平阳霉素与高聚金葡素治疗恶性胸腔积液的疗效比较

目的观察平阳霉素与高聚金葡素治疗恶性胸腔积液的疗效。方法40例恶性胸腔积液患者随机分为两组,分别给予平阳霉素、高聚金葡素治疗,治疗结束后按WHO统一标准观察患者胸腔积液的变化,评价有效率。结果平阳霉素组治疗有效率55％,高聚金葡素组治疗有效率为85％,两组比较差异有统计学意义（P〈0．05）。结论平阳霉索与高聚金葡素胸膜腔内注射对恶性胸腔积液治疗都有一定疗效,高聚金葡素的疗效高于平阳霉素。     

细管胸腔闭式持续引流并药物灌注治疗恶性胸水89例疗效观察

目的应用胞必佳和顺铂治疗恶性胞水,旨在观察临床疗效和毒副作用。方法采用细管行胸腔闭式持续引流,在胸水基本流净,肺复张基础上予以胞必佳600ug,顺铂40mg~80mg作胸腔内灌注一次性疗程。结果总有效率93.26%。毒副作用:胸内注药后出现胸痛、发热、恶心、呕吐等不良反应,经对症处理可以缓解。结论该疗法治疗恶性胸水疗效确切,毒副作用轻,安全方便,值得在临床上推广应用。     

高聚金葡素与卡铂联合治疗恶性胸腔积液疗效观察

目的观察高聚金葡素与卡铂联合治疗恶性胸腔积液的疗效.方法治疗组21例采用高聚金葡素与卡铂胸膜腔灌注;对照组10例单用卡铂灌注.结果治疗组胸腔积液减少的有效率为86%,对照组有效率为50%(P＜0.05);胃肠道反应及白细胞下降率低于对照组.结论高聚金葡素与卡铂联合用药治疗恶性胸腔积液疗效高,副作用小.     

胞必佳联合顺铂治疗恶性胸腔积液疗效观察

目的观察胞必佳联合顺铂(DDP)治疗恶性胸腔积液的疗效和毒副反应。方法48例恶性胸腔积液患者采用单腔中心静脉导管,行胸腔穿刺置管闭式引流,再给予胸腔内注药,其中A组用胞必佳加顺铂,B组单用DDP,治疗结束后4周观察两组的疗效和毒副反应。结果胞必佳加DDP对恶性胸腔积液的有效率为88.5%,优于单用DDP组。结论置入静脉导管胸腔闭式引流后注射胞必佳加DDP是治疗恶性胸腔积液的有效方法。     

胸腔内注入顺铂联合胞必佳治疗恶性胸腔积液疗效比较

目的探讨胸腔内注入顺铂（DDP）联合胞必佳治疗恶性胸腔积液疗效。方法恶性胸腔积液38例患者，随机分为两组，治疗组顺铂联合胞必佳胸腔内注入；对照组：单用顺铂胸腔内注入，观察疗效及药物毒副反应。结果顺铂联合胞必佳组有效率达80％，而单用顺铂组有效率达44％，差异有显著性（P〈0、01）。结论胸腔内联合注入顺铂（DDP）和胞必佳治疗恶性胸腔积液疗效明显。     

胸腔内注射不同药物治疗肺癌胸腔积液疗效对比观察

目的观察不同药物治疗恶性胸腔积液的疗效。方法肺癌恶性胸腔积液66人,随机分成四组:顺铂组50 mg/m2;第1～5天,注药前后充分止呕吐,3周后重复一次;IL-2组200 IU第1～7天,3周后重复一次;金葡素组200 ng(20 ml)1次/周,连用4周;顺铂+金葡素组:顺铂50 mg/m2+金葡素200 ng(20 ml)1次/周,连用4周。结果顺铂组疗效36.8%,IL-2组疗效41.6%,金葡素组疗效81.25%,顺铂+金葡素组疗效89.4%。金葡素组疗效高于顺铂组,有显著差异(P<0.01),也高于IL-2组(P<0.01)。顺铂+金葡素组疗效高于顺铂组,有显著差异(P<0.01),也高于IL-2组(P<0.01)。结论顺铂、IL-2、金葡素及顺铂+金葡素治疗肺癌胸腔积液均有效。顺铂+金葡素疗效并不高于单药金葡素。     

恶性胸腔积液224例临床分析

目的 了解恶性胸腔积液的临床特点和影响疗效的因素。方法 收集确诊为恶性胸腔积液的患者224例，分别对他们的性别、年龄、原发病、首发症状、确诊方式、治疗进行统计，并以疗效为应变量建立ordinal回归方程。结果 胸水非肺癌引起者疗效较肺癌佳，胸水处理以微创置管引流疗效最佳。胸腔内注射药物中，短棒状杆菌疗效最佳，其次是顺铂＋胞必佳。结论 恶性胸腔积液的治疗采取综合治疗，可获满意疗效。     

