ObjectiveTo systematically review the diagnostic value of procalcitonin (PCT) for tuberculous pleural effusion. MethodsWe electronically searched CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library and EMbase from inception to April, 2013, to collect the literature about the diagnostic value of PCT for tuberculous pleural effusion compared with gold standard (positive outcomes of mycobacterium tuberculosis culture). Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. MetaDiSc 1.4 were used to conduct the meta-analysis. ResultsEight studies were finally included. The results of meta-analysis showed the pooled sensitivity and specificity were 0.63 (95%CI 0.58 to 0.68) and 0.76 (95%CI 0.70 to 0.81), respectively. The positive likelihood ratio and negative likelihood ratio were 2.72 (95%CI 1.48 to 5.02) and 0.49 (95%CI 0.29 to 0.82), respectively. The diagnostic odds ratio (DOR) was 5.77 (95%CI 1.89 to 17.58). And the SROC AUC was 0.79. Heterogeneity was mainly derived from the QUADAS score and Begg's test showed there was no presence of publication bias. ConclusionPCT is a potential marker in the diagnosis of benign and tuberculous pleural effusion, which can be used to determine diagnosis identification of tuberculous pleural effusion.
Abstract: Objective To summarize the method and effective result of thoracoscopic intrapleural perfusion hyperthermochemotherapy(TIPHC) for treating malignant pleural effusion caused by lung cancer. Methods Fiftyeight patients with malignant pleural effusion caused by lung cancer were randomly divided into therapeutic group(30 cases) and control group(28 cases) between February 1999 and March 2005. Pleural biopsy and TIPHC under general ansthesia with unilateral ventilation were performed in the therapeutic group, and intrapleural injection of cisplatin was administered in control group after drainage of pleural effusion. The effect on malignant pleural effusion， the change for the concentration of carcinoembryonic antigen(CEA)， cytokeratin-19 fragments (CYFRA21-1)， neuronspecific enolase (NSE) and the side effect were compared before and after the treatment. Results The therapeutic group achieved total response rate of 100.0%, but only 53.6% in control group, with significant difference(χ 2=3.863, Plt;0.05). Furthermore, the concentration of CEA， CYFRA21-1， NSE in therapeutic group dramatically descended than control group(t=2.562,Plt;0.05). But there was no significant difference in side effect (Pgt;0.05). The pathological diagnosis of all the patients were determined in the therapeutic group. Conclusion TIPHC has the advantage of both diagnosis and treatment of malignant pleural effusions. It is safe and effective, and also able to determine the diagnosis. Furthermore, it offers the superiority of small wound， best visualization and convenient pleural biopsy.
【Abstract】Objective To explore the differential diagnostic value of major fibrinolytic parameters in pleural fluid. Methods Tissue-type plasminogen activator( t-PA) and plasminogen activator inhibitor-1( PAI-1) in pleural fluid at the first thoracentesis were measured with ELISA and D-dimer was measured with immunoturbidimetry. Results Eighty-four patients with pleural effusion were enrolled, among which 40 with malignant effusion, 33 with infectious effusion and 11 with transudative effusion. t-PA level was higher in malignant and transudative pleural fluid than that in infectious pleural fluid[ ( 52. 49 ±31. 46) ng /mL and ( 58. 12 ±23. 14) ng /mL vs ( 37. 39 ±22. 44) ng /mL, P lt; 0. 05] , but was not statistically different between malignant pleural fluid and transudative ( P gt; 0. 05) . PAI-1 level was higher in malignant and infectious pleural fluid than that in transudative [ ( 164. 86 ±150. 22) ng/mL and ( 232. 42 ±175. 77) ng/mL vs ( 46. 38 ±16. 13) ng/mL, P lt; 0. 01] , but was not statistically different between malignant and infectious pleural fluid( P gt;0. 05) . D-dimer levels in the three types of pleural fluid were significantly different, which was ( 23. 66 ±25. 18) mg/L, ( 6. 36 ±10. 87) mg/L and ( 66. 90 ±42. 17) mg/L in malignant, transudative and infectious pleural fluid, respectively. As single-item detection for malignant pleural fluid, the cutoff of t-PA was gt; 38. 7 ng/mL( area under ROC curve was 64. 0 ) , with sensitivity of 60. 0% , specificity of 63. 6%, positive predictive value of 66. 7%, negative predictive value of 56. 8% and accuracy of 61. 6% .The cutoff of D-dimer was lt; 27. 0 mg/L( area under ROC curve was 85. 5) , with sensitivity of 84. 8% ,specificity of 72. 5% , positive predictive value of 85. 3% , negative predictive value of 71. 8% and accuracy of78.1%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined examination( t-PA + D-dimer) were 92. 5% , 60. 6% , 74. 0% , 87. 0% , 78. 1% , respectively.Conclusions The t-PA, PAI-1 and D-dimer levels are significantly different in the three types of pleural fluid. The detection of fibrinolytic parameters in pleural fluid, especially the value of D-dimer,may be helpful in the differential diagnosis of pleural effusion.
