每日一题_2024.02.15

A 63-year-old man with a history of follicular lymphoma presented with 2 weeks of fatigue and 3 days of dyspnea. On physical examination, he had decreased breath sounds at the base of both lungs. A chest radiograph revealed pleural effusions, which were greater on the right side than on the left. Thoracentesis of the right side resulted in the removal of 1 liter of milky, yellow fluid. A chylothorax was suspected. Which of the following pleural fluid tests is most commonly used to diagnose a chylothorax?

1例63岁男性滤泡性淋巴瘤患者因乏力2周、呼吸困难3 d就诊。体格检查时，患者双肺基底部呼吸音降低。胸片显示胸腔积液，右侧多于左侧。右侧胸腔穿刺抽吸了1 l乳白色黄色液体，怀疑乳糜胸。下列哪一种胸腔积液检查最常用于诊断乳糜胸?

A. Cholesterol 胆固醇

B. Chylomicrons 乳糜微粒

C. Cytology 细胞学

D. Lactate dehydrogenase 乳酸脱氢酶

E. Triglyceride甘油三酯

答案解析：

正确答案是甘油三酯。患者被诊断为乳糜胸，并发现淋巴细胞性胸膜渗出液，甘油三酯水平为1225 mg/dL(参考值为110 mg/dL)。组织病理学检查显示小的恶性淋巴细胞，其免疫表型与患者之前的滤泡性淋巴瘤相同。非创伤性乳糜胸的最常见原因是癌症，最常见的是淋巴瘤。全身化疗开始后，胸腔积液减少。

正确答案：E