Ishii Soichiro, Sakurashita Hiroshi, Mashida Emiko, Saeki Yasuyuki, Matsuo Hiroaki
Department of Pharmaceutical Services, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551 Japan.
J Pharm Health Care Sci. 2020 Jul 3;6:15. doi: 10.1186/s40780-020-00171-x. eCollection 2020.
Instillation of sterile graded talc in the pleural space is performed to prevent reaccumulation of malignant pleural effusion after drainage. Talc is thought to encourage pleural adhesions as part of the repair process by provoking inflammation, suggesting that adhesions are less likely to form in patients taking corticosteroids or other drugs with anti-inflammatory effects. However, the relationship between steroid therapy and pleurodesis efficacy remains unclear.
We report the outcomes of six patients who underwent pleurodesis at Hiroshima University Hospital while being treated with systemic steroid therapy for non-cancer-related illnesses. Talc pleurodesis was successful at the first attempt in five of the six patients. The five successful cases were receiving low-dose oral prednisolone or methyl prednisolone (range, 1-20 mg/day) at the time of pleurodesis and had serum albumin levels ranging from 2.2 to 3.0 g/dL. In contrast, the patient in whom pleurodesis was unsuccessful was receiving a higher dose of prednisolone (40 mg/day) intravenously and had a relatively low serum album level (1.7 g/dL).
The outcome of pleurodesis may be affected by the dose and/or route of systemic steroid therapy. Further analysis with more patients will be necessary to clarify the relationship between steroid dosage and talc pleurodesis success rate.
在胸腔内注入无菌分级滑石粉，以防止引流后恶性胸腔积液再次积聚。滑石粉被认为是通过引发炎症，在修复过程中促进胸膜粘连，这表明服用皮质类固醇或其他具有抗炎作用药物的患者形成粘连的可能性较小。然而，类固醇治疗与胸膜固定术疗效之间的关系仍不清楚。
我们报告了6例在广岛大学医院接受胸膜固定术的患者的治疗结果，这些患者因非癌症相关疾病正在接受全身类固醇治疗。6例患者中有5例首次滑石粉胸膜固定术成功。5例成功病例在胸膜固定术时接受低剂量口服泼尼松龙或甲泼尼龙（范围为1 - 20毫克/天），血清白蛋白水平在2.2至3.0克/分升之间。相比之下，胸膜固定术未成功的患者静脉注射较高剂量的泼尼松龙（40毫克/天），血清白蛋白水平相对较低（1.7克/分升）。
胸膜固定术的结果可能受全身类固醇治疗的剂量和/或途径影响。需要对更多患者进行进一步分析，以阐明类固醇剂量与滑石粉胸膜固定术成功率之间的关系。
