Chan Christopher, Chan Ken Ka Pang
Department of Medicine & Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
J Thorac Dis. 2024 Jul 30;16(7):4764-4771. doi: 10.21037/jtd-24-467. Epub 2024 Jul 18.
Pleural fluid is a source from which various biomarkers can be obtained and measured to facilitate the management and prognostication of various conditions. This narrative review aims to summarise a few selected applications of pleural fluid biomarker analysis based on the latest literature.
A literature search for articles published in English regarding human subjects from the period January 2000 to December 2023 was performed through PubMed. Publications considered by the authors to be relevant were included in this review, with additional references added based on the authors' judgement. This review considered both prospective and retrospective cohort studies analysing the clinical value of a range of pleural fluid biomarkers.
The biomarkers selected in this narrative review have either established clinical applicability or promising initial results which require further research. Pleural fluid adenosine deaminase, mesothelin and N-terminal pro-B-type natriuretic peptide can optimize the diagnosis of tuberculous pleuritis, malignant mesothelioma and heart failure-related pleural effusion respectively. The detection rate for epidermal growth factor receptor mutations for lung cancer is higher in the pleural fluid than in the pleural tissue or plasma. Suitable targeted therapy in patients with detectable mutations can offer survival benefits. The pleural fluid neutrophil-lymphocyte ratio, soluble urokinase plasminogen activator receptor and plasminogen activator inhibitor 1 carry prognostic implications and can potentially guide subsequent treatment decisions. These biomarkers used individually, or in conjunction with other clinical parameters, should only be utilised in pre-defined, appropriate clinical conditions to maximize their clinical value.
A great variety of different biomarkers are available for analysis in pleural fluid. Further research and development are necessary to widen the spectrum and enhance the clinical utility of pleural fluid biomarkers. Comparison with the diagnostic utilities of serum biomarkers and other investigation parameters, such as radiological findings, could be considered when evaluating the performance of pleural fluid biomarkers.
胸腔积液是获取和检测多种生物标志物的来源，有助于对各种疾病进行管理和预后评估。本叙述性综述旨在根据最新文献总结胸腔积液生物标志物分析的一些选定应用。
通过PubMed对2000年1月至2023年12月期间发表的关于人类受试者的英文文章进行文献检索。作者认为相关的出版物纳入本综述，并根据作者判断添加其他参考文献。本综述考虑了分析一系列胸腔积液生物标志物临床价值的前瞻性和回顾性队列研究。
本叙述性综述中选定的生物标志物要么已确立临床适用性，要么有初步的良好结果但需要进一步研究。胸腔积液腺苷脱氨酶、间皮素和N末端B型脑钠肽前体分别可优化结核性胸膜炎、恶性间皮瘤和心力衰竭相关胸腔积液的诊断。肺癌表皮生长因子受体突变在胸腔积液中的检测率高于胸膜组织或血浆。可检测到突变的患者采用合适的靶向治疗可带来生存益处。胸腔积液中性粒细胞与淋巴细胞比值、可溶性尿激酶型纤溶酶原激活物受体和纤溶酶原激活物抑制剂1具有预后意义，可能指导后续治疗决策。这些生物标志物单独使用或与其他临床参数结合使用时，应仅在预先定义的适当临床情况下使用，以最大化其临床价值。
胸腔积液中有多种不同的生物标志物可供分析。有必要进一步研发以拓宽胸腔积液生物标志物的范围并提高其临床实用性。在评估胸腔积液生物标志物的性能时，可考虑与血清生物标志物及其他检查参数（如影像学结果）的诊断效用进行比较。