Objective To compare the effects of heparin versus urokinase injection intrapleurally in the management of pleural thickening and adhesion due to tuberculous exudative pleurisy. Methods Sixty patients with tuberculous pleurisy were allocated into three groups randomly. Sodium heparin ( heparin group) , urokinase ( urokinase group) , and 0. 9% saline ( control group) were intrapleurally injected respectively. The concentrations of fibrinogen and D-dimer in pleural effusion were measured before and after the injection. The duration of absorption and the total drainage volume of pleural effusion were recorded. The pleural thickness and adhesion were observed two months after the injection. Results In 72 hours after the intrapleural injection, the concentration of fibrinogen( g/L) in the pleural effusion was significantly increased in the heparin group( 1. 13 ±0. 44 vs 0. 34 ±0. 19, P lt; 0. 001) , and significantly decreased in the urokinase group( 0. 25 ±0. 16 vs 0. 38 ±0. 15, P lt; 0. 05) when compared with baseline. Concentrations of D-dimer in the pleural effusions were significantly higher than those at baseline in both the heparin group and the urokinase group( 57. 0 ±17. 6 vs 40. 0 ±15. 4, P lt; 0. 05; 74. 5 ±16. 4 vs 43. 8 ±14. 9, P lt; 0. 001) . There were no significant differences in the absorption duration of pleural effusion among the three groups( P gt;0. 05) . The total drainage volume of pleural effusion was higher in the heparin group and the urokinase group compared to the control group( P lt;0. 01) . And the total volume of pleural effusion was significantly higher in the heparin group and the urokinase group than that in the control group( 2863 mL and 2465 mL vs 1828 mL,P lt;0. 01) . Two months after the intervention, the pleura were thinner[ ( 1. 37 ±0. 82) mm and ( 1. 33 ±0. 85) mmvs ( 3. 06 ±1. 20) mm, P lt; 0. 01] and the incidence of pleural adhesion was significantly lower[ 15% and 20% vs 50% , P lt; 0. 05] in the heparin and the urokinase groups than those in the control group.Conclusion Intrapleural heparin has similar effects with urokinase for prevention pleural thickness andadhesion in tuberculous pleurisy with good availability and safety.
Objective To investigate the expression of aquaporin-1( AQP-1) in pleural mesothelial cells ( PMCs) and the influence of glucose thereupon. Methods Rat PMCs were isolated, cultured, and divided into two groups, ie. a glucose group, cultured with glucose of different concentrations for 24 hours,and a control group, cultured in D-MEM/ F-12 medium. The 100 mmol / L glucose group was administered at the time points of 6, 12, 18, and 24 hours respectively. RT-PCR and Western blotting were used to analyze the mRNA and protein expression of AQP-1. Results The absorbance values of AQP-1 protein expression were 54. 02 ±4. 61, 127. 84 ±9. 41, and 231. 62 ±22. 63, respectively in the PMCs treated with glucose of the concentrations of 50, 100, and 200 mmol / L, all significantly higher than those in the control group( 22. 45 ±2. 16, all P lt; 0. 01) . The absorbance values of AQP-1 protein expression were 24. 68 ±2. 56, 58. 68 ±3. 67, 89. 61 ±6. 62, and 113. 41 ±7. 65 in the PMCs treated with glucose of the concentration of 100 mmol / L after 6, 12, 18, and 24 hours, all significantly higher than those in the control group ( 11. 81 ±1. 45, P lt;0. 01) .Conclusions Glucose induces the expression of AQP-1 mRNA and protein. AQP-1 participates in the pleural fluid formation.
