Cholesterol in Pleural Effusions

肋膜腔積液之胆固醇濃度

施婷婷(Ting-Ting See)；蘇義仁(Yih-Ming Su)；羅雨平(Yee-Ping Law)；劉智球(Chi-Kow Lau)；麥慶雲(Hing-Wan Mak)

肋膜腔積液 ； 胆固醇 ； 滲出液 ； 漏出液 ； Pleural effusion ； Cholesterol ； Exudate ； Transudate

Journal of Medical Sciences

10卷6期（1990 / 12 / 01）

355 - 360

英文

In 1972, Light reported the use of pleural fluid protein ＞ 3 gm/dl, pleural fluid/serum protein ratio ＞ 0.5, pleural fluid lactic dehydrogenase (LDH) ＞ 200 IU or pleural fluid/serum LDH ＞ 0.6 to differentiate exudative and transudative pleural effusions. In 1987, Hamm reported the utilization of pleural fluid cholesterol ＞ 60 gm/dl to diagnose exudates. The purpose of our study is to investigate the validity of Hamm's criterion and its applicability in Orientals. In this prospective study of 40 patients with pleural effusion, the underlying disease could be defined in all cases. By clinical signs and symptoms, chest x-ray, tissue biopsy and operative findings, 25 of these effusions were classified as exudates and 15 as transudates. Pleural fluid protein, LDH and cholesterol levels were studied. Mean cholesterol level in transudative effusions was 24 mg/dl, 66 mg/dl in malignant effusions and 60 mg/dl in inflammatory effusions. Using a dividing line of 40 mg/dl to separate exudates from transudates, only 7.5% were incorrectIy classified. Ratio of pleural fluid cholesterol to serum cholesterol level was also calculated. Mean cholesterol ratio in transudates was 0.14, 0.38 in malignant effusions and 0.55 in inflammatory effusions. Using a dividing ratio of 0.3 the percentage of misclassified effusions was also 7.5. When Light's criteria was used to classify our cases, the resulting error was also 7.5%. Summarizing the above data, we arrived at two conclusions. Firstly the percentage of error was the same whether Light's criteria or pleural fluid cholesterol level was used in diagnosing exudates and transudates. Secondly, the dividing pleural fluid cholesterol value that we got was lower than that reported by Hamm. This can be attributed to a lower serum cholesterol level in Orientals.

In 1972, Light reported the use of pleural fluid protein ＞ 3 gm/dl, pleural fluid/serum protein ratio ＞ 0.5, pleural fluid lactic dehydrogenase (LDH) ＞ 200 IU or pleural fluid/serum LDH ＞ 0.6 to differentiate exudative and transudative pleural effusions. In 1987, Hamm reported the utilization of pleural fluid cholesterol ＞ 60 gm/dl to diagnose exudates. The purpose of our study is to investigate the validity of Hamm's criterion and its applicability in Orientals. In this prospective study of 40 patients with pleural effusion, the underlying disease could be defined in all cases. By clinical signs and symptoms, chest x-ray, tissue biopsy and operative findings, 25 of these effusions were classified as exudates and 15 as transudates. Pleural fluid protein, LDH and cholesterol levels were studied. Mean cholesterol level in transudative effusions was 24 mg/dl, 66 mg/dl in malignant effusions and 60 mg/dl in inflammatory effusions. Using a dividing line of 40 mg/dl to separate exudates from transudates, only 7.5% were incorrectIy classified. Ratio of pleural fluid cholesterol to serum cholesterol level was also calculated. Mean cholesterol ratio in transudates was 0.14, 0.38 in malignant effusions and 0.55 in inflammatory effusions. Using a dividing ratio of 0.3 the percentage of misclassified effusions was also 7.5. When Light's criteria was used to classify our cases, the resulting error was also 7.5%. Summarizing the above data, we arrived at two conclusions. Firstly the percentage of error was the same whether Light's criteria or pleural fluid cholesterol level was used in diagnosing exudates and transudates. Secondly, the dividing pleural fluid cholesterol value that we got was lower than that reported by Hamm. This can be attributed to a lower serum cholesterol level in Orientals.