血清和胸水中CA125在结核性和癌性胸水中的表达及临床意义

目的:探讨血清和胸水中CA125在结核性和癌性胸水中的表达及鉴别诊断意义。方法:抽选我院确诊的结核性胸水病人85例(结核组)和癌性胸水病人71例(癌症组),检测两组患者血清和胸水中CA125表达,并以胸水/血清中CA125比值10(p-CA125/s-CA12510)为临界值,观察其对癌性胸水的鉴别特异度、灵敏度及准确性。结果:癌症组胸水中CA125表达及p-CA125/s-CA125比值均显著高于结核组(P0.05);但血清中两组CA125表达比较差异无显著性(P0.05);两组胸水中,以35U/ml为临界值,两组患者阳性率92.9%(79/85)、100%(71/71)比较差异无显著性(X2=7.0718,P=0.0078)。癌症组中p-CA125/sCA125比值10的比率(84.5%VS 17.6%)明显高于结核组(X2=66.6244,P=0.0000);并以其为诊断癌性胸水的临界值,鉴别诊断特异度、灵敏度及准确性分别为82.3%、84.5%、83.3%。结论:血清和胸水中CA125表达对于鉴别结核性或者是癌性胸水的临床意义不大,但是p-CA125/s-CA125比值对于鉴别结核性和癌性胸水具有一定临床价值。     

腺苷脱氨酶在结核性胸膜炎和恶性胸腔积液的对比临床分析

目的：探究腺苷脱氨酶在结核性胸腔积液和恶性胸腔积液中的含量规律。方法：回顾分析自2010年3月至2012年5月于本院胸心外科住院的胸腔积液患者,对穿刺获得的胸腔积液,用比色法测定胸腔积液中腺苷脱氨酶的水平。测量血中腺苷脱氨酶的水平进行对比。结果：结核性胸膜炎组患者胸腔积液ADA测定值为89．67±47．85IU／L,癌性胸腔积液组水平为24．56±11．491U／L,胸腔积液ADA水平在结核性胸膜炎与癌性胸腔积液组之间存在显著性差异（P〈0．05）;以ADA〉45IU／L诊断结核性胸膜炎：则敏感性为（48／51）94．1,特异性为（48／52）88．9％,以ADA〈45IU／L一诊断恶性胸腔积水：则敏感性（（51／55）89．4％,特异性为（51／54）94．4％;结核性胸膜炎中胸腔积液ADA／血清中ADA比值为2．25±0．72,癌性胸腔积液组水平0．43＋0．1,结核性胸膜炎与癌性胸腔积液组之间存在显著性差异（P〈0．05）;以胸腔积液ADA／血清中ADA比值〉1．0为界诊断结核性胸膜炎：则敏感性为（46／51）90．1,特异性为（45／55）81．8．％,以胸腔积液ADA／血清中ADA比值〈1．0诊断恶性胸腔积水：则敏感性（47／57）82．4％,特异性为（47／53）88．7％。结论：腺苷脱氨酶在结核性胸膜炎和恶性胸腔积液中的含量有明显差异。     

香菇多糖与金葡素治疗恶性胸腔积液的临床研究

目的:恶性胸腔积液是晚期非小细胞肺癌常见的并发症,严重影响患者的生活质量及预后。治疗恶性胸腔积液的方法虽多,但疗效有限,且目前尚无统一的治疗规范。本研究通过向胸腔内注入香菇多糖和金葡素,观察其治疗恶性胸腔积液的疗效和安全性。方法:60例恶性胸腔积液患者随机分成两组,每组30例:A组(香菇多糖组),B组(金葡素组)。通过胸腔闭式引流术排净胸腔积液后,分别向胸腔内注入香菇多糖、金葡素,评价两组的有效率和毒副反应。结果:两组疗效显著:香菇多糖组CR 11例,PR 12例,NC 3例,PD 4例,治疗有效率为76.7%,金葡素组CR 14例,PR 11例,NC 4例,PD 2例,治疗有效率为83.3%,两组疗效比较无显著性差异(x2=0.42,P0.05);两组毒副反应轻微,主要为骨髓抑制、胃肠道反应和发热,两组毒副反应比较无显著性差异(x2=0.58,P0.05),全组无毒性相关死亡。结论:胸腔内注入香菇多糖和金葡素可有效杀灭肿瘤细胞、促进胸膜粘连,显著缓解症状,提高机体免疫功能,改善生活质量和预后。二者疗效相当,不良反应轻微,值得临床大力推荐应用。     

