胸腔积液患者血浆及胸液中血管内皮生长因子测定的临床意义

目的：探讨血管内皮生长因子(vascular endothelial growth factor，VEGF)在恶性胸腔积液患者血浆及胸液中的含量与积液种类和预后之间的关系。方法：采用双抗体夹心ELISA法检测肺癌并恶性胸液（n=32）、结核性胸液（n =34）、漏出性胸液（n =9）患者胸液及血浆中VEGF含量，同时检测各组患者胸液中癌胚抗原（CEA）、腺苷脱氨酶（ADA）的水平。结果：胸液及血浆中VEGF含量在肺癌并恶性胸液（345±167)、(120±79）ng/l显著高于结核性胸液（119±52)、(53±20)ng/L和漏出性胸液（57±22)、(35±12)ng/L，（P均＜0.05）；结核性胸液高于漏出性胸液(P＜0.05）。肺癌并恶性胸液生存期＜6个月者（386±185)ng/L明显高于生存期＞12个月者（201±88)ng/L，（P＜0.05）。VEGF与CEA及LDH水平呈显著正相关（r=0.51,r=0.46,P＜0.01）而与ADA、葡萄糖、蛋白质含量、白细胞总数及分类计数之间无明显相关（P＞0.05）。VEGF对良恶性胸液诊断的灵敏度为75.6%，特异度为73.5%（界值为221ng/L）。结论：VEGF在恶性胸液的形成中起重要作用，其水平高低与预后有关，检测胸液VEGF水平有助于良恶性胸液的鉴别。

Clinical significance of VEGF level in chest fluid and plasma of patients with pleural effusions

Objective: To research the effect and the prognostic assessment of VEGF in malignant pleural effusion, as well as the usefulness of VEGF in differential diagnosis between benign and malignant effusion. Methods： Using the sandwich enzyme-linked immunosorbent assay(ELISA), we detected the level of VEGF, carcinoembryonic antigen(CEA)and adenosine deaminase(ADA)in effusion and plasma respectively in pulmonary carcinoma(n=32), tuberculous(n=34) and transudative(n=9). Results: The level of VEGF in effusion and plasma in patients with pulmonary carcinoma（345±167ng/l and 120±79ng/l）was significantly higher than that in patients with tuberculous（119±52ng/l and 53±20ng/l）and transudative（57±22ng/l and 35±12ng/l）（P＜0.05）; the level of VEGF in tuberculous was higher than that in transudative（P＜0.05）; the level of VEGF in pulmonary carcinoma patients with malignant effusion whose survival time was shorter than six months（386±185ng/l）was evidently higher than that in those who survived longer than twelve months（201±88ng/l）（P＜0.05）.VEGF level was positively correlated with CEA and LDH level（r=0.51,r=0.46, P＜0.01）and not correlated with ADA level, glucose, protein content, the total number of WBC and classified count（P＞0.05）.The VEGF level in pleural effusion provided a diagnostic test for malignancy with a sensitivity of 75.6% and a specificity of 73.5%(cut-off point 221ng/L）. Conclusion： VEGF plays an important role in the malignant pleural effusion accumulation and is related to prognosis. The measurement of VEGF is helpful in discriminating between benign and malignant effusion.