Masoud Hossam Hosny, El-Zorkany Mahmoud Mohamed, Ahmed Azza Anwar, Assal Hebatallah Hany
Department of Chest Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
Tuberc Respir Dis (Seoul). 2021 Jan;84(1):67-73. doi: 10.4046/trd.2020.0081. Epub 2020 Nov 9.
Pleurodesis fails in 10%-40% of patients with recurrent malignant pleural effusions malignant pleural effusion and dyspnea. This study aimed to assess the values of pleural elastance (PEL) after the aspiration of 500 mL of pleural fluid and their relation to the pleurodesis outcome, and to compare the pleurodesis outcome with the chemical characteristics of pleural fluid.
A prospective study was conducted in Kasr El-Aini Hospital, Cairo University, during the period from March 2019 to January 2020. The study population consisted of 40 patients with malignant pleural effusion. The measurement of PEL after the aspiration of 500 mL of fluid was done with "PEL 0.5" (cm H2O/L), and the characteristics of the pleural fluid were chemically and cytologically analyzed. Pleurodesis was done and the patients were evaluated one month later. The PEL values were compared with pleurodesis outcomes.
After 4-week of follow-up, the success rate of pleurodesis was 65%. The PEL 0.5 was significantly higher in failed pleurodesis than it was in successful pleurodesis. A cutoff point of PEL 0.5 >14.5 cm H2O/L was associated with pleurodesis failure with a sensitivity and specificity of 93% and 100%, respectively. The patients with failed pleurodesis had significantly lower pH levels in fluid than those in the successful group (p<0.001).
PEL measurement was a significant predictor in differentiating between failed and successful pleurodesis. The increase in acidity of the malignant pleural fluid can be used as a predictor for pleurodesis failure in patients with malignant pleural effusion.
在复发性恶性胸腔积液和呼吸困难的患者中，胸膜固定术的失败率为10%-40%。本研究旨在评估抽取500 mL胸腔积液后的胸膜弹性（PEL）值及其与胸膜固定术结果的关系，并将胸膜固定术的结果与胸腔积液的化学特征进行比较。
2019年3月至2020年1月期间，在开罗大学的卡斯尔·艾尼医院进行了一项前瞻性研究。研究人群包括40例恶性胸腔积液患者。抽取500 mL液体后，用“PEL 0.5”（cm H2O/L）测量PEL，并对胸腔积液的特征进行化学和细胞学分析。进行胸膜固定术，并在1个月后对患者进行评估。将PEL值与胸膜固定术的结果进行比较。
随访4周后，胸膜固定术的成功率为65%。胸膜固定术失败组的PEL 0.5明显高于成功组。PEL 0.5>14.5 cm H2O/L的临界值与胸膜固定术失败相关，敏感性和特异性分别为93%和100%。胸膜固定术失败的患者胸腔积液中的pH值明显低于成功组（p<0.001）。
PEL测量是区分胸膜固定术失败和成功的重要预测指标。恶性胸腔积液酸度的增加可作为恶性胸腔积液患者胸膜固定术失败的预测指标。
