. Sevim T, Gungor G, Tahaoglu K. Pleural to serum cholinesterase ratio in separation of transudative and exudative pleural effusions. Chest 2001; 119:989-90.
23. Guyton AC. Textbook of Medical Physiology. Philadelphia: WB Saunders Company, 1986: 42-59: 545-61.
24. Tietz N. Fundamentals of Chemical Chemistry. 3rd ed. Philadelphia: WB Saunders Company, 1990: 12-3.
25. Henry JB, Clinical Diagnosis and Management by Laboratory Methods. 9th ed. Philadelphia: WB Saunders Company, 285-9.
26. Grisaru D, Sternfeld M, Eldor A. Structural roles of acetytcholinesterase variants in biology and pathology. Eur J Biochem 1999; 264; 672-86.
27. Cabrer B, Bofill D, Grau A, et al. Valor de la cholinesterasa en liquido pleural para su diagnostlca etiologico. Rev Clin Esp 1978; 150: 1834.
28. Gürbüz N, Tutluoğlu B, Öcal Z ve ark. Plevral effüzyonlarda kolinesteraz ölçümünün tamsal değeri. İzmir Göğüs Hastanesi Dergisi 1999; 13: 15-23.