恶性胸液患者血管内皮生长因子的检测和意义

Synificance of vascular endothelial growth factor level in patients with malignant pleural effusion

目的检测血管内皮生长因子(VEGF)在恶性胸液患者血浆、胸液中的水平。方法采用ELISA法检测肺癌伴恶性胸液(n=30),良性胸液(n=15),漏出性胸液(n=5)患者血浆、胸液中VEGF含量,同时检测各组患者胸液中癌胚抗原(CEA)的水平。另取肺癌伴恶性胸液患者12例,胸腔内注入重组人血管内皮抑素(恩度),每周1～2次,连用2～3周后评价疗效及安全性。结果恶性胸液患者血浆及胸液中VEGF含量为270.35±134.13 pg/ml、450.83±201.80 pg/ml,显著高于良性胸液126.70±50.82 pg/ml、227.28±129.03 pg/ml和漏出性胸液71.85±33.86 pg/ml、82.67±42.24 pg/ml(P均<0.01),其中,恶性胸液患者胸液VEGF又高于血浆(P<0.01)。胸水VEGF对恶性胸液诊断的灵敏度是72.0%,特异度是85.3%,准确度是74.9%(界值为298 pg/ml),当和胸水CEA联合检测时灵敏度达86.7%,特异度达96.0%,准确度达91.7%。结论检测胸液VEGF水平,特别是VEGF+CEA水平有助于良恶性胸液的鉴别。

Objective To detect the level of vascular endothelial growth factor （VEGF） in plasma and pleural effusion in patients with malignant pleural effusion and evaluate its clinical significance. Methods Using ELISA, we detected the level of VEGFin plasma and pleural effusion and CEA in pleural effusion respectively in patients with malignant pleural effusion of lung cancer （n = 30）, benign pleural effusion （ n = 15 ）, transuadative （ n =5 ）. 12 patients with malignant pleural effusion of lung cancer were treated ! or 2 times ev- eryweek by intraplenral injection of recombinant human endostatin （ Endostar）, the efficacy and safety would be evaluated after 2 or 3 weeks. Results The level of VEGF in plasma and effusion in patients with malignant pleural effusion （ 270. 35±134. 13 pg/ml and 450. 83 ±201.80 pg/ml） was synificantly higher than that in patients with benign pleural effusion （ 126. 70 ±50. 82 pg/ml and 227.28 ± 129.03 pg/ml） and transuadative （71.85± 33.86 pg/ml and 82. 67± 42. 24 pg/ml） （P 〈 0. 01 ）, and the level of VEGF in effusion was higher than that in plasma in patients with malignant pleural effusion （ P 〈 0. 01 ）. The VEGF level in pleural effusion provided a diagnostic test for maligancy with a sensitivity of 72.0% and a specificity of 85.3% and a accuracy of 74.9% （ cut-off point 298 pg/ml）, when it was co-examined with CEA, it provided a sensitivity of 86.7% and a specificity of 96. 0% and a accuracy of 91.7%, and the diagnosis efficacy was increased relatively. The efficiency of treating malignant pleural effusion by Endostar was 66. 7%, and it had a low side- effect. Conclusions VEGF plays an important role in the malignant pleural effusion accumulation. The measurement of VEGF especially VEGF ＋ CEA in pleural effusion is helpful in discriminating between benign and malignant pleural effusion. It is prominent to treat malig- nant pleural effusion by Endostar,and it is worth for clinical to use it.