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Neutrophil elastase α1-proteinase inhibitor complexes in pleural effusions

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Summary

Polymorphonuclear (PMN) granulocyte derived neutrophil elastase (NE) is rapidly antagonized by α1-proteinase inhibitor (α1 PI) in vivo. To determine the clinical value of elastase α1-proteinase inhibitor complexes (E-α1 PI) in pleural effusions, fluid samples of 99 patients were examined. Fifty-six had malignant effusions, 30 had nonmalignant exudates (pleural protein above 3 g/dl) mainly of inflammatory origin, and 13 patients had low protein transudates (below 3 g/dl) due to congestive heart failure. Nonmalignant exudates showed significantly higher (P<0.001) concentrations of E-α1 PI compared with malignant effusions or low protein transudates (P<0.001). Malignant exudates secondary to lung cancer were characterized by higher (P<0.001) median pleural E-α1 PI concentrations compared to malignant exudates due to primarily extrathoracic malignancies. Total pleural leukocyte counts and pleural neutrophil counts were performed in 68 effusions. By this means no clear-cut differentiation between malignant and nonmalignant exudates seems possible except for marked empyema. In conclusion, E-α1 PI complexes in pleural fluid may better reflect the stage of inflammation of pleural effusions rather than mere pleural leukocyte counts. Low levels of E-α1 PI complexes (<75 ng/ml) in pleural exudates with protein values above 3 g/dl are characteristic of malignant exudates. Determination of E-α1 PI in pleural exudates may serve as a sensitive marker of inflammation and useful adjunct to pleural cytology in aspects of differential diagnosis of pleural effusions.

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Abbreviations

E-α1 PI:

elastase α1 proteinase inhibitor complexes

NE:

neutrophil elastase

PMN:

polymorphonuclear

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Authors and Affiliations

  1. Medizinische Abteilung, Wilhelminenspital, Wien, Österreich

    H. Klech, G. Rona & F. Kummer

  2. Zentral Laboratorium, Wilhelminenspital, Wien, Österreich

    E. Knoth & P. M. Bayer

Authors
  1. H. Klech
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  2. G. Rona
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  3. E. Knoth
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  4. F. Kummer
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  5. P. M. Bayer
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Klech, H., Rona, G., Knoth, E. et al. Neutrophil elastase α1-proteinase inhibitor complexes in pleural effusions. Klin Wochenschr 66, 346–350 (1988). https://doi.org/10.1007/BF01735792

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  • DOI: https://doi.org/10.1007/BF01735792

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