各类胸腹水中淋巴细胞亚群分布水平的研究

Objective To determine counts of T lymphocyte sub-populations in malignant and tuberculous pleural effusion or ascites and evaluate its significance in difierential diagnosis.Methods T lymphocyte sub-populations in pleural effusion or ascites and peripheral blood were determined in 30 patients with tuberculosis and 31 patients with cancer by flow cytometry.Concentrations of cytokines Th1 and Th2,γ-interferon(IFN-γ),interleukin-12(IL-12)and IL-4 in pleural effusion or ascites were measured by enzyme-linked immunosorbent assay(ELISA).Results Compared to that in peripheral blood,percentage of CD3+ and CD4+ T-celI counts were all higher in both malignant and tuberculous pleural effusion or ascites [(73±6)%and(67±20)%vs.(51±19)%and(48±14)%,P＜0.05].Although CD3+T-cells count was higher in tuberculous pleural effusions or ascites,no difference in ratio of CD3+ and CD4+/CD3+ and CD8+ T-cell counts was found between malignant and tuberculous pleural effusions or ascites.However,ratios of IFN-γ and IL-12 to IL-4 were higher in tuberculous pleural effusion or ascites(54±24 and 82±19vs.8±6 and 19±10,t=10.34 and 16.28,respectively,P＜0.01).Conclusions CD3+ and CD4+ Tcells can be aggregated in both malignant and tuberculous pleural effusions or ascites,80 nature (tuberculosis or malignancy)of pleural effusion or ascites can not be differentiated by CD4+ and/or CD8+ T-cell counts only,and determination of cytokines Th1 and Th2 can help their differentiation.     

Expression of soluble Toll-like receptors in pleural effusions

Background The Toll-like receptors （TLRs） represent a group of single-pass transmembrane receptors expressed on sentinel cells that are central to innate immune responses.The aim of this study was to investigate the presence of soluble TLRs in pleural effusions, and the diagnostic values of TLRs for pleural effusion with various etiologies.Methods Pleural effusion and serum samples were collected from 102 patients （36 with malignant pleural effusion, 36with tuberculous pleural effusion, 18 with bacterial pleural effusion, and 12 with transudative pleural effusion）.The concentrations of TLR1 to TLR10 were determined in effusion and serum samples by enzyme linked immunosorbent assay.Four classical parameters （protein, lactate dehydrogenase, glucose and C-reactive protein （CRP）） in the pleural fluid were also assessed.Receiver-operating characteristic curves were used to assess the sensitivity and specificity of pleural fluid TLRs and biochemical parameters for differentiating bacterial pleural effusion.Results The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 in bacterial pleural effusion were significantly higher than those in malignant, tuberculous, and transudative groups, respectively.Analysis of receiver operating characteristic curves revealed that the area under the curves of TLR1, TLR3, TLR4, TLR7 and TLR9 were 0.831, 0.843,0.842, 0.883 and 0.786, respectively, suggesting that these TLRs play a role in the diagnosis of bacterial pleural effusion.Also, the diagnostic value of TLRs for bacterial pleural effusions was much better than that of biochemical parameters （protein, lactate dehydrogenase, glucose and CRP）.Conclusions The concentrations of TLR1, TLR3, TLR4, TLR7 and TLR9 appeared to be increased in bacterial pleural effusion compared to non-bacterial pleural effusions.Determination of these pleural TLRs may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies.     

Expression of soluble triggering receptor expression on myeloid cells-1 in pleural effusion

Background Triggering receptors expressed on myeloid cells （TREM） proteins are a family of cell surface receptors expressed broadly by cells of the myeloid lineage. The aim of this study was to investigate the clinical significance of soluble TREM-1 （sTREM-1） in pleural effusions, and to determine the effects of pneumonia on pleural sTREM-1 concentrations. Methods Pleural fluid was collected from 109 patients who presented to the respiratory institute （35 with malignant pleural effusion, 31 with tuberculous pleural effusion, 21 with bacterial pleural effusion, and 22 with transudate）. The concentrations of sTREM-1, tumor necrosis factor-a （TNF-a） and interleukin-113 （IL-113） were determined in effusion and serum samples by enzyme linked immunosorbent assay （ELISA）. Results The concentrations of sTREM-1 in bacterial pleural effusion were significantly higher than those in malignant, tuberculous, and transudative groups （all P 〈0.001）. An sTREM-1 cutoff value of 768.1 ng/L had a sensitivity of 86% and a specificity of 93%. Pleural sTREM-1 levels were positively correlated with levels of TNF-a and IL-113. Patients with complicating bacterial pneumonia did not have elevated concentration of sTREM-1 in pleural effusion when compared with patients without pneumonia. Conclusions Determination of pleural sTREM-1 may improve the ability of clinicians to differentiate pleural effusion patients of bacterial origin from those with other etiologies. The occurrence of bacterial pneumonia did not affect pleural sTREM-1 concentrations.     

