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.     

持续循环胸腔热灌注顺铂治疗恶性胸腔积液的疗效观察

正恶性胸腔积液(malignant pleural effusion,MPE)为肺恶性肿瘤最常见的并发症,大量胸腔积液对心脏、肺等产生物理性挤压,使患者出现明显的呼吸困难、胸闷、气短等临床症状,严重影响患者生活质量且病情危重,为疾病预后不良的重要指征[1-2]。目前临床上对于MPE的主要治疗方法为治疗性胸腔穿刺、胸腔闭式引流、胸腔引流后灌注化疗等,但治疗效果较差。我科采用持续循环胸腔热灌注顺铂治疗非小细胞肺癌导致的MPE取得了一定的临床疗效。     

恶性胸腔积液的诊断研究进展

恶性胸腔积液(malignant pleural effusion,MPE)是指细胞病理学证实胸腔积液中有脱落的肿瘤细胞或胸膜组织活检证实存在肿瘤细胞。MPE是由肿瘤直接侵袭胸腔或诱发炎症导致,最常继发于肺癌(尤其是腺癌),其次是乳腺癌,二者所致的MPE占其总数一半以上[1]。第三位是霍奇金淋巴瘤和非霍奇金淋巴瘤,其他病因还包括恶性血液系统肿瘤、胃肠道肿瘤、妇科恶性肿瘤、间皮瘤等[2]。     

恶性胸腔积液治疗指南摘要

发病率、病因与发病机制恶性胸腔积液 (MPE)在肿瘤患者中较为常见。因恶性肿瘤而死亡的患者中 ,15 %发生 MPE。MPE在渗出性积液中 4 2 %至 77%是由恶性疾病引起。几乎所有肿瘤均可侵犯胸膜腔 ,肺癌最常见 ,约占 MPE的1/ 3。乳癌居第二位。淋巴瘤 ,包括何杰金氏病和非何杰金氏淋巴瘤 ,卵巢和胃肠道的肿瘤较少引起 MPE。约 5 %～ 10 %的MPE找不到原发肿瘤。胸膜间皮瘤的发病与地域有关。尸检显示 ,多数胸膜腔转移来源于肿瘤栓子种植于脏层胸膜 ,其次种植于壁层胸膜。其他可能的转移机制包括肿瘤直接侵犯 (肺癌、乳癌、胸壁恶性肿瘤 )…     

CYFRA 21-1对非小细胞肺癌胸腔积液的诊断价值

目的　探讨非小细胞肺癌标记物 (CYFRA 2 1- 1)对非小细胞肺癌 (NSCLC)胸腔积液的诊断价值。方法　用放免法测定了非小细胞肺癌 ,小细胞肺癌 (SCLC)及结核性胸膜炎的胸腔积液CYFRA 2 1- 1水平。结果　非小细胞肺癌胸腔积液的CYFRA 2 1- 1水平 ,无论细胞学阳性或阴性 ,均显著高于小细胞肺癌及结核性胸膜炎的胸腔积液组 (P <0 0 1)。结论　检测胸腔积液CYFRA 2 1- 1对非小细胞肺癌胸腔积液的诊断有重要价值     

恶性胸腔积液治疗的进展

恶性胸腔积液(MPE)是晚期恶性肿瘤的常见并发症.一般认为MPE约占整个胸腔积液的25%,据估计其中75%的MPE为肺癌和乳腺癌所致,25%则由其他肿瘤性疾病所致.     