胸腔内注射不同剂量顺铂治疗肺癌恶性胸水的疗效观察

目的观察胸腔内注射不同剂量顺铂治疗肺癌恶性胸水的临床疗效和不良反应。方法 58例肺癌恶性胸水患者随机分为高剂量组（30例）和低剂量组（28例）。高剂量组采用顺铂80~100 mg/m2胸腔内灌注,每周1次,低剂量组采用顺铂30~50 mg/m2胸腔内灌注,每周1次。两组用药2~4次。结果高剂量组治疗总有效率为86.7%,低剂量组治疗总有效率为71.4%,两组比较差异有统计学意义（P〈0.05）,两组均出现Ⅰ~Ⅱ度恶心呕吐和白细胞下降,但差异无显著性（P〉0.05）,无肝肾功能异常。结论胸腔内注射大剂量顺铂治疗肺癌恶性胸水的临床疗效优于小剂量顺铂,且不良反应可以耐受。     

平阳霉素胸膜固定术对恶性胸腔积液中凝血-抗凝活性的影响

目的观察平阳霉素注入胸膜腔后对恶性胸腔积液（MPE）中纤维蛋白肽A（FPA）浓度及抗凝血酶Ⅲ（ATⅢ）活性的影响,探讨其胸膜固定术机制。方法平阳霉素注入31例MPE患者胸膜腔,检测注药前后各时间点胸水FPA浓度、ATⅢ活性。1个月后根据WHO统一标准进行疗效评价,分为有效组和无效组。结果 18例胸腔积液控制。注药前两组胸水FPA浓度无明显差异（P〉0.05）;注药后均显著高于注药前（P〈0.05）,且有效组浓度显著高于无效组（P〈0.01）。胸水ATⅢ活性在注药前后及组间均无明显差异。结论平阳霉素注入胸膜腔后可通过增强局部凝血活性而达到胸膜粘连的效果。     

恩度和顺铂治疗原发性肺癌合并恶性胸腔积液的短期疗效对比分析

目的回顾性分析69例肺癌合并恶性胸腔积液(malignant pleural effusion, MPE)患者的临床资料,探讨恩度与顺铂胸腔内灌注治疗肺癌合并MPE的短期疗效和不良反应。 方法收集陆军军医大学新桥医院2016年至2018年6月收治的69例肺癌合并MPE患者的临床资料,根据治疗方法的不同,分为恩度组23例,顺铂组46例。两组治疗前均已排尽胸水,恩度组胸腔灌注恩度30 mg,每周2次,顺铂组胸腔灌注顺铂30 mg/m²,每周2次,比较两种药物的疗效及不良反应的差异。 结果恩度组的客观有效率(objective response rate, ORR)为56.5%,顺铂组ORR为26.1%。恩度组的治疗效果显著优于顺铂组,差异有统计学意义(P<0.05)。分层分析发现,在血性胸腔积液患者中,恩度组ORR 88.9%,顺铂组ORR 5%,差异有统计学意义(P<0.05)。在非血性胸腔积液患者中,恩度组ORR 35.7%,顺铂组ORR 42.3%。胸腔积液中癌胚抗原(carcinoembryonic antigen, CEA)数值较低(<100 μg/L)的患者中,恩度组ORR 53.8%,顺铂组ORR 8.3%,差异有统计学意义(P<0.05)。胸腔积液中CEA数值较高(≥100 μg/L)的患者中,恩度组ORR 50%,顺铂组ORR 45.4%。 结论恩度胸腔内灌注治疗原发性肺癌合并MPE是一种安全有效的治疗方法,疗效优于顺铂,尤其对于血性胸腔积液患者、胸腔积液中CEA数值较低(<100 μg/L)的患者,效果更为明显。且恩度组较顺铂组不良反应更小,安全性好,能明显改善患者生活质量。     

Vascular endothelial growth factor and soluble intercellular adhesion molecule-1 in lung adenocarcinoma with malignant pleural effusion: correlations with patient survival and pleural effusion control

