胸水乳酸脱氢酶在肺腺癌并发胸腔积液患者中的临床意义

Clinical significance of pleural effusion LDH in patients with lung adenocarcinoma complicated with malignant pleural effusion

目的通过测定胸水中乳酸脱氢酶(LDH)的水平,探讨胸水LDH对肺腺癌并发胸腔积液患者的临床意义。方法对39例肺腺癌并发胸腔积液患者,以中心静脉导管行胸腔闭式引流,排尽积液后给予顺铂胸腔灌注化疗,表皮生长因子(EGFR)突变阳性者接受络氨酸激酶抑制剂(tyrosine kinase inhibitor,TKI)治疗,无EGFR突变者行常规方案化疗。治疗前采用乳酸底物法检测患者胸腔积液LDH水平,治疗结束后对所有患者进行随访。结果 ROC曲线分析结果显示,以胸水LDH=436.7U/L作为cut-off值,对肺腺癌并发恶性胸腔积液患者预后判断的敏感性为91.7%,特异性为59.3%;低含量(≤436.7U/L)组的中位无进展生存期(mPFS)较高含量(>436.7U/L)组显著延长,其差异有统计学意义(P<0.05);常规化疗组中位无进展生存期与EGFR-TKI治疗组比较,其差异无统计学意义(P>0.05);多因素Cox回归分析显示,胸水LDH水平是影响预后的独立危险因素。结论检测胸水LDH对判断肺腺癌并发恶性胸腔积液患者的预后有重要作用。

Objective To discuss clinical significance by measuring the effusion level of lactate dehydrogenase（LDH） in pa- tients with lung adenocarcinoma complicated with malignant pleural effusion. Methods All of 39 cases of hospitalized patients with lung adenocarcinoma complicated with malignant pleural effusion were subjected to closed drainage of the thoracic cavity using a central venous catheter, and cisplatin reperfusion of the thoracic cavity. The patients with EGFR mutations were subjected to EGFR-TKI treatment. Additionally, the others who no EGFR mutations were accpeted conventional chemotherapy. Lactic acid substrate rate method was performed before treatment in order to monitor levels of pleural effusion LDH. All patients were followed up to after the end of treatment. Results According to the receiver operating characteristic （ROC） curve,when the cut -off value was 436.7 U/L,the sensitivity was 91.7% and the specificity was 59.30%. The mPFS of low pleural effusion LDH （4436.7 U/L） was higher than the high pleural effusion LDH （〉436.7U/L） in patients （P〈0.05）, the difference was statistically significant. There is no significant difference of mPFS between the conventional chemotherapy group and EGFR-TKI treatment group（P〉0.05）. Multivariate Cox regression analysis indicated that the level of pleural effusion LDH was an independent risk predictor for prognosis. Conclusion Detection of pleural effusion LDH in the prognosis of patients with lung adenocarcinoma complicated with malignant pleural effusion was important.