循证护理在恶性胸水治疗中的应用体会

恶性胸腔积液（MPE）是指由肺癌或其他部位恶性肿瘤累及胸膜的胸膜腔积液，是晚期恶性肿瘤的常见并发症，其中肺癌约占MPE的1／3，乳腺癌居第二。     

survivin在非小细胞肺癌恶性胸腔积液中表达的研究及其临床意义

目的探讨survivin在非小细胞肺癌(NSCLC)恶性胸腔积液的表达及其与预后的关系。方法收集48例经病理确诊的NSCLC恶性胸腔积液和30例非恶性胸腔积液标本,通过western blot法检测2组胸水中的survivin含量,并对结果进行相关分析。结果survivin在77.08%的NSCLC恶性胸腔积液标本中有表达,在非恶性胸腔积液中不表达,survivin表达与性别、病理类型无关,与其预后相关(P<0.01)。结论NSCLC患者恶性胸腔积液标本survivin表达为肺癌诊断和预后提供了有价值的判断指标。     

恶性胸腔积液新型诊断标记物研究进展

正恶性胸腔积液(Malignant pleural effusion,MPE)是指原发于胸膜的恶性肿瘤或者其他位置的恶性肿瘤转移至胸膜引起的胸腔积液[1],大多数MPE是由于肿瘤转移引起的,男性中最常见于肺癌转移,女性中最常见于乳腺癌转移。肺癌与乳腺癌转移引起的MPE约占所有MPE的50%-65%[2]。虽然关于MPE的流行病学资料有限,但据估计英国每年约出现50,000例新诊断的MPE[3],2012年美国因MPE     

检测胸腔积液与血清组织多肽特异性抗原比值的意义

肺癌和肺结核是引起胸腔积液的两大病因 ,在原发病灶不清楚的情况下 ,胸腔积液良恶性的鉴别对病因诊断具有指导作用 ,目前除细胞学和常规检查外 ,鉴别肺癌胸腔积液和结核性胸腔积液的方法较少。我们测定了非小细胞肺癌(NSCLC)和结核性胸腔积液患者血清和胸腔积液中组织多肽特异性抗原 (TPS)的水平 ,以探讨胸腔积液与血清TPS比值在鉴别两种胸腔积液中的价值。对象与方法　主要仪器及试剂 :酶标仪 (Anthos2 0 10 )购自奥地利AnthosLabtec公司 ,TPSTM试剂盒购自瑞典康乃格公司。按试剂盒说明书进行TPS检测 ,正常值采用试剂盒提供的参…     

The efficacy and safety of intrapleural hyperthermic perfusion in patients with malignant pleural effusion undergoing video-assisted thoracic surgery: a single-arm clinical trial

BackgroundPatients with malignant pleural effusion (MPE) are usually treated with an indwelling pleural catheter (IPC) or pleurodesis. However, most do not achieve a satisfactory control rate of pleural effusion and have poor prognosis. Distilled water has cytocidal effects of hypotonic shock and can result in the lysis of cancer cells which was used in surgery to eradicate cancer cells. However, there is no study focusing on the efficacy of intrapleural hyperthemic perfusion for MPE under video-assisted thoracoscopic surgery (VATS). This study explored the efficacy and safety of intrapleural hyperthermic perfusion (IHP) with distilled water in patients with MPE.MethodsIn this retrospective, single-arm trial, patients admitted to department of cardiothoracic surgery of Taizhou hospital and diagnosed with MPE caused by non-small cell lung cancer from January 2014 and December 2018 were included. The clinical characteristics including age, gender smoking history, Karnofsky score, volume of pleural effusion, TNM cancer stage, pathology, genetic test of patients were collected. Patients were treated with hyperthermic perfusion. The pleural cavity was perfused with 43.0 ℃ distilled water for 60 minutes under video-assisted thoracic surgery (VATS). The efficacy of treatment was defined as follows: (I) complete remission (CR; no recurrence of pleural effusion after IHP for at least four weeks); (II) partial remission (PR; pleural effusion was decreased by 50% and the condition lasted for 4 weeks; or (III) no remission (NR; no decrease in pleural effusion). Kaplan-Meier method with a log-rank test was used for survival analysis. Cox proportional hazards regression models were applied to perform univariate and multivariate analysesResultsFrom January 2014 through December 2018, 30 patients with MPE caused by non-small cell lung cancer (NSCLC) were treated with hyperthermic perfusion. There were no serious reportable clinical complications associated with the procedure. The response rate was 96.7%, with 63.3% experiencing PR and 33.3% achieving CR. The overall survival (OS) ranged from 2 to 46 months. The median survival was 12 months.ConclusionsIHP proved to be a feasible and safe strategy for patients with MPE in our study but it still needs to be verified with a larger, prospective and randomized trial in the future.     

