胸腔积液（PE）的临床管理面临多样的病因挑战。本研究的目的是调查不同病因胸腔积液（PF）中白介素-36（IL-36）细胞因子的浓度，并评估其在区分PE病因上的诊断效能。本研究纳入89例确认为PE的患者，其中11例为渗出液，24例为恶性胸腔积液（MPE），24例为结核性胸腔积液（TPE），以及30例为肺炎性胸腔积液（PPE）。PPE组进一步分为20例无并发症的肺炎性积液（UPPE）和10例并发症的肺炎性积液（CPPE）/脓胸。使用酶联免疫吸附测定（ELISA）定量测定了所有89例患者PF中IL-36细胞因子的浓度。IL-36α在TPE中表现出优异的诊断准确性，敏感性为91.7％，特异性为83.1％，截断值为435.3 pg/ml。IL-36Ra在PPE中也显示出相对良好的诊断性能，敏感性为80.0％，特异性为76.3％，截断值为390.8 pg/ml。TPE和PPE的多变量logistic回归模型成功开发，证实了它们的诊断实用性。此外，与UPPE相比，CPPE /脓胸中IL-36Ra的水平明显升高。此外，在PF中，IL-36γ与IL-36α和IL-36Ra均呈正相关。IL-36α和IL-36Ra可能作为诊断TPE和PPE的新生物标志物。建立的多变量模型显著提高了TPE和PPE的诊断效能。此外，IL-36Ra可作为评估胸腔炎症程度的指标。此外，PF中IL-36细胞因子之间的相互作用可能有助于它们的表达调节。版权所有© 2023 Elsevier B.V. 发表。

The clinical management of pleural effusion (PE) poses challenges due to its diverse etiologies. The objective of this research was to investigate the concentrations of interleukin-36 (IL-36) cytokines in pleural fluid (PF) from different etiologies and assess their diagnostic efficacy in distinguishing the causes of PE.This study enrolled 89 patients with confirmed PE, comprising 11 cases classified as transudate, 24 cases as malignant pleural effusion (MPE), 24 cases as tuberculous pleural effusion (TPE), and 30 cases as parapneumonic pleural effusion (PPE). The PPE group was further subdivided into 20 cases of uncomplicated parapneumonic effusion (UPPE) and 10 cases of complicated parapneumonic effusion (CPPE)/empyema. The concentrations of IL-36 cytokines in the PF of all 89 patients were quantified by the enzyme-linked immunosorbent assay (ELISA).IL-36α exhibited excellent diagnostic accuracy in TPE, achieving a sensitivity of 91.7% and specificity of 83.1%, along with a cut-off value of 435.3 pg/ml. IL-36Ra also demonstrated relatively favorable diagnostic performance in PPE, with a sensitivity of 80.0% and specificity of 76.3%, along with a cut-off value of 390.8 pg/ml. Multivariable logistic regression models were successfully developed for both TPE and PPE, confirming their diagnostic utility. Furthermore, the levels of IL-36Ra were notably elevated in CPPE/empyema in comparison to UPPE. Moreover, in PF, IL-36γ exhibited positive associations with both IL-36α and IL-36Ra.IL-36α and IL-36Ra may serve as novel biomarkers for diagnosing TPE and PPE, respectively. The multivariate models established significantly enhance the diagnostic efficacy of both TPE and PPE. Furthermore, IL-36Ra can function as an indicator for assessing the extent of pleural inflammation. Additionally, the interaction among IL-36 cytokines in PF may contribute to their expression modulation.Copyright © 2023. Published by Elsevier B.V.