Clinical Value of Vascular Endothelial Growth Factor Combined with Interferon-γ in Diagnosing Malignant Pleural Effusion and Tuberculous Pleural Effusion

In order to investigate the clinical value of vascular endothelial growth factor （VEGF） combined with interferon-γ （IFN-γ） in diagnosing malignant pleural effusion and tuberculous pleural effusion, 42 cases of malignant pleural effusion and 45 cases of tuberculous pleural effusion in Tongji Hospital, from March 2004 to May 2005, were included, The carcinoembryonic antigen （CEA）, VEGF and IFN-γ levels of pleural effusion were detected by using ELISA, and adenosine deaminase （ADA） activity was determined by using enzyme kinetic analytical method. The sensitivity, specificity, accuracy and area under the curve （AUCR^ROC） of CEA and VEGF, VEGF/IFN-γ ratio, ADA and IFN-γ were measured by receiver operating characteristic curve （ROC）, The results showed that CEA, VEGF levels and VEGF/IFN-γ ratio were significantly higher and the ADA and IFN-γ levels were significantly lower in malignant group than those in tuberculous group （P〈0,01）, The sensitivity, specificity, accuracy and AUCR^ROC of VEGF/IFN-γ ratio （88,7%, 99,8%, 94,4%, 0.96 respectively） were higher than those of CEA （67.8%, 96.1%, 82,4%, 0.78 respectively） and VEGF （81,5%, 84,3%, 82.9%, 0.79 respectively）. The sensitivity, specificity, accuracy and AUCR^ROC of IFN-γ （85.7%, 96,4%, 90.9%, 0.94 respectively） were higher than those of ADA （80,2%, 87,6%, 83.8%, 0,81 respectively）. It was concluded that VEGF/IFN-γ ratio and IFN-γ could be used as valuable parameters for the differential diagnosis of malignant pleural effusion and tuberculous pleural effusion.

The diagnostic significance and the assessment of the value of vascular endothelial growth factor as a marker for success of chemical pleurodesis in malignant pleural effusion

Differential diagnosis of pleural effusion is an important issue, since the treatment modalities and prognosis strictly depend on early and correct diagnosis of the underlying etiology. We assessed the efficacy of vascular endothelial growth factor (VEGF) in the differential diagnosis of patients with malignant and non-malignant pleural diseases. And also is assessed of the VEGF as a marker for success of chemical pleurodesis in malignant pleural effusion. Pleural effusions of 40 patients with a mean age of 55 (range, 26 to 78 years) were examined. A total of 20 patients had malignant pleural effusion;malignant mesothelioma (n=7), lung cancer (n=5) and metastatic malignancies (n=8). Twenty patients had benign pleural effusion;fibrinous pleuritis (n=6), tuberculosis (n=3) empyema (n=5), congestive heart failure (n=3), and acute pancreatitis (n=3). Definitive diagnosis was obtained in all cases with blind or open pleural biopsy, and cytological examination. VEGF levels were determined by enzyme-linked immunosorbent assay. The VEGF level of pleural effusion was comparably higher in the malignant group. The mean level of VEGF in patients with malignant pleural effusions (21.7 ± 1.8 ng/ml) was significantly (P <0.001) higher than that of (13.2 ± 1.5 ng/ml) non-malignant effusions. No significant difference was found regarding the VEGF levels and histological types in malignant pleural effusions. Negative correlation was observed between success rate of pleurodesis and VEGF level of pleural effusion (p= 0.015). The measurement of VEGF levels in pleural effusion may be useful to differentiate malignant from nonmalignant pleural effusions. VEGF level may also be an important prognostic marker for effective treatment of the patients who had malignant pleural effusions with pleurodesis. It is important issue in here whether VEGF could be useful in prognostication of outcome of chemical pleurodesis or not.