The mechanisms by which vascular endothelial growth factor (VEGF) and soluble intercellular adhesion molecule-1 (sICAM-1) contribute to lung cancer growth have not been fully elucidated. This study aimed to assess the role of VEGF and sICAM-1 in control of pleural effusions (PE) and survival in patients with primary human lung adenocarcinoma. Using enzyme-linked immunoadsorbent assay, the concentrations of VEGF and sICAM-1 were measured in pleural effusions and serum from a total of 79 lung adenocarcinoma patients with malignant pleural effusions (MPE) and 24 patients with tuberculosis. Data were correlated with the efficacy of MPE control and survival. Compared to patients with tuberculosis, the levels of VEGF and sICAM-1 in both PE and serum were significantly higher in patients with lung adenocarcinoma. Statistically significant correlation was observed between PE VEGF levels and MPE control. PE VEGF≥2760 pg/ml was used as a cut-off point for failure to MPE control (odds ratio=7.06; 95% confidence interval (CI), 2.40-20.78; P<0.001). The median progression-free survival (PFS) from response assessment was 3 months. In a multivariate analysis, PE VEGF (hazard ratio [HR], 1.16; 95% CI, 1.02-1.32), serum sICAM-1 (HR, 1.90; 95% CI, 1.17-3.07) were confirmed as independent prognostic factors for PFS. The levels of VEGF in PE can be used to predict the therapeutic efficacy in the control of MPE and this, together with serum level of sICAM-1 is potential survival factors in lung adenocarcinoma patients with MPE.     

非小细胞肺癌性恶性胸腔积液研究进展

恶性胸腔积液（malignantpleuraleffusion,MPE）约占临床所有胸腔积液的40％,多数MPE患者症状严重,预后差,总体生存期3～6个月,且现有治疗效果不佳。MPE的病因复杂,主要为肿瘤对胸膜的直接侵袭和转移。肺癌是MPE最常见的病因,约15％晚期非小细胞肺癌会发生MPE。本文将综述非小细胞肺癌所致MPE的发生机制,并详细介绍MPE诊疗和预后进展。     

Th9细胞和Th17细胞与恶性胸腔积液的相关性研究进展

恶性胸腔积液(malignant pleural effusion,MPE)是一种常见的肺癌晚期并发症,15％的肺癌患者有胸腔积液,且约50％的患者出现胸腔积液是在肺癌晚期.肺癌患者一旦出现胸腔积液即意味着病变已局部或全身播散,患者的生存期缩短、生活质量明显下降.MPE目前无特异的治疗方法.Th9细胞和Th17细胞在抗肿瘤免疫中发挥了重要作用,下面就MPE中Th9细胞和Th17细胞的相关研究作一综述.     

Use of an implantable pleural catheter for trapped lung syndrome in patients with malignant pleural effusion

STUDY OBJECTIVES: We describe a series of patients with symptomatic, refractory malignant pleural effusion (MPE) and underlying trapped lung syndrome who underwent placement of a small-bore, flexible indwelling pleural catheter for home drainage of recurrent MPE. DESIGN: The medical records of 11 consecutive patients who underwent pleural catheter placement for MPE with trapped lung syndrome were reviewed retrospectively. SETTING: Patients were evaluated and followed up in the Pulmonary Outpatient Practice at the Hospital of the University of Pennsylvania. PATIENTS: Nine men and two women with underlying malignancies including lung cancer, lymphoma, and mesothelioma underwent pleural catheter placement. INTERVENTIONS: Thirteen pleural catheters were placed in 11 patients, all under local anesthesia. Patients received detailed instructions for drainage and catheter care. They were reevaluated weekly for the first 2 weeks, and then as clinically indicated. Patients typically performed pleural drainage at home up to 1,000 mL two or three times weekly. MEASUREMENTS AND RESULTS: All patients reported symptomatic benefit, defined as improved dyspnea and exercise tolerance, except for one patient. In 10 patients, the pleural catheters remained in place until death, for 15 to 234 days. The mean length of placement was 115 days. One patient required revision after catheter occlusion. Other complications included catheter infection, localized skin breakdown, and possible cellulitis. CONCLUSION: We have described a series of patients with MPE and trapped lung syndrome for whom placement of a permanent pleural catheter provided a convenient, effective alternative to the procedures currently in use. Our patients reported good symptomatic relief following catheter placement with few major complications.     

Th1/Th2细胞因子与平阳霉素治疗恶性胸腔积液疗效的相关性

目的探讨胸水及血浆中Th1/Th2细胞因子与平阳霉素（PYM）治疗恶性胸腔积液（MPE）疗效的关系。方法 24例非小细胞肺癌并发MPE患者均行胸腔闭式引流术,并给予胸膜腔内注射PYM24～32mg治疗。应用双抗体夹心酶联免疫吸附测定法（ELISA）法检测治疗前后胸水及外周血中干扰素-γ（IFN-γ）、肿瘤坏死因子-α（TNF-α）和白介素-4（IL-4）的浓度。一个月后根据WHO标准对MPE患者进行疗效评价。然后根据疗效将24例患者分为有效组和无效组,比较各组治疗前后胸水和外周血标本中IFN-γ、TNF-α和IL-4浓度的变化。结果有效组胸水中IFN-γ和TNF-α浓度在注药后24h和72h均显著高于注药前（P〈0.05）,而IL-4浓度在注药后72h较注药前出现下降趋势,有统计学意义（P〈0.05）。无效组胸水中IFN-γ、TNF-α和IL-4浓度在注药前后无显著差异（P〉0.05）。结论 PYM可刺激IFN-γ、TNF-α增多以及IL-4减少,以促进胸膜炎症形成胸膜粘连。胸膜腔内Th1细胞因子升高和Th2细胞因子减少与PYM胸膜固定术疗效有关。     