Efficacy and Safety of Talc Pleurodesis for Malignant Pleural Effusion: A Meta-Analysis

Background

Talc pleurodesis has been widely used to control malignant pleural effusion; however, it is still not clear whether talc pleurodesis is more effective than other local therapies. We performed a meta-analysis to evaluate the efficacy and safety of talc pleurodesis in the management of malignant pleural effusion.

Methods

PubMed, Embase, and Web of Science were searched for English-language studies of clinical controlled trials comparing talc pleurodesis with control therapies until August 8, 2013. Success rate and incidence of adverse events were evaluated. Relative risks were estimated using random- or fixed- effects model and statistical heterogeneity was assessed using I² test.

Results

Twenty trials involving 1,525 patients with malignant pleural effusion were included. The success rate of talc pleurodesis was significantly higher than that of control therapies (relative risk, 1.21; 95% confidence interval, 1.01–1.45; p = 0.035) with similar adverse events. In addition, thoracoscopic talc poudrage was more effective than bedside talc slurry (relative risk, 1.12; 95% confidence interval, 1.01–1.23; p = 0.026).

Conclusions

The current evidences suggested the benefit for talc pleurodesis in the treatment of malignant pleural effusion. Talc pleurodesis, especially thoracoscopic talc poudrage pleurodesis, should be performed in patients with malignant pleural effusion, especially those with life-expectancy longer than one month.     

Recombinant Human Endostatin Endostar Suppresses Angiogenesis and Lymphangiogenesis of Malignant Pleural Effusion in Mice

Background

Malignant pleural effusion (MPE) is a common complication of lung cancer. One widely used treatment for MPE is Endostar, a recombined humanized endostatin based treatment. However, the mechanism of this treatment is still unclear. The aim of this study was to investigate the effects of Endostar in mice with MPE.

Methods and Materials

Lewis lung carcinoma (LLC) cell line expressing enhanced green fluorescent protein (EGFP) was injected into pleural cavity to establish MPE mice model. Mice were randomly divided into four groups. High dose of Endostar (30 mg/kg), low dose of Endostar (8 mg/kg), normal saline, or Bevacizumab (5 mg/kg) was respectively injected into pleural cavity three times with 3-day interval in each group. Transverse computed tomography (CT) was performed to observe pleural fluid formation 14 days after LLC cells injection. Mice were anesthetized and sacrificed 3 days after final administration. The volume of pleural effusion n was measured using 1 ml syringe. Micro blood vessel density (MVD), Lymphatic micro vessel density (LMVD), the expression level of vascular endothelial growth factor A (VEGF-A) and VEGF-C were observed by immunohistochemistry (IHC) staining.

Results

The volume of pleural effusion as well as the number of pleural tumor foci, MVD and the expression of VEGF-A were significantly reduced in high dose of Endostar treat group. More importantly, LMVD and the expression of VEGF-C were markedly lower in treat group than those in the other three control groups.

Conclusion

Our work demonstrated that Endostar played an efficient anti-cancer role in MPE through its suppressive effect on angiogenesis and lymphangiogenesis, which provided a certain theoretical basis for the effectiveness of Endostar on the MPE treatment.     

