림프구성 흉막염의 감별 진단에서 NO(nitric oxide)의 측정
Measurement of Nitric Oxide in the Differential Diagnosis of Lymphocytic Pleural Effusion
윤호주 (한양대학교)
박성수 (한양대학교)
손장원 (한양대학교)
신동호 (한양대학교)
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초록
배 경 : 림프구성 흉막염의 감별 진단은 매우 중요하나, 적절한 검사 후에도 감별이 되지 않는 예가 있다. NO는 급성 염증반응 시 혈청, 객담, 호기 응축액 등에서 증가하는 것으로 알려져 있으며, 활동성 폐결핵 환자의 객담 및 호기에서도 증가하고 적절한 치료 후 감소하는 것으로 보고된 바 있어, 결핵성 흉막염에서도 증가할 가능성이 있으나, 결핵성 흉막염에서 NO에 대해서는 연구된 바가 없다. 이에 림프구성 흉막염 중 결핵성 흉막염의 감별진단에 있어서 NO의 유용성에 대해 알아보고자 하였다.대상 및 방법 : 2004년 4월부터 2005년 4월까지 한양대 구리병원에 급성 흉막염으로 입원하여 흉수 검사 결과 림프구성 흉막염 소견을 보였던 환자를 대상으로 흉수 및 혈청 NO를 측정하였으며, 대상 환자는 27명으로, 남:여 각각 14:13명이었고, 평균 연령은 48세였다. 최종 진단은 결핵성 흉막염 17명, 악성 흉수 10명이었다.
- keywords
- NO(nitric oxide), Malignant pleural effusion, Tuberculous pleurisy, NO(nitric oxide), Malignant pleural effusion, Tuberculous pleurisy
Abstract
Background : Differential diagnosis of lymphocytic pleural effusion is difficult even with many laboratory findings. Nitric oxide(NO) level is higher in the sputum or exhaled breath of patients with active pulmonary tuberculosis than in those without tuberculosis. In addition, there are some reports about the increased level of NO metabolites in body fluids of cancer patients. However, there is no data on the NO levels in the pleural fluid of patients with tuberculous pleurisy. Method : The serum and pleural fluid NO in the patients with acute lymphocytic pleural effusion were analyzed. Results : Of total 27 patients, there were 14 males and average age of patients was 48 years. The final diagnosis was tuberculous pleurisy in 17 cases and malignant pleural effusion in 10. The pleural fluid NO level was 540.1±116.4 μmol in the tuberculous pleurisy patients and 383.7±71.0 μmol in the malignant pleural effusion patients. The serum NO level was 624.7±142.0 μmol in tuberculous pleurisy patients and 394.4±90.4 μmol in malignant pleural effusion patients. There was no significant difference in the serum and pleural fluid NO level between the two groups. The NO level in the pleural fluid showed a significant correlations with the pleural fluid neutrophil count, the pleural fluid/serum protein ratio, and pleural fluid/serum albumin ratio (p<0.05 in each). The protein concentration, leukocyte and lymphocyte count in the pleural fluid were significantly higher in the tuberculous pleurisy patients than the malignant pleural effusion patients (p<0.05 in each). Conclusion : NO is not a suitable marker for a differential diagnosis of lymphocytic pleural effusion. However, the NO level in the pleural fluid might be associated with the neutrophil recruitment and protein leakage in the pleural space. (Tuberc Respir Dis 2005; 59: 361-367)
- keywords
- NO(nitric oxide), Malignant pleural effusion, Tuberculous pleurisy, NO(nitric oxide), Malignant pleural effusion, Tuberculous pleurisy
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