Malign plevral sıvıların ayırıcı tanısında bazı biyolojik markırların (CRP,CEA,IL 6, IL 8,TNF α) prediktif değeri
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Tarih
2015
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info:eu-repo/semantics/closedAccess
Özet
Plevral efüzyon pek çok değişik etyoloji ile ilgili olabilir ve intratorasik veya sistemik hastalıklarda ortaya çıkabilir. Plevral sıvının varlığını klinik ve radyolojik olarak saptamak kolay olmakla birlikte, sıvının etyolojisini bulmak o kadar da kolay değildir. Radyolojik yöntemler, sıvının biyokimyasal ve hücresel analizi, sitolojik muayene, mikrobiyolojik analizler, kapalı veya açık biyopsi işlemleri gibi tüm tanısal işlemler yerine getirilirse bile tanı alamayan hastalar olabilmektedir. Plevra içerdiği hücresel elemanlar ve bunların ürettiği etkileştiği medyatörler nedeniyle dinamik ve metabolik olarak aktif bir membrandır. Malign plevral efüzyonları teşhis etmede; plevral sıvının, elektron mikroskobik incelenmesi, hücrelerinin kromozom analizi, CEA seviyesinin ölçümü gibi birçok tanısal test önerilmiştir. Bu nedenle plevral sıvıda çok sayıda tümör markırı çalışılmıştır. Plevral hastalıklarda immünolojik mekanizmaların araştırılmasına ve anlaşılmasına yönelik çalışmalar yapılmıştır. Beningn ve malign efüzyonlarda sitokin üreten hücreler ve sitokinlerin varlığı rapor edilmiştir. Biz de bu çalışmamızda, eksuda vasfındaki plevral sıvılarda, malign plevral efüzyonları tespit etmede, plevral sıvı sitolojisi ve plevral biyopsi yanında, basit hızlı çalışılan bazı markırların (CRP, CEA, IL6, IL8, TNF?) sıvıda ölçümünün yararlı olup olamayacağını araştırdık. Çalışma prospektif olarak gerçekleştirildi ve çalışmaya değişik etyolojilere sahip eksuda vasfında plevral sıvısı olan 70 hasta alındı. Olgular, malign plevral efüzyon grubu (n= 27) ve benign plevral efüzyon grubu (n= 43) olarak gruplandırıldı. Hastaların plevral sıvılarında, rutin Light kriterleri, hücre sayımı, pH ölçümü yanında, CRP, CEA, IL-6, IL-8, TNF? düzeyleri çalışıldı. Farklı grupların plevral sıvıda ölçülen biyolojik markırlarının kıyaslanmasında Mann Whitney U testi kullanıldı.. Plevral sıvı CEA ve IL-6 seviyeleri malign plevral efüzyon grubunda, benign plevral efüzyon grubuna göre belirgin olarak yüksek idi. Bu fark istatistiksel olarak anlamlıydı (p<0.01 ve p=0.002 ). Plevral sıvı CRP ve TNF? seviyeleri kıyaslandığında, benign efüzyon grubunda daha yüksek olmakla birlikte, bu fark istatistiksel olarak anlamlı değildi. Her iki grubun, plevral sıvı IL-8 seviyeleri karşılaştırıldığında, IL-8 malign plevral efüzyon grubunda yüksekti ancak aralarında istatistiksel olarak anlamlı bir fark saptanmadı ( p=0.511) Sonuç olarak, vaka sayımız az olmakla birlikte, bulgularımız, eksudatif sıvıların malign ve benign sıvılar olarak ayırıcı tanısı yapılırken CEA ve IL-6’nın, bu konuda yararlı olabileceklerini göstermiştir. Malign plevral efüzyonların ayırıcı tanısında, invaziv tetkikler yerine CRP, CEA ve birtakım sitokinlerin kullanımı ile ilgili daha fazla sayıda vaka içeren geniş serilere ve standardize kit ve yöntemlerle yapılacak çok merkezli çalışmalara ihtiyaç olduğunu düşünmekteyiz.
