합병부폐렴삼출 및 농흉의 치료성적과 예후인자

연구배경: 폐렴 환자 중 약 40%에서 흉막삼출이 동반되고 이 가운데 약 10%에서 배액이 필요한 합병부폐렴삼출 또는 농흉으로 진행된다. 저자들은 합병부폐렴삼출 및 농흉 환자에서 치료성적과 예후인자에 대해 알아보고자 하였다. 방법: 2001년 9월부터 2005년 12월까지 합병부폐렴삼출 및 농흉으로 치료받았던 115명의 환자를 대상으로 후향적 연구를 시행하였다. 결과: 대상환자 중 101예(87.8%)에서 치료성공을 보였는데 다변량분석에서 흉막액 LDH 수치(OR 7.37; 95% CI, 1.63-33.37; p=0.009)가 치료성공 및 실패에 중요한 예후인자로 나타났다. 해열기간과 유의한 상관관계를 보인 인자로는 흉막액의 농성여부(r=0.236; p=0.01)와 섬유소용해물질 사용빈도(r=0.257; p=0.01)가 확인되었고 입원기간과 유의한 상관관계를 보인 인자는 없었다. 결론: 흉막액 LDH 수치가 합병부폐렴삼출 및 농흉에서 치료성적과 연관된 예후인자로 생각된다. Background: Pleural effusion develops in approximately 40% of pneumonia patients. In 5-10% of these cases, it progresses to complicated parapneumonic effusion (CPPE) or empyema that requires drainage. The prognostic factors of CPPE and empyema remain to be clarified. We examined the treatment outcomes of CPPE and empyema and elucidating their prognostic factors. Methods: One hundred and fifteen patients with CPPE or empyema, who were diagnosed and treated in Kyungpook National University Hospital (Daegu, Korea) between September 2001 and December 2005, were retrospectively analyzed. All the data was acquired from their chart review, and regarding treatment results, the time to defervescence and the length of hospital stay were analyzed. Results: The treatment was successful in 101 patients with a success rate of 87.8%. Multivariate analysis showed the level of pleural fluid lactate dehydrogenase (LDH) to be a significant prognostic factor (odds ratio [OR] 7.37; 95% confidence interval [CI], 1.63 to 33.37; p=0.009). Pussy pleural fluid (r=0.236; p=0.01) and the frequency of urokinase use (r=0.257; p=0.01) correlated with the time to defervescence. However, there was no clinical factor that correlated with the length of hospital stay. Conclusion: The pleural fluid LDH level is a useful prognostic factor for monitoring treatment results of CPPE and empyema. (Tuberc Respir Dis 2007; 63: 24-30)