Th17/Treg Imbalance in Malignant Pleural Effusion

Both T helper IL-17-producing cells （Thl7 cells） and regulatory T cells （Tregs） have been found to be increased in malignant pleural effusion （MPE）. However, the possible imbalance between Thl7 cells and Tregs, as well as the association of.Thl7/Treg and Thl/Th2 cells in MPE remains to be elucidated. The objective of the present study was to investigate the distribution of Th 17 cells in relation to Tregs, as well as Thl/Th2 balance in MPE. The number ofThl7, Tregs, Thl, and Th2 cells in MPE and peripheral blood was determined by using flow cytometry. The relationship among the number of Thl7, Tregs, Thl, and Th2 cells was explored. It was found that the number of Thl7, Tregs, Thl, and Th2 cells was all increased in MPE as compared with the corresponding peripheral blood. The number of Thl7 cells was correlated negatively with Tregs in MPE, but not in blood. Thl7 cells and Thl7/Treg ratio were positively, and Tregs were negatively, correlated with Thl cells, but not with either Th2 cells or Th1/Th2 ratio in MPE. This study supports earlier data that both Thl7 cells and Treg are present at higher frequencies in MPE than in the autologous blood. For the first time, we show that Thl7/Treg imbalance exists in MPE.

Comparison of intra-pleural injection efficacy between Endostar and Bevacizumab combined with pemetrexed/cisplatin for the treatment of malignant pleural effusion in patients with epidermal growth factor receptor-/anaplastic lymphoma kinase-lung adenocarci

Objective To compare intra-pleural injection efficacy and safety between Endostar and bevacizumab combined with pemetrexed/cisplatin for the treatment of malignant pleural effusion in patients with epidermal growth factor receptor(EGFR)-/anaplastic lymphoma kinase(ALK)-lung adenocarcinoma. Methods Sixty-four pCVatients with EGFR-/ALK-lung adenocarcinoma with malignant pleural effusion(MPE) were admitted to the authors' hospital between January 2016 and June 2017. Patients were randomly divided into two groups: Endostar combined with pemetrexed/cisplatin(Endostar group); and bevacizumab plus pemetrexed/cisplatin(Bevacizumab group). They underwent thoracic puncture and catheterization, and MPE was drained as much as possible. Both groups were treated with pemetrexed 500 mg/m^2, intravenous drip(d1), cisplatin 37.5 mg/m^2 per time, intra-pleural injection(d1, d3). Patients in the Endostar group were treated with Endostar 30 mg per time, intra-pleural injection(d1, 3), and patients in the Bevacizumab group were treated with bevacizumab 5 mg/kg per time, intra-pleural injection(d1). Only one cycle of treatment was applied. MPE was extracted before treatment and on day 7 after treatment. The levels of vascular endothelial growth factor(VEGF) were determined using ELISA. Efficacy and side effects were evaluated according to the Response Evaluation Criteria in Solid Tumors(RECIST) version 1.1, and National Cancer Institute Common Terminology Criteria for Adverse Events(CTCAE) version 3.0 criteria. Results The objective response rates in the Endostar and Bevacizumab groups were 50.0% and 56.3%, respectively; there was no statistical difference between the groups(P > 0.05). After one cycle of treatment, the mean VEGF levels in MPE in both groups decreased significantly, and there was no significant difference in the degree of decline between the two groups(P > 0.05). In both groups, pre-treatment VEGF levels for patients achieving complete response were significantly higher than those for patients achieving stable disease + progressive disease(P < 0.05). No specific side effects were recorded. Conclusion Endostar and Bevacizumab demonstrated similar efficacy in controlling MPE in patients with EGFR-/ALK-lung adenocarcinoma through an anti-angiogenesis pathway, with tolerable side effects. The levels of VEGF in MPE could predict the efficacy of intra-pleural injection of anti-angiogenesis drugs.

Management of recurrent malignant pleural effusions with a tunneled indwelling pleural catheter

In this review, we report on the use of indwelling pleural catheters in the treatment of malignant pleural effusions. We describe the most commonly used catheter. Also, treatment with indwelling pleuralcatheters as compared to talc pleurodesis is reviewed. A comparison of efficacy, costs, effects on quality of life, and complications is made. Only one randomized controlled trial comparing the two is available up to date, but several are underway. We conclude that treatment for malignant pleural effusions with indwelling pleural catheters is a save, cost-effective, and patientfriendly method, with low complication rates.

