Chung Chi-Li, Yeh Ching-Yu, Sheu Joen-Rong, Chen Yi-Chu, Chang Shi-Chuan
Department of Chest Medicine, Taipei Medical University Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Am J Med Sci. 2007 Dec;334(6):452-7. doi: 10.1097/MAJ.0b013e318123eead.
Repeated thoracenteses is indicated in patients with refractory, symptomatic transudative effusions. However, their effect on cytokines and fibrinolytic activity in pleural transudates remains unclear.
Twenty-one patients with symptomatic, large amount of free-flowing transudative effusions caused by heart failure were studied. Thoracentesis with drainage of 500 mL of pleural fluid per day was done for 3 consecutive days (days 1 to 3). Pleural fluid characteristics, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1 beta, IL-8, vascular endothelial growth factor (VEGF), tissue-type plasminogen activator (tPA), and plasminogen activator inhibitor type 1 (PAI-1) were measured during each tap. Chest ultrasonography was done on day 6 to detect the fibrin strands in pleural effusion and the outcome of effusion was evaluated within 7 days after repeated thoracenteses.
Effusion levels of lactate dehydrogenase, neutrophils, TNF-alpha, IL-1 beta, IL-8, VEGF, and PAI-1 increased significantly during repeated thoracenteses. Furthermore, the values of PAI-1 and PAI-1/tPA obtained on days 2 and 3 were highly correlated with those of TNF-alpha, IL-1 beta, IL-8, and VEGF. On day 6, pleural fibrins were observed on chest ultrasonography in 6 patients (29%, fibrinous group) but were absent in the remaining 15 patients (nonfibrinous group). Compared with the nonfibrinous group, the effusion levels of TNF-alpha, IL-1 beta, VEGF, and PAI-1 on day 2 and day 3, and recurrence of symptomatic effusion after repeated thoracenteses were significantly higher in fibrinous group.
Repeated thoracenteses may induce local release of proinflammatory cytokines, VEGF and PAI-1, which may result in fibrin deposition and impair resolution of pleural transudates.
对于难治性有症状的漏出性胸腔积液患者，需反复进行胸腔穿刺抽液。然而，其对胸腔漏出液中细胞因子和纤溶活性的影响仍不清楚。
对21例因心力衰竭导致有症状的大量自由流动漏出性胸腔积液患者进行研究。连续3天（第1至3天）每天进行胸腔穿刺抽液500 mL。每次穿刺时测量胸腔积液特征、肿瘤坏死因子（TNF）-α、白细胞介素（IL）-1β、IL-8、血管内皮生长因子（VEGF）、组织型纤溶酶原激活物（tPA）和纤溶酶原激活物抑制剂1型（PAI-1）。在第6天进行胸部超声检查以检测胸腔积液中的纤维条索，并在反复胸腔穿刺抽液后7天内评估积液的转归。
在反复胸腔穿刺抽液期间，乳酸脱氢酶、中性粒细胞、TNF-α、IL-1β、IL-8、VEGF和PAI-1的积液水平显著升高。此外，第2天和第3天获得的PAI-1和PAI-1/tPA值与TNF-α、IL-1β、IL-8和VEGF值高度相关。第6天胸部超声检查发现6例患者（29%，纤维蛋白组）有胸腔纤维蛋白，其余15例患者（非纤维蛋白组）未发现。与非纤维蛋白组相比，纤维蛋白组第2天和第3天的TNF-α、IL-1β、VEGF和PAI-1积液水平以及反复胸腔穿刺抽液后有症状积液的复发率显著更高。
反复胸腔穿刺抽液可能诱导促炎细胞因子、VEGF和PAI-1的局部释放，这可能导致纤维蛋白沉积并损害胸腔漏出液的消散。
