平阳霉素胸膜固定术对恶性胸腔积液中凝血-抗凝活性的影响

The effect of intrapleural pingyangmycin administration on activity of coagulation-anticogulation in malignant pleural effusion

目的观察平阳霉素注入胸膜腔后对恶性胸腔积液(MPE)中纤维蛋白肽A(FPA)浓度及抗凝血酶Ⅲ(ATⅢ)活性的影响,探讨其胸膜固定术机制。方法平阳霉素注入31例MPE患者胸膜腔,检测注药前后各时间点胸水FPA浓度、ATⅢ活性。1个月后根据WHO统一标准进行疗效评价,分为有效组和无效组。结果 18例胸腔积液控制。注药前两组胸水FPA浓度无明显差异(P>0.05);注药后均显著高于注药前(P<0.05),且有效组浓度显著高于无效组(P<0.01)。胸水ATⅢ活性在注药前后及组间均无明显差异。结论平阳霉素注入胸膜腔后可通过增强局部凝血活性而达到胸膜粘连的效果。

Objective To observe the changes of the concentrations of fibrinopeptide A（FPA） and the activity of antithrombin Ⅲ（AT Ⅲ） in malignant pleural effusion（MPE） before and after intrapleural pingyangmycin administration,and therefore to investigate the mechanism by which pingyangmycin produces pleurodesis.Methods A total of 31 patients with MPE underwent intrapleural pingyangmycin administration.the concentrations of FPA,the activity of AT Ⅲ in pleural effusion were detected before and after treatment.The pleurodesis efficacy according to WHO standard was evaluated 1 month later.Results There were 18 cases in effective group.The concentrations of FPA showed no significant difference between effective and failure group before intrapleural pingyangmycin administration（P〉0.05）;then after treat,they were significantly higher than before（P〈0.05）and were higher in effective group than failure one（P〈0.01）.The activity of AT Ⅲ in pleural effusion showed neither significant difference before and after treat in two groups nor significant difference between effective and failure one.Conclusion The mechanism of pleurodesis is related to increasing coagulative activity in the pleural cavity.