Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
PLoS One. 2013;8(1):e53169. doi: 10.1371/journal.pone.0053169. Epub 2013 Jan 7.
To investigate the relationship among angiogenic cytokines, fibrinolytic activity and effusion size in parapneumonic effusion (PPE) and their clinical importance.
From January 2008 through December 2010, 26 uncomplicated (UPPE) and 38 complicated (CPPE) PPE were studied. Based on chest ultrasonography, there were non-loculated in 30, uni-loculated in 12, and multi-loculated effusions in 22 patients. The effusion size radiological scores, and effusion vascular endothelial growth factor (VEGF), interleukin (IL)-8, plasminogen activator inhibitor type-1 (PAI-1) and tissue type plasminogen activator (tPA) were measured on admission. Treatment outcome and pleural fibrosis, defined as radiological residual pleural thickening (RPT), were assessed at 6-month follow-up.
The effusion size and effusion VEGF, IL-8 and PAI-1/tPA ratio were significantly higher in CPPE than in UPPE, and significantly higher in multi-loculated PPE than in non-locualted and uni-loculated PPE, respectively. VEGF (cutoff value 1975 pg/ml) and IL-8 (cutoff value 1937 pg/ml) seemed best to discriminate between UPPE and CPPE. VEGF, IL-8 and effusion size correlated positively with PAI-1/tPA ratio in both UPPE and CPPE. Moreover, the level of VEGF, but not IL-8, correlated positively with effusion size in all patients (r = 0.79, p<0.001) and in UPPE (r = 0.64, p<0.001) and CPPE (r = 0.71, p<0.001) groups. The patients with higher VEGF or greater effusion were prone to have medical treatment failure (n = 10; VEGF, odds ratio 1.01, p = 0.02; effusion size, odds ratio 1.26, p = 0.01). Additionally, ten patients with RPT had larger effusion size and higher levels of VEGF and PAI-1/tPA ratio than did those without.
In PPE, VEGF and IL-8 levels are valuable to identify CPPE, and higher VEGF level or larger effusion is associated with decreased fibrinolytic activity, development of pleural loculation and fibrosis, and higher risk of medical treatment failure.
探讨肺炎旁胸腔积液（PPE）中血管生成细胞因子、纤溶活性与胸腔积液量之间的关系及其临床意义。
2008 年 1 月至 2010 年 12 月，共纳入 26 例单纯性胸腔积液（UPPE）和 38 例复杂性胸腔积液（CPPE）患者。根据胸部超声结果，30 例为非分隔性胸腔积液，12 例为单分隔性胸腔积液，22 例为多分隔性胸腔积液。入院时，检测胸腔积液的影像学评分、血管内皮生长因子（VEGF）、白细胞介素（IL）-8、纤溶酶原激活物抑制剂-1（PAI-1）和组织型纤溶酶原激活物（tPA）。6 个月随访时，评估治疗效果和胸腔纤维化，即影像学残留胸腔增厚（RPT）。
CPPE 的胸腔积液量、VEGF、IL-8 和 PAI-1/tPA 比值明显高于 UPPE，多分隔性胸腔积液明显高于非分隔性和单分隔性胸腔积液。VEGF（截断值 1975 pg/ml）和 IL-8（截断值 1937 pg/ml）似乎可以最好地区分 UPPE 和 CPPE。VEGF、IL-8 和胸腔积液量与 UPPE 和 CPPE 中的 PAI-1/tPA 比值呈正相关。此外，在所有患者（r = 0.79，p<0.001）以及 UPPE（r = 0.64，p<0.001）和 CPPE（r = 0.71，p<0.001）组中，VEGF 水平与胸腔积液量呈正相关（r = 0.79，p<0.001），但 IL-8 与胸腔积液量无相关性。VEGF 或胸腔积液量较高的患者更易发生药物治疗失败（n = 10；VEGF，优势比 1.01，p = 0.02；胸腔积液量，优势比 1.26，p = 0.01）。此外，有 RPT 的 10 例患者的胸腔积液量更大，VEGF 和 PAI-1/tPA 比值更高。
在 PPE 中，VEGF 和 IL-8 水平有助于识别 CPPE，较高的 VEGF 水平或更大的胸腔积液量与纤溶活性降低、胸腔分隔形成和纤维化发展以及药物治疗失败风险增加相关。
