الفائدة التشخيصية لمعايرة CRP في سائل الجنب في دراسة انصباب الجنب

الملخص EN

BACKGROUND :Pleural effusion is commonly manifested in pulmonary ,pleural or extra-pulmonary disease .It may be transudate ,caused by heart failure or exudate, induced by inflammation, infection, or neoplasm .Despite the progress made on its investigation methods , it is still a major diagnostic problem.A specific test is therefore required for differential diagnosis of pleural effusion.C-reactive protein is an acute phase protein synthesized by hepatocytes.Few studies had reported the value of pleural C-reactive protein in differentiating between transudative and exudative effusions ,and in the aetiological diagnosis of exudative pleural effusion as well.

OBJECTIVE: The purpose of this study is to: Evaluate the role of pleural fluid CRP in discriminating between transudative and exudative effusions .

Determine the value of pleural CRP in the aetiological diagnosis of exudative pleural effusion.

Materials and Methods: A cross-sectional study at ALmoasat university hospital between March 2018 and March 2019.

Pleural fluid CRP levels were obtained in 62 patients with pleural effusion, using an immunoturbidmetric method.

According to the criteria used 20 patients included in the transudate group and 42 patients in the exudate group.

In the exudate group 10 patients had parapneumonic effusion, 18 neoplastic effusions, 9 tuberculous effusion, and 5 pulmonary embolism.

We compared first CRP levels between transudates and exudates.

Then between the causes of exudative effusion.

RESULS: Pleural fluid CRP levels were significantly higher in the exudate group(P=0.000).

When the exudate sub-groups were compared, the parapneumonic effusion CRP levels were significantly higher than those in non-parapneumonic effusions (tuberculous, neoplastic, pulmonary embolism)(P=0.000).

The tuberculous effusion CRP levels were lower than those in parapneumonic effusions but they are significantly higher than those found in malignant effusion subgroup(P=0.03).

CONCLUSION: Pleural CRP tittering could be a useful diagnostic marker for differentiation between exudative and transudative pleural effusions.

In the differential diagnosis of plueral effusions, higher CRP levels may prove to be a rapid, practical and accurate test of differentiating infective effusions (parapneumonic or tuberculous) from other exudate types.

Pleural fluid CRP ≥14 mg/l had 74% sensitivity and 90% specificity in diagnosis of exudate.

Pleural fluid levels ≥79 mg/l had 50% sensitivity and 100% specificity in diagnosis of parapneumonic effusion.

Pleural fluid levels ≥42.5mg/l had 68.4%sensitivity and 100% specificity in diagnosis of infective effusion.

Pleural CRP>42.5mg /l exclude totally malignant effusion