Effect of intrapleural endostatin and mannatide infusion on malignant molecule expression in pleural fluid of malignant pleural effusion

Objective:To study the effect of intrapleural endostatin and mannatide infusion on malignant molecule expression in pleural fluid of malignant pleural effusion.Methods:Patients with lung cancer and malignant pleural effusion treated in our hospital between April 2013 and December 2015 were selected and randomly divided into two groups, the observation group received intrapleural endostatin and mannatide infusion treatment and control group accepted routine intrapleural infusion treatment. 4 weeks after treatment, the pleural fluid samples were collected to determine the levels of tumor markers, invasion-related molecules, VEGF-related molecules and anti-tumor cytokines.Results:4 weeks after treatment, CEA, CYFRA21-1, NSE, SCC-Ag, CXCL12, CXCR4, MMP2, MMP9, VEGF-A, VEGF-B, VEGF-C, VEGF-D, VEGF-R1, VEGF-R2 and VEGF-R3 levels in pleural fluid of observation group were significantly lower than those of control group while LASS2/TMSG-1, IFN-γ, IL-2, TNF-α, IL-17 and IL-23 levels were significantly higher than those of control group.Conclusion:Intrapleural endostatin and mannatide infusion treatment of malignant pleural effusion can more effectively kill cancer cells, inhibit cell invasion, angiogenesis and lymphangiogenesis, and enhance antitumor immune response.

Correlation of RCAS1 and Claudin-18 expression with proliferation and invasion gene expression in malignant pleural effusion

Objective: To investigate the correlation of RCAS1 and Claudin-18 expression with proliferation and invasion gene expression in malignant pleural effusion. Methods: A total of 187 patients with primary non-small cell lung cancer complicated by malignant pleural effusion were selected as malignant pleural effusion group and 56 patients with tuberculous pleural effusion were selected as tuberculous pleural effusion group. The expression of RCAS1 and Claudin-18 gene as well as proliferation and invasion-related genes in the pleural effusion were compared between the two groups, and Pearson test was used to evaluate the correlation of RCAS1 and Claudin-18 expression with proliferation and invasion gene expression in malignant pleural effusion. Results: RCAS1 and Claudin-18 mRNA expression in pleural effusion of malignant pleural effusion group were greatly higher than those of tuberculous pleural effusion group. Proliferation genes LRRC3B and TCF21 mRNA expression in pleural effusion of malignant pleural effusion group were lower than those of tuberculous pleural effusion group whereas SIRT1 and EZH2 mRNA expression were higher than those of tuberculous pleural effusion group;invasion genes DDX17, Nectin4, Vav3, NGAL and Snail mRNA expression were higher than those of tuberculous pleural effusion group whereas EFEMP1 and MCPH1 mRNA expression were lower than those of tuberculous pleural effusion group. The Pearson test showed that the RCAS1 and Claudin-18 expression in malignant pleural effusion were directly correlated with the expression of proliferation-related genes and invasion-related genes. Conclusion: RCAS1 and Claudin-18 expression increase abnormally in malignant pleural effusion, the specific expression is directly correlated with tumor cell proliferation and invasion activity, and they can be used as the reliable indicators for the identification of benign or malignant pleural effusion.

Study on the Correlation between Syndrome Differentiation of Malignant Pleural Effusion Treated by External Treatment of Traditional Chinese Medicine and Immunohistochemistry of Biopsy Tissue Based on Medical Video-assisted Thoracoscope

Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavity and immunohistochemistry of biopsy tissue,to classify malignant pleural effusion according to syndrome differentiation,and to explore the scientific nature of its theory.Methods:From March 1,2014 to February 28,2015,40 cases of malignant pleural effusion were treated in Beijing Chaoyang Hospital affiliated to Capital Medical University.According to the proposed TCM diagnostic criteria for yin and yang syndrome differentiation,and collect age,gender,course of disease,clinical symptoms,tumor primary focus,histomorphological manifestations and immunohistochemical results and other related information,and carry out statistical data processing.Results:The positive syndrome was mainly metastatic lung adenocarcinoma,which accounted for the majority of all MPE cases,up to 75%.The immunohistochemical results of biopsy tissues were mainly CEA and TTF-1 positive;While pleural effusion caused by pleural mesothelioma was the main type of yin syndrome,and the results of immunohistochemistry combined with biopsy were mainly positive for D2-40,Calretinin,WT-1 and CK5/6.Conclusion:TCM syndrome differentiation of MPE based on internal thoracoscopy combined with biopsy immunohistochemical results has sufficient theoretical basis and certain scientific nature,and further clinical research is needed to verify its effectiveness and practicability in the future.

