Martínez Moragón E, Aparicio Urtasun J, Sanchis Aldás J, Fullana Monllor J, Sanchis Moret F, Montalar Salcedo J, Marco Martínez V
Servicio de Neumología, Hospital Universitario La Fe, Valencia.
Med Clin (Barc). 1993 Jul 3;101(6):201-4.
Malignant pleural effusions (MPE) are a common complication in patients with advanced neoplasms. Even though no large series confirming this exist, tetracycline pleurodesis has become the therapy of choice. The aim of this retrospective study was to evaluate its efficacy, adverse effects and possible factors predicting the success of the method.
Between 1985 through 1991, 91 patients with cytologically or histologically confirmed MPE were treated with 1,000-1,500 mg tetracycline pleurodesis. There were 49 females and 42 males, with a mean age of 59 years. The most common malignancies were lung, breast and unknown primary carcinomas. 85% patients complained of dyspnea and the volume of the effusion was moderate in half the cases. 12 variables were analyzed in relation with the probability of response through chi 2 test; survival and recurrence times were calculated with Kaplan and Meier's method.
73 patients were evaluable, with a 67% response rate (22 complete, 27 partial). Time to relapse was significantly higher for partial responses (mean 112 days) than for failures (mean 33 days). 37 patients presented mild complications (pain and fever). Karnofsky performance status (70% or greater), size of the effusion (small or moderate), chest radiograph (only effusion) and pleural LDH (600 U/l or less) attained favourable prognostic significance. Median survival was reached at 6 months.
Tetracycline pleurodesis is an effective and well-tolerated paliative treatment for MPE. Along with other known parameters (pleural pH and glucose levels), Karnofsky performance status, size of the effusion, chest radiograph and pleural LDH allow to predict its results and optimize its indications.
恶性胸腔积液（MPE）是晚期肿瘤患者常见的并发症。尽管尚无大型系列研究证实，但四环素胸膜固定术已成为首选治疗方法。本回顾性研究旨在评估其疗效、不良反应以及预测该方法成功的可能因素。
1985年至1991年间，91例经细胞学或组织学确诊的MPE患者接受了1000 - 1500mg四环素胸膜固定术治疗。其中女性49例，男性42例，平均年龄59岁。最常见的恶性肿瘤为肺癌、乳腺癌和原发性不明的癌。85%的患者有呼吸困难主诉，半数病例胸腔积液量为中等。通过卡方检验分析了12个变量与反应概率的关系；采用Kaplan和Meier法计算生存和复发时间。
73例患者可评估，有效率为67%（完全缓解22例，部分缓解27例）。部分缓解患者的复发时间（平均112天）明显高于未缓解患者（平均33天）。37例患者出现轻度并发症（疼痛和发热）。卡氏评分（70%或更高）、胸腔积液大小（小或中等）、胸部X线片（仅见胸腔积液）和胸腔乳酸脱氢酶（600 U/l或更低）具有良好的预后意义。中位生存期为6个月。
四环素胸膜固定术是一种治疗MPE的有效且耐受性良好的姑息治疗方法。与其他已知参数（胸腔pH值和葡萄糖水平）一起，卡氏评分、胸腔积液大小、胸部X线片和胸腔乳酸脱氢酶可用于预测其结果并优化其适应证。