Clinical Value of Vascular Endothelial Growth Factor Combined with Interferon-γ in Diagnosing Malignant Pleural Effusion and Tuberculous Pleural Effusion

In order to investigate the clinical value of vascular endothelial growth factor （VEGF） combined with interferon-γ （IFN-γ） in diagnosing malignant pleural effusion and tuberculous pleural effusion, 42 cases of malignant pleural effusion and 45 cases of tuberculous pleural effusion in Tongji Hospital, from March 2004 to May 2005, were included, The carcinoembryonic antigen （CEA）, VEGF and IFN-γ levels of pleural effusion were detected by using ELISA, and adenosine deaminase （ADA） activity was determined by using enzyme kinetic analytical method. The sensitivity, specificity, accuracy and area under the curve （AUCR^ROC） of CEA and VEGF, VEGF/IFN-γ ratio, ADA and IFN-γ were measured by receiver operating characteristic curve （ROC）, The results showed that CEA, VEGF levels and VEGF/IFN-γ ratio were significantly higher and the ADA and IFN-γ levels were significantly lower in malignant group than those in tuberculous group （P〈0,01）, The sensitivity, specificity, accuracy and AUCR^ROC of VEGF/IFN-γ ratio （88,7%, 99,8%, 94,4%, 0.96 respectively） were higher than those of CEA （67.8%, 96.1%, 82,4%, 0.78 respectively） and VEGF （81,5%, 84,3%, 82.9%, 0.79 respectively）. The sensitivity, specificity, accuracy and AUCR^ROC of IFN-γ （85.7%, 96,4%, 90.9%, 0.94 respectively） were higher than those of ADA （80,2%, 87,6%, 83.8%, 0,81 respectively）. It was concluded that VEGF/IFN-γ ratio and IFN-γ could be used as valuable parameters for the differential diagnosis of malignant pleural effusion and tuberculous pleural effusion.     

胸腹水中C反应蛋白等免疫化学指标测定的临床意义

The levels of C-reactive protein(CRP),adenosine deaminase(ADA),total cholesterol (TC),lactate dehydrogenase(LDH),carcinoembryonic antigen(CEA),ferritin(Fer),β2-microglobulin (β2-MG),alpha-fetoprotdn(AFP),carbohydrate anfigen12-5(CA125),carbohydrate antigen19-9(CAl99),carbohydrate antigen15-3(CA153),eyfra211(CY211)and neuron specific enolase(NSE)were detected by automatic chemistry analyzer or electrogenerated chemiluminescence analyzer in pleural and peritoneal exudates from 48 cases oftuberculosis and 82 cases of malignant tumors.The levels of CRP,ADA and β2-MG in tuberculotic exudates were higher than those in malignant exudates(P<0.01).However,the levels of TC,LDH,CEA,Fer,CA153,CY211,NSE,AFP,CA125 and CA199 in malignant exudates were higher than those in tuberculotic exudates(P<0.01).Combined determination of CRP,ADA,TC,LDH,CEA,Fer,and β2-MG in pleural and peritoneal exudates are of value in differentiation of tuberculosis from malignant exudates.Combined determination of CA153.CY211 and NSE in pleural effusions and AFP,CA125 and CA199 in peritoneal effusions can improve the semitivity and specificity of diagnosis for malignant exudates.     

胸腹水中C反应蛋白等免疫化学指标测定的临床意义

The levels of C-reactive protein(CRP),adenosine deaminase(ADA),total cholesterol (TC),lactate dehydrogenase(LDH),carcinoembryonic antigen(CEA),ferritin(Fer),β2-microglobulin (β2-MG),alpha-fetoprotdn(AFP),carbohydrate anfigen12-5(CA125),carbohydrate antigen19-9(CAl99),carbohydrate antigen15-3(CA153),eyfra211(CY211)and neuron specific enolase(NSE)were detected by automatic chemistry analyzer or electrogenerated chemiluminescence analyzer in pleural and peritoneal exudates from 48 cases oftuberculosis and 82 cases of malignant tumors.The levels of CRP,ADA and β2-MG in tuberculotic exudates were higher than those in malignant exudates(P<0.01).However,the levels of TC,LDH,CEA,Fer,CA153,CY211,NSE,AFP,CA125 and CA199 in malignant exudates were higher than those in tuberculotic exudates(P<0.01).Combined determination of CRP,ADA,TC,LDH,CEA,Fer,and β2-MG in pleural and peritoneal exudates are of value in differentiation of tuberculosis from malignant exudates.Combined determination of CA153.CY211 and NSE in pleural effusions and AFP,CA125 and CA199 in peritoneal effusions can improve the semitivity and specificity of diagnosis for malignant exudates.     