Gastric Malrotation Relieved by Pleural Effusion Drainage

Mr M., 55-year-old, with metastatic adenocarcinoma of lung (stage IV) was admitted to the hospital after an earlier visit to oncology, where he presented with abdominal pain and distention suspected of having ascites for the first time. After performing abdominal CT and gastric passage film, it was hypothesized that clinical manifestation was related to gastric malrotation. The latter was forced by the huge left pleural effusion. Draining the pleural effusion may be complicated by a trapped lung, an adverse effect where the lung does not expand post drainage. After considering the palliative therapeutic options the effusion was drained, the stomach recoiled to its anatomical position, gastric malrotation was relieved, and the patient resumed oral nutrition. Though gastric malrotation due to a huge, malignant left pleural effusion is rare, it should be considered as more patients are being treated for lung cancer.

端粒酶、γ-干扰素、腺苷酸脱氨酶及结核感染T细胞斑点试验在诊断结核性和恶性胸腔积液中的作用分析

目的 评价端粒酶、γ-干扰素(IFN-γ)、腺苷酸脱氨酶(ADA)及T细胞斑点试验(T-SPOT.TB)检测在诊断结核性和恶性胸腔积液中的价值。方法 纳入40例早期结核性胸膜炎患者(结核组)和40例恶性胸腔积液患者(肿瘤组),分别在治疗前抽取患者胸腔积液及空腹血液,应用酶联免疫吸附分析法检测端粒酶的含量和IFN-γ的浓度,应用比色分析法检测ADA的活性,采用Elispot斑点计数检测T-SPOT.TB阳性率。结果 结核组和肿瘤组的端粒酶含量分别为(1.46±0.73)×10~(-3) nmol/L和(3.34±1.72)×10~(-3) nmol/L,结核组端粒酶含量低于肿瘤组(P<0.01);结核组和肿瘤组的IFN-γ含量分别为(137.44±38.93) U/L和(27.94±8.46) U/L,ADA含量分别为(68.42±9.58) U/L和(15.39±4.43) U/L,2组患者IFN-γ含量和ADA含量比较,差异有统计学意义(P<0.01)。结核组IFN-γ浓度、ADA活性及T-SPOT.TB阳性率均高于肿瘤组(P<0.01)。联合应用端粒酶、IFN-γ、ADA及T-SPOT.TB 4个诊断指标的诊断试验鉴别诊断结核性和恶性胸腔积液的敏感度为0.974,特异度为0.974。结论 联合应用端粒酶、IFN-γ、ADA及T-SPOT.TB 4个诊断指标的诊断试验在结核性胸腔积液和恶性胸腔积液的鉴别诊断中具有重要意义。

miR-506-3p、sST2和CEA在恶性胸腔积液患者中表达水平及诊断价值分析

目的分析miR-506-3p、可溶性生长刺激表达基因2蛋白(sST2)和癌胚抗原(CEA)在恶性胸腔积液患者中表达水平及其诊断价值。方法选取108例胸腔积液患者作为研究组,根据超声检查及病理检查结果,将32例结核性胸腔积液患者纳入结核性组,41例癌性胸腔积液患者和35例淋巴瘤性胸腔积液患者纳入恶性组。另随机抽取54例本院健康体检者纳入对照组。比较研究组患者及对照组健康体检者的血清sST2、CEA水平;比较恶性组与结核性组患者胸水miR-506-3p、sST2和CEA水平。采用ROC分析各指标对恶性胸腔积液的诊断价值。结果血清sST2和CEA水平,恶性组>结核性组>对照组(P<0.05)。与结核性组比较,恶性组胸水miR-506-3p水平降低(P<0.05),而sST2和CEA水平升高(P<0.05)。ROC结果显示,血清sST2、CEA及胸水miR-506-3p、sST2、CEA对恶性胸腔积液均具有诊断价值,且联合诊断的灵敏度最高。结论在恶性胸腔积液患者中,胸水miR-506-3p低表达,而血清和胸水sST2、CEA高表达;对恶性胸腔积液具有一定诊断价值,且联合诊断的灵敏度最高。