Effects of Intracavitary Administration of Endostar Combined with Cisplatin in Malignant Pleural Effusion and Ascites

This study evaluated the efficacy and safety of intracavitary administration of recombinant human endostatin (Endostar) combined with cisplatin chemotherapy in treating malignant pleural effusion and ascites. Forty-five patients with malignant pleural effusion and ascites were divided into the EP group (n = 23), who received Endostar and cisplatin intracavitarily, and P group (n = 22), who were intracavitarily treated with cisplatin only. Pleural effusion and ascites were completely drained before treatments. The treatment was administered once a week; two treatments were considered as one course. The outcome quality of life as well as toxicity were evaluated. The objective overall response and disease control rates were, respectively, 78.3 % (18/23) and 87.0 % (20/23) in EP group. In contrast, these parameters were significantly (p < 0.05) lower in P groups: 40.9 % (9/22) and 59.1 % (13/22), respectively. The improvement rate of Karnofsky Performance Status was 87.0 % (20/23) in EP group versus 59.1 % (13/22) in P group (p < 0.05). All patients tolerated the combined treatment well, and no severe adverse effects were observed. Intracavitary injection of Endostar combined with cisplatin is effective and safe to treat malignant pleural effusion and ascites.     

The Malignant Pleural Effusion as a Model to Investigate Intratumoral Heterogeneity in Lung Cancer

Malignant Pleural Effusions (MPE) may be useful as a model to study hierarchical progression of cancer and/or intratumoral heterogeneity. To strengthen the rationale for developing the MPE-model for these purposes, we set out to find evidence for the presence of cancer stem cells (CSC) in MPE and demonstrate an ability to sustain intratumoral heterogeneity in MPE-primary cultures. Our studies show that candidate lung CSC-expression signatures (PTEN, OCT4, hTERT, Bmi1, EZH2 and SUZ12) are evident in cell pellets isolated from MPE, and MPE-cytopathology also labels candidate-CSC (CD44, cMET, MDR-1, ALDH) subpopulations. Moreover, in primary cultures that use MPE as the source of both tumor cells and the tumor microenvironment (TME), candidate CSC are maintained over time. This allows us to live-sort candidate CSC-fractions from the MPE-tumor mix on the basis of surface markers (CD44, c-MET, uPAR, MDR-1) or differences in xenobiotic metabolism (ALDH). Thus, MPE-primary cultures provide an avenue to extract candidate CSC populations from individual (isogenic) MPE-tumors. This will allow us to test whether these cells can be discriminated in functional bioassays. Tumor heterogeneity in MPE-primary cultures is evidenced by variable immunolabeling, differences in colony-morphology, and differences in proliferation rates of cell subpopulations. Collectively, these data justify the ongoing development of the MPE-model for the investigation of intratumoral heterogeneity, tumor-TME interactions, and phenotypic validation of candidate lung CSC, in addition to providing direction for the pre-clinical development of rational therapeutics.     

aAd-p53基因靶向治疗癌性胸腹水的临床效果分析

目的:探讨aAd-p53注射液靶向灌注治疗癌性胸腹水的临床疗效和安全性。方法:选择2012年5月-2014年2月在我院接受治疗的癌性胸腹水患者80例,根据治疗方法的不同,将患者随机分为研究组和对照组,每组40例。研究组患者采用腔内灌注rAd-p53治疗,对照组患者采用表阿霉素灌注治疗,观察并比较两组患者的治疗总有效率、不良反应的发生率及KPS功能评分的变化情况。结果:所有患者均顺利完成灌注治疗,病情获得好转,生存质量得到改善。研究组和对照组的治疗总有效率分别为70%、67.5%,两组比较无显著性差异(P0.05)。两组治疗后KPS评分均显著高于治疗前,且研究组高于对照组,差异具有统计学意义(P0.05)。研究组和对照组不良反应的发生率分别为20%和25%,研究组低于对照组,但两组差异并无统计学意义(P0.05)。结论:rAd-p53注射液靶向灌注治疗是一种治疗癌性胸腹水安全有效的方法,值得临床推广。     

Pleural Effusion and Fibrosis during Treatment with Methysergide

Two patients being treated for migraine with methysergide developed extensive pleural fibrosis, and in addition one of them had bilateral pleural effusions, After treatment was stopped these complications, which are thought to have been due to the drug, cleared in the next few months.     