Pleural effusion may be related to many differrent etiologies and it may occur in intrathoracic and systemic diseases. It is easy to determine the existence of pleural effusion as clinical and radiological, but it is not very easy to determine the etiology of effusion. There may be undiagnosed patients even if all of the diagnostic procedures such as radiologic methods, biochemical and cellular analysis of effusion, cytologic examination, microbiological analysis and closed and open biopsy are applied. Pleura is an active membrane because of the cellular components it consists and the mediators that these components produce and interact. In diagnosing the malignant pleural effusions, many diagnostic tests such as electron microscopic examination of pleural fluid, the chromosomal analysis of pleural fluid cells, evaluation of pleural fluid CEA level are recommended. So, many tumor markers are investigated in pleural fluid for diagnosing. Many studies are made for investigating and understanding of immunological mechanisms in pleural disases. The existance of cytokines and the cells that produce cytokine are reported in benign and malignant effusions. In this study, in addition to pleural fluid cytology and pleural biopsy, we investigated if some simple, rapid, biochemical tests ( IL6, IL8, TNF?, CRP, CEA ) would be usefull or not in the discrimination of malignant pleural effusions in exudative pleural fluids. It was a prospective study and 70 patients who had exudative pleural effusions with different etiologies were included in this study. The cases were grouped as malignant pleural effusion group (n= 27) and benign pleural effusion group (n=43). In patient’s pleural fluids, except from routine Light criteria, cell counting and pH evaluation; CRP, CEA, IL-6, IL-8, TNF? were investigated. Mann Whitney U test was used in the comparing biological markers evaluated in pleural fluids of different groups. The levels of pleural fluid CEA and IL-6 were significantly high in malignant pleural effusion group compared to benign pleural effusion group. This difference was statistically meaningful ( p<0.01 ve p= 0.002 ). When the levels of pleural fluid CRP and TNF were compared, it was higher in benign effusion group, but it was not meaningful statistically. When IL-8 levels of both groups were compared, IL-8 was higher in malignant effusion group; but, statistically a meaningful difference was not found between them ( p=0.511) In conclusion, although the number of our cases is low, our findings show that in distinguishing exudative pleural fluids as malignant and benign, CEA and IL-6 can be usefull in this subject. In differential diagnosis of malignant pleural effusions, we think that, wide serials that include more cases and multi-centric studies with standard kit and methods are needed about the usage of CRP, CEA and some cytokines instead of invasive examinations.
Pleural effusion may be related to many differrent etiologies and it may occur in intrathoracic and systemic diseases. It is easy to determine the existence of pleural effusion as clinical and radiological, but it is not very easy to determine the etiology of effusion. There may be undiagnosed patients even if all of the diagnostic procedures such as radiologic methods, biochemical and cellular analysis of effusion, cytologic examination, microbiological analysis and closed and open biopsy are applied. Pleura is an active membrane because of the cellular components it consists and the mediators that these components produce and interact. In diagnosing the malignant pleural effusions, many diagnostic tests such as electron microscopic examination of pleural fluid, the chromosomal analysis of pleural fluid cells, evaluation of pleural fluid CEA level are recommended. So, many tumor markers are investigated in pleural fluid for diagnosing. Many studies are made for investigating and understanding of immunological mechanisms in pleural disases. The existance of cytokines and the cells that produce cytokine are reported in benign and malignant effusions. In this study, in addition to pleural fluid cytology and pleural biopsy, we investigated if some simple, rapid, biochemical tests ( IL6, IL8, TNF?, CRP, CEA ) would be usefull or not in the discrimination of malignant pleural effusions in exudative pleural fluids. It was a prospective study and 70 patients who had exudative pleural effusions with different etiologies were included in this study. The cases were grouped as malignant pleural effusion group (n= 27) and benign pleural effusion group (n=43). In patient’s pleural fluids, except from routine Light criteria, cell counting and pH evaluation; CRP, CEA, IL-6, IL-8, TNF? were investigated. Mann Whitney U test was used in the comparing biological markers evaluated in pleural fluids of different groups. The levels of pleural fluid CEA and IL-6 were significantly high in malignant pleural effusion group compared to benign pleural effusion group. This difference was statistically meaningful ( p<0.01 ve p= 0.002 ). When the levels of pleural fluid CRP and TNF were compared, it was higher in benign effusion group, but it was not meaningful statistically. When IL-8 levels of both groups were compared, IL-8 was higher in malignant effusion group; but, statistically a meaningful difference was not found between them ( p=0.511) In conclusion, although the number of our cases is low, our findings show that in distinguishing exudative pleural fluids as malignant and benign, CEA and IL-6 can be usefull in this subject. In differential diagnosis of malignant pleural effusions, we think that, wide serials that include more cases and multi-centric studies with standard kit and methods are needed about the usage of CRP, CEA and some cytokines instead of invasive examinations.
Açıklama
Anahtar Kelimeler
Göğüs hastalıkları, Plevral efüzyon, Sitokin, CRP, CEA