斑蝥酸钠维生素B_(6)联合化疗药物胸腔内热灌注治疗肺癌合并恶性胸腔积液的疗效和安全性

目的观察斑蝥酸钠维生素B_(6)联合化疗药物胸腔内热灌注治疗肺癌合并恶性胸腔积液的疗效和安全性。方法选取2018—2022年扬中市人民医院收治的肺癌合并恶性胸腔积液患者130例,按照随机抽签法分为A组与B组,各65例。所有患者将胸腔积液完全排出后,A组经导管注入注射用顺铂、地塞米松磷酸钠注射液、注射用人白介素-2胸腔内热灌注,B组在A组基础上加用斑蝥酸钠维生素B_(6)注射液胸腔内热灌注。比较2组临床疗效,KPS评分改善分级,治疗前后肿瘤标志物[癌胚抗原(CEA)、细胞角蛋白19片段抗原21-1(CYFRA21-1)和神经元特异性烯醇化酶(NSE)],不良反应。结果B组客观缓解率高于A组(82.67%vs.50.67%,χ^(2)=17.280,P<0.001)。B组KPS评分改善分级优于A组(u=2.053,P=0.040)。治疗后,2组血清CEA、CYFRA21-1、NSE水平低于治疗前,且B组低于A组(P<0.01)。B组与A组不良反应总发生率比较,差异无统计学意义(34.67%vs.29.33%,χ^(2)=0.490,P=0.484)。结论斑蝥酸钠维生素B_(6)联合化疗药物胸腔内热灌注治疗肺癌合并恶性胸腔积液可提高疗效、改善患者功能状态,抑制肿瘤标志物表达,延缓病情进展,且未提高不良反应发生率。

金水葶苓汤对肺癌移植瘤恶性胸腔积液模型小鼠的治疗作用及机制研究

目的:通过复制Lewis肺癌移植瘤胸腔积液小鼠模型,考察金水葶苓汤对模型小鼠胸腔积液的抑制作用。方法:通过胸腔注射Lewis细胞复制C57小鼠胸腔积液肺癌模型,观察金水葶苓汤及金水葶苓汤协同顺铂注射液对模型小鼠胸腔积液体积、胸壁转移瘤数量和转移瘤质量、生存时间的影响;采用Western blotting法检测壁层胸膜AQP1和胸腔积液中VEGF蛋白表达的水平,评价金水葶苓汤对肺癌移植瘤胸腔积液小鼠的治疗作用和机制。结果:与模型组比较,各给药组小鼠体质量增长明显升高,胸腔积液体积、胸壁转移瘤数量、转移瘤质量明显降低,小鼠胸腔积液中VEGF及胸膜中AQP1蛋白表达明显低于模型组,差异均有统计学意义(P<0.05或P<0.01),且金水葶苓汤+顺铂组比单用金水葶苓汤或顺铂注射液效果更好,差异有统计学意义(P<0.05)。结论:金水葶苓汤可以抑制恶性胸腔积液模型小鼠胸腔积液生成,改善小鼠体质量,延长小鼠生存时间,降低胸壁肿瘤转移数量和抑制肿瘤生长,降低胸腔积液中VEGF及胸膜中AQP1蛋白表达水平,且金水葶苓汤协同顺铂注射液优于金水葶苓汤或顺铂注射液单用效果。

CD97、CD55和C1q联合检测在结核性胸腔积液和恶性胸腔积液鉴别诊断中的应用价值

目的探究CD97、CD55和C1q联合检测在结核性胸腔积液(TPE)和恶性胸腔积液(MPE)鉴别诊断中的应用价值。方法选取2023年赣南医学院第一附属医院收治的150例胸腔积液(PE)患者为研究对象,依据病理诊断分为TPE组(78例)和MPE组(72例),比较2组一般临床资料及CD97、CD55和C1q水平。分析CD97、CD55、C1q及其联合检测在TPE与MPE鉴别诊断中的应用价值。结果2组患者年龄、性别、吸烟史、糖尿病史、胸膜结节、胸膜厚度、发热、胸痛等对比差异均无统计学意义(P>0.05)。MPE组CD97、C1q水平低于TPE组,而CD55水平高于TPE组(均P<0.05)。ROC曲线分析显示,CD97在鉴别诊断TPE和MPE时的AUC为0.718,以113.53 ng·mL^(-1)为临界值,其敏感度、特异度为69.44%、70.51%;CD55在鉴别诊断TPE和MPE时的AUC为0.735,以69.43 ng·mL^(-1)为临界值,其敏感度、特异度为81.94%、55.13%;C1q在鉴别诊断TPE和MPE时的AUC为0.690,以8.91 mg·L^(-1)为临界值,其敏感度、特异度为98.61%、38.46%;CD97、CD55和C1q联合在鉴别诊断TPE和MPE时的AUC为0.753,敏感度、特异度为58.33%、92.31%。结论CD97、CD55、C1q检测对TPE和MPE均有一定鉴别诊断价值,但三者联合诊断价值更大,特异度更高。