Diagnosis and management of malignant pleural effusions

Abstract:   Malignant pleural effusions (MPEs) complicate the clinical course of patients with a broad array of malignancies, which are most often due to lymphomas or carcinomas of the breast, lung, gastrointestinal tract or ovaries. Patients may present with a MPE as the initial manifestation of a cancer or develop an effusion during the advanced phases of a known malignancy. In either circumstance, the median survival after presentation with a MPE is 4 months. Effusions may result from direct pleural invasion (MPE) or indirect effects (paraneoplastic effusions), such as impairment of fluid efflux from the pleural space by lymphatic obstruction or pleural effects of cancer radiation or drug therapy. Because only 50% of patients with cancer who develop a pleural effusion during their clinical course have a MPE, careful evaluation of the effusion to establish its aetiology is required to direct therapy. Management is palliative with interventions directed towards decreasing the volume of intrapleural fluid and the severity of associated symptoms.     

分泌性磷蛋白1在肺癌所致恶性胸腔积液中的表达及其诊断价值

目的 探讨分泌性磷蛋白1(SPP1,别名osteopontin)在晚期肺癌所致恶性胸腔积液(MPE)中的表达及其作为辅助诊断的可能性.方法 选取96例肺癌患者MPE标本为病例组,遴选24例肺部良性疾病患者胸腔积液标本为对照组,使用ELISA法检测标本SPP1表达量.采用SPSS16.0软件统计,并用t检验分析病例组与对照组SPP1的表达水平,建立ROC曲线甄选cutoff界值.结果 在120例胸腔积液标本中,病例组SPP1含量(-x±s=1568.9±1297.15 ng/ml)较对照组(-x±s =644.12±480.50 n/ml)显著增高(t =4.766,P＜0.01),cutoff界值=1247.90 ng/ml(敏感度=38.54％,特异度=95.83％,曲线下面积0.662,95％,CI0.554～0.770).结论 SPP1在MPE中显著升高,胸腔积液中SPP1表达水平可用于MPE辅助诊断,但不适宜临床常规诊断.     

Tenascin-c和癌胚抗原检测在恶性胸腔积液中的诊断价值

目的探讨肌腱蛋白C(Tenascin C,Tn-C)和癌胚抗原(CEA)联合检测在肺癌所致胸腔积液中的表达及其临床意义。方法采用酶联免疫吸附(ELISA)法及电化学发光法分别检测60例肺部良性疾病所致胸腔积液和60例恶性胸腔积液中Tn-C和癌胚抗原(CEA)的表达,分析Tn-C蛋白的表达与临床特征及肺癌诊断的关系。结果恶性组患者胸腔积液中Tn-C的表达水平高于对照组(P0.05),Tn-C在胸水中的表达与患者的性别、吸烟状况、肿瘤大小、病理分期及病理分型无关(P0.05),与淋巴结的转移有关(P0.05);两组患者的Tn-C血清浓度无统计学差异(P0.05)。根据ROC曲线,以Tn-C浓度为41.508ng/ml为最佳诊断临界点,此点所对应的诊断恶性胸腔积液(MPE)敏感性为90%,特异度为46.67%,联合CEA诊断的灵敏度为80%,特异度为98.3%。结论 Tn-C在肺癌所致恶性胸腔积液中的表达水平较高,与CEA联合检测可提高恶性胸腔积液的诊断灵敏度及特异度,故Tn-C可作为肺癌诊断的良好标记物。     

Novel insights into the systemic treatment of lung cancer malignant pleural effusion

Lung cancer is the most common fatal malignancy worldwide. Approximately 75% of non‐small‐cell lung cancer (NSCLC) patients are diagnosed at an advanced or a metastatic stage. Since 2007, NSCLC patients with malignant pleural effusion (MPE) are staged as M1 disease. During the last decades, chemotherapeutic agents failed to offer a significant improvement of survival in patients with metastatic disease. The current review aims to summarize the actual situation of the recently developed therapies in patients with lung cancer and MPE.