Malignant pleural effusion from lung adenocarcinoma treated by gefitinib

Small molecule inhibitors targeting epidermal growth factor receptor (EGFR) are known to be active against non-small cell lung cancer (NSCLC) although the pharmacodynamics of these agents on malignant pleural effusion (MPE) remains unclear. Here we describe a case of lung adenocarcinoma with massive MPE treated successfully by gefitinib and chest drainage. Using sequential MPE samples before and during gefitinib therapy, the morphological changes and apoptosis of cancer cells were analyzed. Apoptosis of cancer cells was detected as early as 4 hours on, but not before, gefitinib therapy, suggesting that the pharmacodynamic assessment of such molecular targeting agents might be feasible for MPE.     

Ⅰ期非小细胞肺癌CT形态学征象对预后的影响分析

目的 探讨分析Ⅰ期非小细胞肺癌CT形态学征象对预后的影响分析.方法 分析整理我院就诊的158例I期非小细胞肺癌患者的资料进行图像评估.结果 所有患者经治疗术后5年内共107例存活,死亡51例,5年生存率为67.7%.患者肿瘤密度经单因素预后分析,差异无统计学意义（P＞0.05）.患者肿瘤边缘情况、肿瘤与胸膜关系、肿瘤周围征象比较,差异有统计学意义（P＜0.05）.结论 肿瘤周围情况、肿瘤与胸膜的关系及肿瘤的周围征象都对Ⅰ期非小细胞肺癌预后有着一定的影响.     

胸膜固定术治疗肺癌并发恶性胸腔积液的疗效分析

目的回顾性分析胸膜腔内注入顺铂、高聚金葡素、平阳霉素、胞必佳、肿瘤坏死因子治疗肺癌并发恶性胸腔积液(MPE)的疗效及影响因素。方法对我院2002至2009年确诊肺癌并发MPE共125例患者的临床资料进行分析。结果顺铂组有效率为81.82%,高聚金葡素组为61.90%,平阳霉素组为60.53%,胞必佳组为55.56%,肿瘤坏死因子组为46.67%。除高聚金葡素组外,顺铂组疗效明显高于其他3组(P0.05)。单因素分析显示,疗效受全身应用糖皮质激素、胸水引流方式、胸水部位影响。结论胸膜固定术是治疗肺癌并发MPE的有效方法 ,顺铂疗效最佳。闭式引流较胸穿抽液疗效高,单侧胸水较双侧胸水疗效高(P0.05),全身应用糖皮质激素降低疗效(P0.05)。     

恩度联合顺铂胸腔内注射治疗非小细胞肺癌恶性胸腔积液临床观察

目的 观察恩度联合顺铂胸腔内灌注治疗非小细胞肺癌恶性胸腔积液的临床疗效和安全性.方法 8例肺癌恶性胸腔积液患者,予顺铂、恩度联合注入,视胸水吸收情况一周后可以重复.使用后评价临床疗效、生活质量并观察毒副反应.结果 8例患者治疗胸水有效率为87.5％,生活质量改善率为87.5％.毒副反应较少.结论 恩度联合顺铂治疗非小细胞肺癌恶性胸腔积液是一种安全、可行的治疗手段,有较好的近期疗效,值得临床推广应用.     