肺癌患者外周血和胸腔积液T细胞受体组库特征分析

目的 比较肺癌患者外周血和胸腔积液的T细胞受体(TCR)组库的免疫学特征。方法 收集2020年7月至2021年1月在复旦大学附属中山医院就诊的5例合并恶性胸腔积液肺癌患者的外周血和胸腔积液,分离外周血单个核细胞(PBMC)和胸腔积液单个核细胞(PEMC),提取基因组DNA,采用Illumina MiSeq平台对TCR进行高通量测序,分析TCR组库的多样性等特征。结果 PBMC和PEMC中的TCR克隆型、VJ pairs和互补决定区3(CDR3)序列的多样性和相关性差异均无统计学意义。PBMC中检测到的TCR克隆数量高于PEMC(P<0.05),VJ pairs和CDR3数量与PEMC差异无统计学意义。PBMC和PEMC配对样本的共有VJ pairs数量占总VJ pairs的比例高于共有克隆型和CDR3序列的数量比例(P<0.05),后两者差异无统计学意义。PEMC中高扩增克隆(HEC)数量和占比均高于PBMC。同时鉴定了36个在PBMC和PEMC中差异表达的VJ pairs,其中25个在PEMC中表达升高、9个在PEMC中表达降低。结论 肺癌患者外周血和胸腔积液的TCR组库表现出不同的特征性变化,可能为肺癌重要的免疫病理学特征。

斑蝥酸钠维生素B_(6)注射液联合顺铂治疗恶性胸腔积液的效果观察

目的:观察斑蝥酸钠维生素B_(6)注射液联合顺铂治疗恶性胸腔积液的效果。方法:选取2022年1月—2023年4月江西省胸科医院收治的60例恶性胸腔积液患者,用随机数字表法分为对照组和治疗组,各30例。对照组采用单纯顺铂胸腔灌注,治疗组采用顺铂联合斑蝥酸钠维生素B_(6)注射液胸腔灌注。比较两组近期疗效、不良反应、肿瘤标志物及血清T细胞亚群。结果:治疗组完全缓解率和总有效率均高于对照组,差异均有统计学意义(P<0.05)。治疗组不良反应总发生率低于对照组,差异有统计学意义(P<0.05)。治疗后1个月,治疗组CEA、CA125及CA199均低于对照组,差异均有统计学意义(P<0.05)。治疗后1个月,治疗组CD4^(+)T细胞、CD8^(+)T细胞及CD4^(+)/CD8^(+)均高于对照组,差异均有统计学意义(P<0.05)。结论:对恶性胸腔积液患者,斑蝥酸钠维生素B_(6)与顺铂联合胸腔灌注,近期疗效较佳,加强抗癌抑癌效应,能有效减少不良反应,机体免疫力可受到保护并有一定程度的提升。

王笑民基于命元三焦膜原理论探讨恶性胸腔积液治疗思路

总结基于命元三焦膜原理论探讨恶性胸腔积液的治疗思路。生理情况下,命门内蕴元阴元阳,三焦敷布元阴元阳,膜原为脏腑之间的空腔间隙,沟通表里内外;病理情况下,癌毒内生,暗耗真阴,相火亢盛,精血暗耗则大肉尽脱、虚火灼肺;阴损及阳,元阳式微,肾虚气逆,发为虚喘。元气亏虚,三焦失养,津液凝血蕴结胸膜膜原则发为恶性胸腔积液。是以命元亏虚、肾虚气逆为本,三焦膜原不利为标。治疗上注重峻补真阴为先,不忘引火归原,常用引火汤重用熟地黄;疏利三焦膜原,强调辛燥散邪,方以达原饮加味。标本同治,疗效确切。

