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作者对46例胸腔积液病人在抗菌治疗前同时测定63个标本的胸液乳酸盐(PFL)和血液乳酸盐(BL)值,结果以细菌性胸膜炎PFL 最高,平均值为17.74mmol/L,如以≥6 mmol/L 作为诊断细菌性胸膜炎的阈值,其特异性为100%,敏感性为88.6%。PFL 减去BL 取得平均差值,也以细菌性胸膜15.9mmol/L 为最高,如以≥6 mmol/L 作为诊断细菌性胸膜炎阈值,其特异性为100%,敏感性为93.8%。以上数据有力提示,测定胸水中的乳酸含量,对于早期诊断化脓性胸膜炎极有帮助。本组有5个“假阳性标本”,其中2例为胸膜癌肿病人,此两人后来也出现明显的细菌性胸腔积液。例数虽少,但作者认为PFL 具有判断预后价值的可能性,仍值得注意。有些学者报告,未感染的恶性胸腔积液PFL 可升高。高PFL 也可见诸霉菌性、类风湿性以及结核性胸膜炎,但本文3例结核性胸腔积液的病人中仅1例出现PFL 升高.另两个“假阳性标本”可能是全身乳酸性酸中毒使PFL 升高,与胸膜腔感染无关。
The authors of 46 cases of pleural effusion in patients with antibacterial therapy before simultaneous determination of 63 specimens of pleural fluid lactate (PFL) and blood lactate (BL) value, the results of the highest bacterial pleurisy PFL, the average value of 17.74mmol / L, such as ≥ 6 mmol / L as the threshold for the diagnosis of bacterial pleurisy, the specificity was 100%, the sensitivity was 88.6%. The mean difference of PFL minus BL was also the highest in bacterial pleura of 15.9 mmol / L. For example, the threshold value of ≥6 mmol / L was used to diagnose bacterial pleurisy. The specificity was 100% and the sensitivity was 93.8%. The above data suggest that the determination of lactic acid in pleural effusion, for the early diagnosis of suppurative pleurisy very helpful. This group has 5 “false positive specimens”, of which 2 cases of pleural cancer patients, the two later also showed significant bacterial pleural effusion. Although the number of cases is small, the author thinks it is worth noting that PFL has the possibility of judging the prognostic value. Some scholars have reported that uninfected malignant pleural effusion PFL can be increased. High PFL can also be seen with fungal, rheumatoid, and tuberculous pleurisy, but only one of the three patients with tuberculous pleural effusion showed elevated PFL.The other two “false positives” may be systemic lactic acid Poisoning increased PFL, has nothing to do with pleural infection.