结核性胸膜炎纤溶活性的测定及意义

目的:探讨结核性胸腔积液的纤溶活性特点和预后的关系.方法:通过ELISA法测定结核性胸腔积液、肺癌并癌性胸腔积液、充血性心力衰竭伴漏出性胸腔积液患者血浆及胸液中纤溶酶原激活物抑制剂-1(PAI-1)、组织型纤溶酶原激活物(t-PA)及D-二聚体(D-D)水平.其中结核性胸腔积液根据X胸片在疗程结束时被分为伴有胸膜增厚组和不伴有胸膜增厚组.结果:3组患者的血浆PAl-1、t-PA和D-D无显著性差异(P0.05);结核性胸液中PAI-1较癌性胸液、心衰伴漏叶出性胸液升高(P<0.05),t-PA较癌性胸液、心衰伴漏出性胸液明显下降(P<0.05).伴有胸膜增厚组的结核性胸液中PAI-1较不伴有胸膜增厚组升高(P<0.05),t-PA较不伴有胸膜增厚组下降(P<0.05).胸液D-D在不同病因的3组胸腔积液之间及2组结核性胸液之间无显著性差异(P>0.05).结论:与癌性胸腔积液及心衰伴漏出性胸腔积液比较,结核性胸液内PAI-1上升,t-PA下降,PAI-1与t-PA的失衡显著.胸膜腔内PAI-1、t-PA的失衡与胸膜纤维化形成密切相关.胸液纤溶因子PAI-1与t-PA的检测有助于结核性胸膜炎预后的判断,而胸液D-D的检测对胸腔积液的鉴别诊断及预后判断没有帮助.

Detection of fibrinolytic activity and its clinical significance in patients with tuberculous ple-urisy

Objectives:To measure fibrinolytic activity in the patients with tuberculous pleurisy and to evaluate the relationship between the effusion levels of these fibrinolytic components and the development of residual pleural thickening(RPT) in these patients. Methods:The plasma and effusion levels of PAI-1,D-D and t-PA were measured using an enzyme linked immunosorbent assay(ELISA)in 41 patients with TB,39 patients with lung cancer,11 patients with heart failure. pleural thickening was measured and defined as a pleural thickness of 10 mm found on chest radiographs at the completion of anti-TB chemotherapy in tuberculous pleurisy patients. Results:There was no significant difference in plasma PAI-1,t-PA and D-D levels among three diseases groups(P > 0.05). Tuberculosis exudates had significantly higher values for PAI-1 and lower values for t-PA than malignant exudates and transudate effusion caused by heart failure(P < 0.05). There was no significant difference in effusion D-D level in three groups(P > 0.05). Significantly higher levels of PAI-1 and significantly lower values of t-PA in effusions were found in patients with RPT than those in patients without RPT(P < 0.05). Conclusion:The release of PAI-1 increased while t-PA level decreased in TB pleural effusions. The imbalance of PAI-1 and t-PA may result in the development of pleural thickening in patients with TB pleurisy. Detection of pleural fluid D-dimer levels has no help in the differential diagnosis of an effusion.