연구배경 : Cytokine은 주요한 염증 매개 물질로서 질환에 따라 다른 양상을 보일 수 있어, 흉수를 일으키는 다양한 원인 질환의 감별에 이용되어 왔다. 이 중에서 악성 흉수, 결핵성 흉수, 부폐렴 삼출액 및 농흉에서 INF-${gamma}$, IL-2R, IL-6, IL-1를 동사에 측정하여 비교한 연구는 많지 않아 본 연구를 시행하게 되었다. 방법 : 흉수를 주소로 내원한 환자 중에서 흉수 천자로 삼출액이 확인된 환자들을 대상으로 흉수를 채취하여, ELISA kit를 이용하여 INF-${gamma}$, IL-2R, IL-6, IL-10 농도를 측정하였다. 결과 : 악성 흉수, 결핵성 흉수, 부폐렴 삼출액 및 농흉에서 흉수 내의 cytokine의 순서대로, INF-${gamma}$는 $16.7{pm}50$, $295.5{pm}585.5$, $10.0{pm}0$ pg/ml, IL-2R은 $3247.4{pm}1713.3$, $7423.5{pm}3752.8$, $3790.2{pm}3201.1$ pg/ml, IL-6는 $600{pm}12.8$, $556.4{pm}161.7$, $514.4{pm}224.8$ pg/ml, IL-10은 $28.2{pm}55.5$, $11.3{pm}11.7$, $98.4{pm}141.7$ pg/ml로 각각 측정되어, 결핵성 흉수가 다른 원인의 흉수에 비해 IL-2R 농도가 의 있게 높았으며, IFN-${gamma}$ 농도도 높은 경향을 나타내었으며, 부폐렴 삼출액에서는 IL-10농도가 다른 원인의 흉수에 비해 의미있게 높았다. 결론 : 결론적으로 흉수 내의 IL-2R농도 측정은 결핵성 흉수와 다른 원인의 흉수를 감별하는데 어느 정도 도움이 될 것으로 사료되며, IL-10 측정은 부폐렴 삼출액과 다른 원인의 흉수를 감별하는데 어느 정도 도움을 줄 것으로 생각된다.
Background : Cytokines are chemical mediators that control and modulate many inflammatory processes. They work in different fashions in a variety of diseases. Discriminating between malignant effusion, tuberculous effusion, and parapneumonic effusion are crucial from the clinical view-point in Korea. In the current study, interferon-gamma (IFN-${gamma}$), soluble interleukin-2 receptor (IL-2R), interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured for this purpose. Methods : Pleural fluids from patients with malignant disease, tuberculosis, parapneumonic effusion and lung empysema were collected and gauged using commercial ELISA kits. Results : 34 patients were enrolled in this study. Among these 15 cases were malignant effusions, 12 were tuberculosis pleurisy and 7 were parapneumonic effusion and lung empyema. The levels of cytokines measured in this study were as follows, in order of frequency, malignant effusion, tuberculous effusion, parapneumonic effusion and lung empyema. The levels of INF-${gamma}$ were higher in tuberculous effusion than in malignant or parapneumonic effusion ($295.5{pm}585.5$ vs. $16.7{pm}50$ vs. $10.0{pm}0$ pg/ml, p>0.05). The levels of IL-2R were higher in tuberculous effusion than in malignant or parapneumoruc effusion ($7423.5{pm}3752.8$ vs. $3247.4{pm}1713.3$ vs. $3790.2{pm}3201.1$ pg/ml, p<0.05). No significant differences were found in the levels of IL-6 between the groups ($600{pm}12.8$ pg/ml in malignant effusion, $556.4{pm}161.7$ pg/ml in tuberculous effusion, $514.4{pm}224.8$ pg/ml in parapneumoruc effusion). IL-10 levels were higher in parapneumoruc effusion than in malignant or tuberculous effusions ($98.4{pm}141.7$ vs. $28.2{pm}55.5$ vs. $11.3{pm}11.7$ pg/ml, p<0.05). Conclusion : These results suggest that the measurement of IL-2R levels in pleural fluids may be a useful means of differentiating between tuberculous effusion and pleural effusions of other origins, and that the measurement of IL-10 levels in pleural fluids may be useful to differentiate between parapneumonic effusion and pleural effusions of other origins.
