Eksuda vasfında plevra sıvılarının ayırıcı tanısında plevral sıvı neopterin düzeyinin önemi
Özet
Neopterin is synthesized by macrophes from guanosine triphosphate (GTP) with stimulation of T-cell derived interferon-?. It?s nonspesific marker of cellular immune system. Neopterin is elevated in serum and body fluids due to infections, malignancy, autoimmune diseases, transplant rejection, renal failure and coronary artery disease. Many studies showed the importance of elevated neopterine levels for the prognosis and response to therapy. Tuberculous pleurisy is the second most common form of extra pulmonary tuberculosis. Prompt diagnosis and treatment can prevent reactivation tuberculosis.Aim of this study was to investigate the value of pleural effusion neopterine concentration, in discriminating the tuberculous effusion from the other exudative effusions.We evaluated the pleural effusion neopterine, ADA, glucose, LDH, protein and serum white blood cell concentrations of seventy patients. There were 4 groups. 19 patients with transudative effusion, 14 patients with tuberculous effusion, 18 patients with parapneumonic effusions-empyema and 19 patients with malignant pleural effusions. The highest mean pleural effusion neopterine level was in the transudative pleural effusion group (32±24.9 nmol/L). Mean pleural effusion neopterine levels of the other goups were as follows: 26.8±20 nmol/L for parapneumonic effusions-empyema, 19.84±15.9 nmol/L for tuberculous pleural effusion group and 12.52±4 nmol/L for malignant pleural effusion group. There were significant differences between malignant pleural effusion -transudative groups and malignant pleural effusion- parapneumonic effusions-empyema groups (p<0.05). Pleural effusion mean ADA concentration was significantly higher than the other groups in the tuberculous effusion group (68 U/L).We concluded that measurement of pleural effusion neopterine concentration doesn?t have any value in discriminating the tuberculous effusion from the other exudative effusions. And pleural effusion ADA measurement is superior to the neopterine measurement.