苦参注射液与恩度联合顺铂对肺癌恶性胸腔积液患者血清炎症因子水平的影响

目的:探讨苦参注射液与恩度分别联合顺铂对肺癌恶性胸腔积液患者血清炎症因子水平影响。方法:收集我院以非小细胞肺癌合并恶性胸腔积液患者68例,按照就诊先后顺序分为实验组和对照组。对照组予恩度联合顺铂化疗,实验组予苦参注射液联合顺铂化疗。于患者治疗前后进行CD8~+、IL-2检测,KPS评分,并进行生活质量评价及胸腔积液疗效评价比较,以及药物不良反应评价。结果:1治疗后实验组CD8~+下降、IL-2均上升(P0.05);2治疗后实验组KPS评分较对照组明显上升(P0.05);3实验组患者生活质量评价明显好于对照组,胸腔积液疗效优于对照组(P0.05)。结论:苦参注射液联合顺铂较恩度联合顺铂对肺癌合并恶性胸腔积液患者CD8~+T淋巴细胞及IL-2水平有更明显调节作用,且安全性更佳,对肺癌合并恶性胸腔积有显著临床疗效,对提高患者生活质量、延长患者生存期有重要意义。     

应用电视胸腔镜诊治病因不明胸腔积液的疗效观察

目的:探讨电视胸腔镜(video-assisted thoracoscopic surgery VATS)在诊治病因不明胸腔积液中的应用价值.方法:回顾分析2005年4月～2011年4月196例病因不明胸腔积液经电视胸腔镜手术的临床资料.均应用电视胸腔镜进行探查,根据病变情况选择切口部位.排净胸腔积液后,分离粘连,进行胸膜活检后恶性患者行胸膜固定术.结果:196例均明确诊断:140例恶性胸腔积液,36例结核胸腔积液,20例炎性胸腔积液.胸腔镜手术178例,胸腔镜辅助胸壁小切口手术18例.手术时间30～75min,平均54 min.出血量10～120mL,平均53 mL.10例出现术后肺漏气,胸腔引流量＜50 mL/24h拔除胸腔引流管,胸管留置时间4～19天,平均9.4天.191例成功控制胸腔积液,全组无院内死亡.22例接受化疗的恶性胸腔积液患者,随访14～34个月,平均23个月,复查胸片显示无胸腔积液、积气.结论:电视胸腔镜安全、有效、微创,便于操作,可作为诊治病因不明胸腔积液的主要方法.     

碘伏胸膜固定术与胸腔镜滑石粉胸膜固定术治疗恶性胸腔积液的对比研究

目的:对乳腺癌胸腔转移的恶性胸腔积液的患者,通过使用胸腔镜滑石粉喷洒和通过胸导管注入聚合碘行胸膜固定术,比较两种方法的有效性、安全性及成功率。方法:42个乳腺癌胸腔转移的恶性胸腔积液的患者纳入了此项前瞻性随机对照研究。所有患者都有中度至重度呼吸困难(MRC呼吸困难量表Ⅲ-Ⅴ级)。22个患者完成胸腔镜滑石粉胸膜固定术(A组),而20例(B组)在床旁完成胸腔注入聚合碘。比较两组患者胸膜固定的成功率,呼吸困难缓解情况,住院时间以及胸痛、发热等并发症发生情况。结果:胸膜固定术成功率两组无明显差异(91%vs 85%,P=0.9),术后并发症两组均较低。手术后,因胸膜炎性胸痛需要止痛处理的A组明显高于B组(18%vs 0,P=0.2)。手术后48小时内,A组患者中有4个病人(18%),B组中1个患者(5%)出现发热(38℃)。治疗后两组呼吸困难症状得到了较好的控制,呼吸困难程度为(Ⅰ-Ⅱ),但两组之间无统计学差异(P0.05)。没有患者在医院内死亡。术后B组患者的住院时间更短(P=0.009)。平均症状无进展时间隔为6.6(范围3-15)月。随访中胸腔积液复发需要从新干预的A组有2例,B组3例。结论:对于乳腺癌转移性胸腔积液,聚合碘可作为胸腔镜滑石粉胸膜固定术外不错的选择。聚合碘容易获得,便宜且安全,可通过胸腔引流管给药,如果必要可以重复操作。