Clinical course of asymptomatic malignant pleural effusion in non-small cell lung cancer patients: A multicenter retrospective study

The British Thoracic Society guidelines recommend observation for patients with asymptomatic malignant pleural effusion (MPE). However, asymptomatic MPE can become symptomatic. This study examined the clinical course of asymptomatic MPE in patients with non-small cell lung cancer (NSCLC), including the incidence and timing of symptom development of asymptomatic MPE and the associated factors.Retrospective data of 4822 NSCLC patients between January 2012 and December 2017 were reviewed. Symptom development of asymptomatic MPE was defined as the development of symptoms requiring additional treatment, such as insertion of a chest tube, within 1 year in patients who lacked MPE symptoms at the time of diagnosis. Clinical information, pathological parameters, and radiological characteristics were reviewed. Patient data up to 1 year from the initial diagnosis were reviewed.Of 113 patients with asymptomatic MPE, 46 (41%) became symptomatic within 1 year despite appropriate anticancer treatment. The median time to symptom development was 4 months, and 38 patients (83%) developed symptoms within 6 months. Multivariate logistic regression showed that female sex (odds ratio [OR], 0.256; 95% confidence interval [CI], 0.101–0.649; P = .004) and the depth of pleural effusion on initial computed tomography (CT) (OR, 0.957; 95% CI, 0.932–0.982; P = .001) were independently associated with symptom development of asymptomatic MPE.A fraction of 41% of patients with asymptomatic MPE became symptomatic within 1 year. Female sex and larger MPE on initial CT were independently associated with symptom development of asymptomatic MPE.     

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。     

胎盘生长因子在非小细胞肺癌胸腔积液中的表达及其对临床疗效的影响

目的 探讨胎盘生长因子(PlGF)在非小细胞肺癌(NSCLC)并发胸腔积液患者中的表达及其对临床疗效的影响.方法 回顾性分析比较44例NSCLC并发恶性胸腔积液患者血清和胸腔积液中PlGF的表达水平;并与患者的临床疗效做相关分析.结果 NSCLC患者血清中PlGF的表达水平为(545.05±26.35) ng/L,显著高于健康对照者[(478.62±17.82) ng/L].而在NSCLC胸腔积液中PlGF的水平为(1 094.61±176.48) ng/L,显著高于漏出性胸腔积液(100.81±43.97) ng/L;但与炎症性良性胸腔积液中PlGF水平[(933.54±216.29) ng/L]比较,差异无统计学意义.患者治疗后,疗效判定分别为完全缓解13例,部分缓解16例,无效15例;3个疗效组中PlGF表达水平依次升高,完全缓解＜部分缓解＜无效,差异有统计学意义(F=24.62,P＜0.01),而治疗效果则依次递减.结论 PlGF在NSCLC并发恶性胸腔积液患者血清和胸腔积液中呈高水平表达,且与患者的临床疗效呈负相关.PlGF作为促血管生成因子,在NSCLC的发病中可能通过刺激肿瘤血管的生长和渗透性而促进胸腔积液的生成.     

重组人p53腺病毒联合顺铂治疗NSCLC合并胸腔积液临床研究

目的本研究评价重组人p53腺病毒注射液（rAd-p53）联合顺铂治疗肺癌所致胸腔积液的临床疗效和毒副反应。方法将38例非小细胞肺癌（NSCLC）合并胸腔积液患者随机分为治疗组和对照组两组。所有患者均在第1、8 d应用吉西他滨1.0 g/m2静脉点滴,每3周重复1次。在上述治疗基础上,治疗组胸腔内注入rAd-p53 1×10^12 VP和顺铂30 mg/m2每次;对照组仅胸腔内注入顺铂30 mg/m2每次,两组均每周重复1次,连用4次后观察疗效。结果治疗组和对照组的有效率分别为80.95%和47.06%（P〈0.05）;治疗组和对照组的一般状况改善率分别为66.67%和29.41%（P〈0.05）;两组患者主要不良反应均为发热、胸痛、消化道反应及白细胞减少,治疗组发热的发生率高于对照组（P〈0.05）,主要为自限性,36 h后一般都能自行恢复。结论重组人p53腺病毒注射液联合顺铂治疗肺癌所致胸腔积液疗效确切,安全,值得临床推广使用。