Yedikule Chest Disease and Surgery Training and Research Hospital, İstanbul, Turkey.
Respir Med. 2013 Aug;107(8):1260-5. doi: 10.1016/j.rmed.2013.04.011. Epub 2013 Jun 18.
We aimed to evaluate the diagnostic and prognostic value of measuring survivin levels, which is an inhibitor of apoptosis in pleural effusions.
Group I, malignant (MPE) (n = 51); Group II, tuberculosis (TPE) (n = 18); Group III transudative (TE) (n = 9) effusions were enrolled prospectively. We used ELISA to analyze 78 effusions. The value for the differential diagnosis and the correlation between survivin and survival in MPE were analyzed.
Survivin level was 41.75 ± 76.20 in MPE, 15.83 ± 10.92 in TPE and 8.33 ± 8.67 in TE. When the patients divided two groups as malignant and non-malignant pleural effusion (non-MPE), survivin level was significantly higher in MPE (41.75 ± 76.20) than in non-MPE (13.33±2.05) (p = 0.012). The cutoff value for survivin levels detected by ROC curve analysis was 7.5 pg/ml, with sensitivity and specificity values of 72%, 44%, respectively. Survivin had no discriminative power in differentiating exudative effusions of MPE from TPE (p = 0.405). There was no correlation between survivin level and age, sex, location, fluid pH, glucose, protein, albumine and ADA level while there was significant moderate correlation with fluid LDH (r = 0.49; p < 0.001). Survivin levels can distinguish patients who had poor prognosis (median survival 75 days, n = 24) and those who had good prognosis (median survival 219 days, n = 27, p = 0.03) in MPE. In conclusion, survivin expression levels detected with ELISA had no discriminative power in differentiating exudative effusions included MPE and TPE. Elevated survivin levels are associated with poor survival in MPE. Our results suggest that survivin may be a potential prognostic marker in MPE.
评估凋亡抑制因子 survivin 在胸腔积液中的表达水平对胸腔积液的诊断和预后的价值。
我们前瞻性纳入了三组胸腔积液患者：恶性胸腔积液（MPE）组（n=51），结核性胸腔积液（TPE）组（n=18），以及漏出液组（TE）（n=9）。采用 ELISA 法检测 78 例胸腔积液患者的 survivin 水平，分析其在鉴别诊断中的价值，并探讨 survivin 与 MPE 患者生存时间的相关性。
MPE 组、TPE 组、TE 组的 survivin 水平分别为 41.75±76.20、15.83±10.92、8.33±8.67。当将患者分为恶性和非恶性胸腔积液（非-MPE）两组时，MPE 组的 survivin 水平明显高于非-MPE 组（41.75±76.20）比非-MPE 组（13.33±2.05）高（p=0.012）。ROC 曲线分析发现，survivin 水平的截断值为 7.5pg/ml，其敏感度和特异度分别为 72%、44%。survivin 对区分 MPE 和 TPE 所致渗出性胸腔积液并无诊断价值（p=0.405）。survivin 水平与年龄、性别、积液部位、pH 值、葡萄糖、蛋白、白蛋白和 ADA 水平均无相关性，与积液 LDH 水平呈中度正相关（r=0.49，p<0.001）。MPE 患者中，预后不良组（中位生存时间 75 天，n=24）和预后良好组（中位生存时间 219 天，n=27）的 survivin 水平差异有统计学意义（p=0.03）。
ELISA 法检测 survivin 水平对区分包括 MPE 和 TPE 在内的渗出性胸腔积液无诊断价值。MPE 患者中，survivin 水平升高与预后不良相关。这些结果提示 survivin 可能是 MPE 的一个潜在预后标志物。