Objective To investigate the value of tumor type M2 pyruvate kinase ( M2-PK) in the differential diagnosis of pleural effusion. Methods A total of 146 patients with pleural effusion during January 2006 to December 2008 were recruited at the department of respiratory medicine of the Shantou Affiliated Hospital and the First Affiliated Hospital of Sun Yat-sen Medical College. Pleural effusion was malignant in 72 cases ( 52 cases with lung cancer and 20 cases with metastatic lung cancer) and benign in 74 cases ( 54 cases with infective pleural effusion and 20 with transudation effusion) . The patients were divided into a malignant pleural effusion group, an infective pleural effusion group, and a transudation group.Then the infective group was further divided into subgroups of tuberculosis pleural effusion group andparapneumonic effusion group. The concentration of tumor M2-PK in pleural fluid obtained during the first thoracocentesis was measured by enzyme-linked immunosorbent assay( ELISA) . Results The concentration of tumor M2-PK was significantly higher in the malignant pleural effusion group compared with the benignpleural effusion groups ( P lt; 0. 01) . Significant differences were also found in the concentration of tumor M2-PK between malignant pleural effusion caused by lung cancer and metastatic lung cancer( P lt; 0. 05) .When the cutoff value of tumor M2-PK was set at 18. 68 U/mL, the sensitivity, specificity, and accuracy for the diagnosis of malignant pleural effusion was 87. 6% , 86. 0% , and 87. 4%, respectively. Furthermore,the detection of tumor M2-PK in combination with CEA showed better diagnostic sensitivity( 96. 0% ) ,specificity ( 85. 0% ) , and accuracy ( 91. 1% ) . Conclusions The detection of tumor M2-PK in pleural effusion is of some clinical significance in the differential diagnosis of benign and malignant pleural effusion.The detection of tumor M2-PK in combination with CEA is a good diagnostic tool with high sensitivity andspecificity.
Objective To evaluate the clinical efficacy and safety of pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion. Methods Twenty-three patients with malignant tumor confirmed by biopsy or postoperative pathology, complicated with malignant pleural effusion confirmed by exfoliative cytology, were treated between March 2013 and June 2014. All the 23 patients underwent thoracic puncture and catheter drainage for the removal of contraindications for chemotherapy. Then, pleural infusion chemotherapy was performed with docetaxel (40 mg/m2), normal saline (250 mL) and dexamethasone (10 mg), 21 days as a cycle. Before pleural infusion chemotherapy with docetaxel, all the patients were given standard pretreatment with dexamethasone, cimetidine/ranitidine or promethazine. The efficacy and safety of the treatment were evaluated in each cycle. Results Among the 23 selected patients, 6 were evaluated as complete remission and 11 as partial remission, with an effective rate of 73.91%. All the patients had acceptable tolerance in the process of the treatment. The most common side effects were bone marrow suppression (78.26%), and nausea and vomiting (82.61%). No such complications as allergy, fluid retention, cardiac toxicity or degree-Ⅳ adverse reactions were detected. Conclusion Pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion is effective with mild adverse reactions, which is worthy to be popularized.