Semi-rigid thoracoscopy for undiagnosed exudative pleural effusions: a comparative study

Background Thoracoscopy is highly sensitive and accurate for detecting pleural effusions. However, most respiratory physicians are not familiar with the use of the more common rigid thoracoscope or the flexible bronchoscope, which is difficult to manipulate within the pleural cavity. The semi-rigid thoracoscope combines the best features of the flexible and rigid instruments. Since the practice with this instrument is limited in China, the diagnostic utility of semi-rigid thoracoscopy （namely medical thoracoscopy） under local anesthesia for undiagnosed exudative pleural effusions was evaluated . Methods In 50 patients with undiagnosed pleural effusions who were studied retrospectively, 23 received routine examinations between July 2004 and June 2005 and the rest 27 patients underwent medical thoracoscopy during July 2005 and June 2006. Routine examinations of the pleural effusions involved biochemistry and cytology, sputum cytology, and thoracentesis. The difference in diagnostic sensitivity, costs related to pleural fluid examination and complications were compared directly between the two groups. Results Medical thoracoscopy revealed tuberculous pleurisy in 6 patients, adenocarcinoma in 7, squamous-cell carcinoma in 2, metastatic carcinoma in 3, mesothelioma in 2, non-Hodgkin＇s lymphoma in 1, and others in 4. Only 2 patients could not get definite diagnoses. Diagnostic efficiency of medical thoracoscopy was 93% （25/27）. Only 21% patients were diagnosed after routine examinations, including parapneumonic effusion in 2 patients, lung cancer in 2 and undetermined metastatic malignancy in 1. Twelve patients with tuberculous pleurisy were suspected by routine examination. Costs related to pleural effusion testing showed no difference between the two groups （P=0.114）. Twenty-three patients in the routine examination group underwent 97 times of thoracentesis. Two pleural infection patients and 2 pneumothorax patients were identified and received antibiotic treatment and drainage. Medical thoracoscopy cou     

Diagnostic and therapeutic value of thoracoscopy for pleural effusions: experience from 628 consecutive cases in China

Pleural effusions, the excessive accumulations of fluid in pleural space, are frequently associated with a variety of clinical diseases, such as cancer, tuberculosis, pneumonia, etc. This means that both malignant and benign diseases can cause pleural effusions. Therefore, it is essential for clinicians to determine the etiology prior to the treatment of patients with pleural effusions.     

Different plasma levels of interleukins and chemokines: comparison between children and adults with AIDS in China

Background The immunological differences between children and adults with AIDS in China are not well documented. Th1/Th2 cytokines and chemokines are two types of immune factors intimately involved in disease progression of HIV-1 infection. This study aimed to identify changes in plasma levels of Th1/Th2 cytokines inerleukin （IL）-18, IL-16, IL-10 and chemokines regulated on activation, normal T cell expressed and secreted （RANTES）, stromal cell-derived factor-1 （SDF-1） and monocyte chemoattractant protein-1 （MCP-1） in HIV-l-infected children and adults in China. Methods Seventy-five children with AIDS and 35 adult AIDS patients were recruited and clinical data were collected. CD4^＋ T lymphocyte counts were measured by flow cytometery and plasma HIV RNA levels were measured by quantitative RT-PCR. Plasma levels of IL-18, IL-10, IL-16, RANTES, MCP-1, SDF-1a and SDF-1β were quantified by enzyme-linked immunosorbent assay. The levels of β2-microglobulin （β2-MG） and soluble Fas （sFas） were measured to validate the level of humoral and cellular immune activation. Results The mean levels of all cytokines in pediatric and adult AIDS patients were significantly higher than in their healthy controls （P 〈0.01）. The mean levels of these cytokines were higher in pediatric patients than in adult patients （P 〈0.05, except for SDF-la and β2-MG）. Some of the cytokine levels in patients younger than 6 years old was higher than in older children and adults with AIDS （IL-10, IL-18, SDF-la, MCP, RANTES and sFas, P 〈0.05）. Levels of IL-18, IL-10, RANTES and β2-MG of pediatric patients increased as the levels of viral load increased （P 〈0.05）. Conclusions Abnormal immune activation can be measured in Chinese pediatric and adult patients with AIDS, and is higher in children than in adult patients. The cytokines levels coincide with disease progression of AIDS, but have no direct relationship with total CD4^＋ T cell count.