Antonangelo Leila, Vargas Francisco S, Teixeira Lisete R, Acencio Milena M P, Vaz Marcelo A Costa, Filho Mário Terra, Marchi Evaldo
Laboratory of Pleura-Pulmonary Division and Division of Applied Physiology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Lung. 2006 Mar-Apr;184(2):105-11. doi: 10.1007/s00408-005-2569-9.
This study evaluated the extracellular matrix (collagen and elastic fibers) in pleurodesis induced by intrapleural talc (TL) or silver nitrate (SN). Study subjects were 420 rabbits divided into two groups and sacrificed from 15 min to 12 months after the injection of the sclerosing agents at intervals previously defined. Pleural adhesions and fibrosis were graded (0-4), and the collagen and elastin were quantified. The maximum score of the pleural adhesions was observed two months after TL (2.80 +/- 0.99) and 15 days after SN (3.75 +/- 0.25). More intense pleural adhesions were observed in the SN group from day 5 (p < 0.05). Pleural thickness and pleural fibrosis were, in general, significantly higher after SN (p < 0.05). Increased deposition of collagen and elastin was observed in both groups but was more evident in the SN group. In the TL group, a linear correlation was observed between pleural adhesions and fibrosis (r = 0.775), between pleural adhesions and collagen (r = 0.779), and between fibrosis and collagen (r = 0.709). In the SN group, these correlations were acceptable (r = 0.605, 0.665, and 0.663). The elastin presented a correlation of 0.707 (p < 0.001) in the TL group and of 0.564 (p < 0.001) in the SN group. In conclusion, intrapleural 0.5% silver nitrate and talc (400 mg/kg) are effective in the induction of pleurodesis. However, the intensity of adhesions and the richness of collagen after SN, in combination with the early onset of tissue remodeling, demonstrate the local superiority of this agent. Considering the easy availability and instillation, the low cost, and the absence of important side effects, silver nitrate might be considered as a sclerosing agent to induce pleurodesis in humans.
本研究评估了经胸腔内注入滑石粉（TL）或硝酸银（SN）诱导胸膜固定术中的细胞外基质（胶原蛋白和弹性纤维）。研究对象为420只兔子，分为两组，在注射硬化剂后按照预先确定的时间间隔，从15分钟至12个月进行处死。对胸膜粘连和纤维化进行分级（0 - 4级），并对胶原蛋白和弹性蛋白进行定量分析。TL注射后两个月观察到胸膜粘连的最高评分（2.80 +/- 0.99），SN注射后15天观察到最高评分（3.75 +/- 0.25）。从第5天起，SN组观察到更强烈的胸膜粘连（p < 0.05）。总体而言，SN注射后胸膜厚度和胸膜纤维化显著更高（p < 0.05）。两组均观察到胶原蛋白和弹性蛋白沉积增加，但在SN组更明显。在TL组中，观察到胸膜粘连与纤维化之间（r = 0.775）、胸膜粘连与胶原蛋白之间（r = 0.779）以及纤维化与胶原蛋白之间（r = 0.709）呈线性相关。在SN组中，这些相关性尚可（r = 0.605、0.665和0.663）。弹性蛋白在TL组中的相关性为0.707（p < 0.001），在SN组中的相关性为0.564（p < 0.001）。总之，胸腔内注入0.5%硝酸银和滑石粉（400 mg/kg）在诱导胸膜固定术方面是有效的。然而，SN注射后粘连强度和胶原蛋白丰富度，以及组织重塑的早期发生，证明了该药物在局部的优越性。考虑到其易于获取和注入、低成本以及无重要副作用，硝酸银可被视为一种用于诱导人类胸膜固定术的硬化剂。