Objective To analyze the clinical features and survival of lung cancer with pleural effusions. Methods A total of 982 consecutive patients with a newly diagnosed lung cancer from January 2008 to December 2014 were retrospectively reviewed. To analyze the clinical features and survival differences, the total patients were divided into the following two groups: with (n=204) or without (n=778) pleural effusions. Results Lung cancer comprised 682 (69.5%) males and 300 (30.5%) females, with an average age of 59.74 years (19–93 years). There were 487(49.6%) squamous carcinoma, 254 (25.9%) adenocarcinoma and 166 (16.9%) small cell lung cancer; 113 (11.5%) lung cancer at early stage (Ⅰ–Ⅱ), 247 (25.2%) cases at stage Ⅲ and 567 (57.7%) at stage Ⅳ. The median survival time of all patients was 12 months. Patients with pleural effusions had a worse prognosis compared to patients without (median survival time: 11 vs.12 months, P=0.003), the median survival time could be reduced by 1 month in males (P=0.004), 3 months in elder patients over 60 years (P<0.001), 4 to 8 months in carcinoma and small cell lung cancer (P≤0.001), and 2 to 3 months in advanced lung cancer (stage Ⅲ and Ⅳ) (P<0.05). Any or combined treatment of surgery, radiotherapy, chemotherapy and targeted therapy was associated with an improved overall survival of about 2 months (P=0.009), and targeted therapy could even improve the median survival time by 1 to 8 months (P=0.002). Conclusions About 20.8% of the patients developed pleural effusion at the same time during the course of lung cancer. Pleural effusion is a poor prognostic factor of lung cancer.
Objective To evaluate the value of Sysmex XT-4000i hematology analyzer in its body-fluid mode in cell count and cell differential count of pleural effusion, ascites and cerebrospinal fluid samples. Methods A total of 95 pleural effusion, ascites and cerebrospinal fluid samples were collected from patients hospitalized between May and September 2015. The samples were tested by Sysmex XT-4000i hematology analyzer (instrument method) and modified Neubauer hemocytometer (manual method) for cell count, and the results of them were compared and analyzed. Results The instrument method and the manual method had a good consistency in nuclear cell count and erythrocyte count (kappa=0.965,P< 0.001; kappa=0.988,P<0.001). There was no significant difference in the count of mononuclear cells (P> 0.05). However, there was a significant difference in the count of multiple nuclear cells (P<0.05). Conclusions Hematology analyzer in its body-fluid mode may replace manual method in cell count of pleural effusion, ascites and cerebrospinal fluids for its high precision, high efficiency and easy operation. However, cell differential count of this method needs microscopic examination assistance.
Abstract： Objective To summarize early clinical result of total cavopulmonary connection, and analyze the risk factors contributing to prolonged postoperative recovery. Methods Between February 2009 and August 2010, 58 patients with functional univentricular complex congenital heart disease received total cavopulmonary connection in Beijing Fu Wai Hospital. All of them were diagnosed by echocardiogram and angiography including 26 patients with single ventricle, 10 patients with tricuspid atresia, 4 patients with pulmonary artery atresia, 5 patients with double outlet rightventricle, 1 patient with transposition of great arteries, and 12 patients with corrected transposition of the great arteries.Fifty seven patients underwent extracardiac conduit total cavopulmonary connection, and only one patient underwent total cavopulmonary connection with an intracardiac lateral tunnel. According to their postoperative pleural drainage volume and duration, these 58 patients were divided into a large pleural drainage volume group (17 patients with 10 males and 7 females, mean age of 8.61±6.73 years）that included patients with large volume and long duration of pleural drainage, and a little pleural drainage volume group (41 patients with 15 males and 26 females, mean age of 7.21±4.24 years) . A univariable analysis was conducted to compare the risk factors that effected recovery result between the two groups. Results There was no death in hospital period. The average length of hospital stay was 12.30±9.80 d . Average drainage time (18.00±5.50 d versus 5.00±2.20 d , t= -1.967, P ＜ 0.05）, drainage volume (12.30±2.60 ml/(kg·d) versus 2.80±1.70 ml/(kg·d), t=-3.221, P ＜ 0.05), and hospital stay (20.10±7.20 d versus 7.20±1.10 d, t=-2.003, P ＜ 0.05） of the large pleural drainage volume group were significantly larger or longer than those of the little pleural drainage volume group. Univariate analysis showed that preoperative pulmonary pressure measured by catheter in the large pleural drainage volume group was significantly higher than that in the little pleural drainage volume group (17.42±5.34 mm Hg versus 13.91±5.22 mm Hg，t=-2.073，P ＜ 0.05). Conclusions The mortality and major morbidities after total cavopulmonary connection are low in the current era. Preoperative high pulmonary pressure is a risk factor for large amount of pleural drainage and prolonged recovery.