Marcadores biológicos no líquido pleural

• Autor(a) principal: Pereira, Paulo Ricardo Oliveira
• Data de Publicação: 2009
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10316/19193
• topic: Marcadores biológicos; Pleura; Derrame plural

Several diseases cause fluid accumulation in the pleural space. The first step in the differential diagnose of a pleural effusion consists in the distinction between exsudates and transudates. A pleural effusion is an exsudate when one or more Light’s criteria are present, though, in a certain percentage of cases, a transudate may be misclassified according to these criteria. This first step is extremely important. Nevertheless, within each of these two categories one needs to further investigate in order to find the etiology. Using an array of biochemical, cytological, immunological and microbiological tests, thoracocentesis allows the etiological determination in 70 % of the cases and with the complement of new biological markers in almost 90 % of the circumstances. A transudate is almost always caused by heart failure or cirrhosis. On the other hand, an exsudate constitutes a more challenging diagnostic exercise. An exsudate may be classified as malignant or non-malignant (eg. parapneumonic, tuberculous pleurisy, post-embolic or secondary to connective tissue diseases). In this text, the author will discuss Light’s criteria (critics and alternatives) as well as the role of the measurement of several biological markers divided into the following categories: (1) biochemical (2) tuberculosis-related markers (3) tumoral markers (4) immunological (5) oxidative stress markers The aim of this work is to review the biological markers that can be measured in the pleural fluid and their utility in the differential diagnose of a pleural effusion, discussing, when available, their therapeutical and prognostic significance.