الفهرس 
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Abstract
A pleural effusion is an abnormal collection of fluid in the pleural space resulting from excess fluid production or decreased absorption. The development of inflammation in the pleura results in an increased vascular permeability leading to pleural fluid accumulation, this pleural fluid is enriched in Proteins, Inflammatory cells, and mediators. Cytokines are proteins with relatively low molecular weight that are secreted by cells in response to a variety of different stimuli and act as key mediators of the host response to various infectous, inflammatory, and immunologic challenges. The pleotropic cytokine interleukin-6 (IL-6) is a major marker of systemic response to inflammatory process and is involved in the regulation of a variety of cellular responses. The present study was a prospective study conducted on 40 patients with pleural effusions, admitted to chest department, Minoufiya University Hospitals and Al-Mahalla Al-Kobra Chest Hospital during the period from October 2012 till may 2013. These patients were classified according to their final diagnosis into 2 groups: 1-Group I: included 15 patients with transudative pleural effusion. and subdivided into 3 groups: group Ia: included 6 cases with trasudative pleural effusions due to liver cell failure, group Ib: included 6 cases with trasudative pleural effusions due to heart failure and group Ic: included 2 cases with trasudative pleural effusions due to heart and liver cell failure and 1 case due to renal failure. 2-Group II: included 25 patients with exudative pleural effusion. and subdivided into 3 groups: group IIa: included 4 cases with exudative tuberculous effusions, group IIb: included 6 cases with exudative parapneumonic pleural effusions and group IIc: included 10 cases with exudative malignant pleural effusions, 2 cases with exudative collagen pleural effusions, 1 case with exudative effusion due to pulmonary embolism,1 case with exudative pleural effusions due to cholecystectomy operation and 1 case with exudative pleural effusion due to Meig`s syndrome. The Aim of this study was: 1- To asses the role of IL-6 in differentiation between exudative and transudative effusions. 2-To asses if IL-6 can differentiate between different aetiologies of effusions. Patients were subjected to: 1-History taking and complete physical examination. 2- Routine laboratory investigations e.g.: Liver function tests, complete blood picture, erythrocyte sedimintion rate, blood urea and serum creatinine. 3- Radiological examination:- - Plain chest X- ray postero- anterior and lateral views. - Whenever needed the following were done: a- CT scan of the chest. b- Abdominal ultrasonography. c- Echocardiography. 4- Tuberculin skin test. 5- Sputum examination for: acid fast, alcohol fast bacilli (AFB) by Ziehl Neelsen staining on 3 successive days. 6- Sputum cytology. 7- Diagnostic thoracocentesis. The pleural fluid obtained was subjected to following examination: 1. Physical examination by nspection for colour, aspect , odour and specific gravity . 2. Chemical examination including : protein level , LDH level ,total and differential cell count ,and adenosine deaminase when tuberculous effusion was suspected. 3. Bacteriological examination. 4. Cytological examination for malignat cell. 5. Quantitive measurement of IL-6 in pleural fluid and serum was done by enzyme linked immuno assay (ELIZA) .The level was expressed as u/ml . The present work revealed: There was a highly significant difference between exudates and transudate as regards to serum and pleural effusion IL-6 levels that were higher in exudates than transudates. In comparing between the three types of exudates, there was higher concentration of IL-6 in the serum and pleural effusion of parapneumonic effusion than malignant and tuberculous exudative pleural effusion and higher concentration in malignant than tuberculous effusion. Effusion IL-6 level could differentiate between parapneumonic and non parapneumonic exudative effusion while it could′t differentiate between tubercolous and non tubercolous or between malignant and non malignant exudative pleural effusion. There was highly significant difference between pleural effusion due to liver cell failure and heart failure as regard to effusion IL-6 level, it had higher concentration in patient with heart failure than liver cell failure. There was a significant positive correlation between serum IL-6 and serum and effusion LDH. And a significant positive correlation between effusion IL-6 and effusion protein, serum and effusion LDH and serum IL-6. The cut off point of pleural fluid IL-6 was 420 u/ml. and 37 u/ml for serum IL-6 to differentiate exudative effusions from transudative effusions.