肺癌恶性胸腔积液来源肿瘤细胞的小鼠PDX模型构建及实验验证

目的·构建肺癌患者恶性胸腔积液(malignant pleural effusion,MPE)肿瘤细胞来源的肿瘤异种移植(patientderived tumor xenograft,PDX)模型,并进行实验验证。方法·从基因表达综合数据集(Gene Expression Omnibus,GEO)下载人肺癌伴MPE单细胞转录组测序公共数据GSE131907和人肺癌实体瘤单细胞转录组测序公共数据GSE203360,对数据进行聚类、差异基因本体功能富集分析,明确应用MPE建模的可行性。同时收集肺癌患者的MPE样本,经离心、裂解红细胞等富集细胞操作后,将其植入非肥胖型糖尿病重症联合免疫缺陷(non-obese diabetic/severe combined immunodeficient,NOD/SCID)小鼠皮下,待移植瘤生长至1000 mm³时进行瘤体传代及保存。对稳定传代移植瘤进行组织病理学检测,通过苏木精-伊红染色(hematoxylin-eosin staining,H-E染色)观察细胞组织形态,免疫组织化学法(immunohistochemistry,IHC)检测肺癌标志物表达情况。结果·经单细胞数据分析发现MPE中肿瘤细胞的增殖功能更强,提示MPE中肿瘤细胞PDX建模或具备更佳成瘤效果;共收集35例肺癌MPE样本,成功构建13例PDX模型,成功率达37.14%;在组织病理学检测中,H-E染色可见移植瘤组织细胞异型性明显,IHC检测显示细胞角蛋白7(cytokeratin 7,CK7)、甲状腺转录因子1(thyroid transcription factor-1,TTF1)和天冬氨酸蛋白酶A(Napsin A)等肺癌标志物均呈阳性表达。结论·通过富集肺癌患者MPE中的肿瘤细胞,成功构建了更为简便高效、可实时动态建模的PDX模型。该模型保留了肺癌患者肿瘤细胞的恶性特征及蛋白表达特性,为肺癌伴MPE患者的基础研究和临床用药指导提供了重要的实验模型工具。

贝伐珠单抗联合胸腺法新治疗NSCLC合并MPE的疗效及其机制

探讨贝伐珠单抗联合胸腺法新治疗非小细胞型肺癌(NSCLC)合并恶性胸腔积液(MPE)的疗效及化疗耐药性的影响。选取80例本科室收治的NSCLC合并MPE患者的病例资料,根据治疗方式分为对照组(采用常规治疗)和研究组(采用在常规治疗基础上联合贝伐珠单抗及胸腺法新治疗),每组40例。结果显示,与对照组比较,研究组患者的临床有效率显著增高,相关血清指标显著降低,RRM1表达水平显著降低。结果说明,在常规治疗的基础上,贝伐珠单抗联合胸腺法新可显著提高NSCLC合并MPE患者的治疗效果,其机制可能与改善机体免疫功能,可降低耐药性有关。

重组人血管内皮抑制素胸腔灌注治疗对非小细胞肺癌恶性胸腔积液患者的效果

目的分析不同剂量重组人血管内皮抑制素(恩度)胸腔灌注治疗对非小细胞肺癌(non-small cell lung cancer,NSCLC)恶性胸腔积液患者的疗效与安全性。方法选取150例NSCLC恶性胸腔积液患者作为研究对象,分为3组,各50例。3组均给予恩度胸腔灌注治疗:低剂量组30 mg,中剂量组60 mg,高剂量组90 mg。对比3组的疗效、肿瘤标志物[细胞角蛋白片段21-1(cytokeratin fragment 21-1,CYFRA21-1)、癌胚抗原(carcinoembryonic antige,CEA)、癌抗原125(cancer antigen 125,CA125)、癌抗原19-9(cancer antigen 19-9,CA19-9)]变化以及安全性。结果治疗后,中、高剂量组的总有效率高于低剂量组(P<0.05),中、高剂量组总有效率比较差异无统计学意义(P>0.05);3组CYFRA21-1、CEA、CA19-9水平均降低(P<0.05),低剂量组CEA、CA125、CA19-9水平高于中、高剂量组(P<0.05);3组并发症总发生率比较差异无统计学意义(P>0.05)。结论恩度60 mg与90 mg进行胸腔灌注治疗均可提高NSCLC恶性胸腔积液患者的疗效,还有助于积极控制肿瘤标志物水平,且随恩度用药剂量的增加其用药风险并未升高。