Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Difference of Clinical Features according to Hypoalbuminemia in the Children with Pleural Effusion

흉수가 있는 환아에서 저알부민혈증의 정도에 따른 임상 양상의 차이

  • Sung, Min-Jung (Department of Pediatrics, College of Medicine, Pusan National University) ;
  • Park, Hee-Ju (Department of Pediatrics, College of Medicine, Pusan National University)
  • 성민정 (부산대학교 의과대학 소아과학교실) ;
  • 박희주 (부산대학교 의과대학 소아과학교실)
  • Received : 2004.12.14
  • Accepted : 2005.03.07
  • Published : 2005.05.15
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Abstract

Purpose : Hypoalbuminemia is a rare cause of pleural effusion. The relationship between the severity of hypoalbuminemia and the clinical course of pleural effusion is unclear. The aim of this study was to evaluate the change of clinical course according to the severity of hypoalbuminemia due to pleural effusion in children. Methods : A total of 96 patients admitted to Pusan National University Hospital with pleural effusion from August 1998 to August 2004 were studied retrospectively. The 79 patients who had only infectious causes were evaluated according to their albumin levels. They were divided into the two groups : group 1 had serum albumin levels of ${\leq}2.5g/dL$; group 2 : >2.5 g/dL. The clinical courses of each group were compared. Results : The nature of pleural effusion was transudates in seven cases and exudates in 89 cases. The most commom causes of transudates were renal failure(four cases) and the most common causes of exudates were parapneumonic effusion(58 cases). There was no statistical significance in mean ages, BUN, creatinine, potassium, bilirubin and WBC in each group. Four patient in group 1 and 26 patients in group 2 improved after medication of antibiotics or anti-tuberculosis agents only. Fourteen patients in group 1 and 26 patients in group 2 improved after thoracostomy with use of antibiotics. Eight patients in group 1 and one patient in group 2 had ventilator care with use of antibiotics therapy. Conclusion : Children who were diagnosed as pleural effusion with low serum albumin levels on admission had poorer prognoses than those with normal levels. We conclude that lower serum albumin level on admission is an important prognosis factor in a patient with pleural effusion.

목 적 : 흉수가 있는 환아에서 저알부민혈증의 중등도에 따른 임상 경과의 차이점을 알아보고자 하였다. 방 법 : 1999년 8월부터 2004년 8월까지 부산대학교병원에 입원 당시 흉수가 있었던 환아 96명 중 감염이 원인 질환인 환아 79명을 혈청 알부민 수치에 따라 두 군으로 나누었다(1군 : ${\leq}2.5g/dL$, 2군 : >2.5 g/dL). 각 환자의 연령, 성별, 혈청 알부민 수치를 포함한 기본 혈액 검사, 흉부 방사선 촬영 결과와 각 군에서 환아의 치료 방법 및 예후를 의무 기록을 바탕으로 후향적으로 조사하였다. 결 과 : 79명 중 남아 48명, 여아 31명이었고, 평균 나이는 3.9세 이었다. 각 군에서 기본 혈액 검사는 차이가 없었고, 원인이 되었던 질환은 폐렴 58례, 농흉 12례, 폐 결핵 8례, 심낭염과 폐렴이 동반된 환아는 1례이었다. 각 군별로 입원 기간은 1군이 더 긴 것으로 나왔고, 항생제나 항결핵제 사용만으로 회복된 환아는 1군에서 4례, 2군에서 26례로 각 군별 환자 비율에 유의한 차이를 나타냈다(P=0.004). 항생제 사용하면서 흉관 삽입을 한 경우는 1군에서 14례, 2군에서 26례로 각 군별 환자 비율에 차이가 없었다. 그리고 인공 호흡기 치료가 필요하였던 경우가 1군에서 8례, 2군에서 1례로 분포되어 있었고, 통계학적으로 유의한 차이를 보였다(P=0.000). 결 론 : Starling 법칙에 따라 모세혈관의 정수압의 상승과 삼투압의 감소가 흉수를 일으킨다고 알려져 있지만 뚜렷한 체액의 저류 없이 저알부민혈증을 가진 경우도 드물게 흉수를 일으킬 수 있다. 그리고 혈청 알부민 수치가 낮을수록 인공 호흡기 치료를 하거나 사망하는 경우와 같은 치명적인 결과를 초래할 가능성이 높다.

Keywords

References

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