Th1/Th2细胞因子与平阳霉素治疗恶性胸腔积液疗效的相关性

The relationship between T-helper type 1/T-helper type 2 cytokines and the efficacy of intrapleural pingyangmycin treatment for malignant pleural effusion

目的探讨胸水及血浆中Th1/Th2细胞因子与平阳霉素(PYM)治疗恶性胸腔积液(MPE)疗效的关系。方法 24例非小细胞肺癌并发MPE患者均行胸腔闭式引流术,并给予胸膜腔内注射PYM24～32mg治疗。应用双抗体夹心酶联免疫吸附测定法(ELISA)法检测治疗前后胸水及外周血中干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)和白介素-4(IL-4)的浓度。一个月后根据WHO标准对MPE患者进行疗效评价。然后根据疗效将24例患者分为有效组和无效组,比较各组治疗前后胸水和外周血标本中IFN-γ、TNF-α和IL-4浓度的变化。结果有效组胸水中IFN-γ和TNF-α浓度在注药后24h和72h均显著高于注药前(P<0.05),而IL-4浓度在注药后72h较注药前出现下降趋势,有统计学意义(P<0.05)。无效组胸水中IFN-γ、TNF-α和IL-4浓度在注药前后无显著差异(P>0.05)。结论 PYM可刺激IFN-γ、TNF-α增多以及IL-4减少,以促进胸膜炎症形成胸膜粘连。胸膜腔内Th1细胞因子升高和Th2细胞因子减少与PYM胸膜固定术疗效有关。

Objective This study was undertaken to investigate the relationship between T-helper type 1/T-helper type 2 cytokines and the efficacy of intrapleural pingyangmycin（PYM） treatment for malignant pleural effusion （MPE）.Methods 24 patients of non-small cell lung cancer with MPE underwent the closed thoracic drainage,and they were treated by intrapleural administration of PYM 24～32mg.The concentrations of interferon-γ （IFN-γ）,tumornecrosis factor-α （TNF-α） and interleukin-4 （IL-4） in pleural effusion and peripheral blood were detected by ELISA,which were collected before and after therapy.According to uniform standards of WHO,treatment of MPE was evaluated a month later.Then according to the efficacy,24 patients were divided into effective group and void group,data were ready for statistical analysis.Results In effective group,the concentrations of IFN-γ and TNF-α in pleural fluid 24 h,72 h after the administration increased evidently than those before the injection （P〈0.05）,while the concentrations of IL-4 were lower in pleural fluid 72 h after injection than before treatment （P〈0.05）.In void group,the concentrations of IFN-γ,TNF-α and IL-4 in pleural fluid had no diversity before and after treatment （P〈0.05）.Conclusion PYM can stimulate the augment of IFN-γ,TNF-α and the decline of IL-4 in order to promote the pleurisy followed by forming the pleural fibrosis.The increase of Th1 cytokines and the decrease of Th2 cytokines in pleural cavity may be relevant to the efficacy of PYM pleurodesis.