影响胸管引流联合硬化剂治疗恶性胸腔积液疗效的多因素分析

Multi-factor analysis of the curative effect of thoracic drainage and intrapleural injection of adhesion agent in the treatment of the malignant pleural effusion

目的 观察胸管引流联合硬化剂治疗恶性胸腔积液（MPE）的疗效,并探讨其影响因素.方法 回顾性分析196例实施胸管引流并行硬化剂胸膜粘连的MPE患者的临床资料.将性别、年龄、KPS评分、原发肿瘤的组织来源、胸水部位、胸水中细胞数、蛋白值、LDH值、硬化剂的种类、使用硬化剂前24 h的胸水引流量、胸膜固定术后继续引流至拔管的时间等11个因素作为研究对象,分析影响疗效的因素.结果 196例患者中,治疗后显效61例,有效71例,无效64例,总有效率67.3％.单因素分析表明,患者的KPS评分、原发肿瘤的组织来源、胸水部位、胸水蛋白值、LDH值、硬化剂的种类、使用硬化剂前24 h的胸水引流量与疗效相关（x2=6.55、11.95、6.93、9.05、14.58、10.57、13.44,均P＜0.05）.多因素Logistic回归分析又显示：KPS评分、原发肿瘤的组织来源、硬化剂的种类、使用硬化剂前24h的胸水引流量是影响疗效的独立因素（OR值=1.78、2.12、11.40、6.30,均P＜0.05）.结论 KPS评分≥70分、原发于乳腺癌、使用注射用A群链球菌（沙培林）作为硬化剂、使用硬化剂前24 h的胸水引流量≤200 mL的MPE患者,粘连疗效较好.

Objective To study the effect of chest drainage and injection of pleural adhesion agent in the treatment of the malignant pleural effusion （MPE）,and to discuss the influences about it.Methods The data of the in-hospital patients with MPE who received thoracostomic drainage and pleural adhesions were retrospectively analyzed.11 factors were selected as research subjects,such as sex,age,KPS score,tissue origin of primary tumor,the position of hydrothorax,the cell number,the level of protein,the level of LDH in the effusion,species of sclerosant,the fluid volume of hydrothorax in 24 hours before using sclerosant,the duration between pleurodesis and removing the tude.Then,the factors that affected the effect of pleurodesis were analyzed.Results In total 196 cases,61 patients acquired significant efficacy,71 men achieved good result,and 64 people had no effect.The total effective rate was 67.3%.Univariate analysis showed that KPS score,tissue origin of primary tumor,the position of hydrothorax,the level of protein and LDH in the effusion,species of sclerosant,the fluid volumeof hydrothorax in 24 hours before using sclerosant were related to the effect.Multivariate Logistic regression analysis indicated that KPS score,tissue origin of primary tumor,the position of hydrothorax,the level of protein and LDH in the effusion,species of sclerosant,the fluid volume of hydrothorax in 24 hours before using sclerosant were indepent factors for efficacy of the pleurodesis.Conclusion It seems that good adhesion effect achieved in patients with MPE that KPS score ≥70,primary breast carcinoma,using sapylin as a sclerosant,the fluid volume of hydrothorax ≤ 200nmL in 24 hours before using sclerosant.