平阳霉素胸膜固定术对纤溶系统活性及转化生长因子β1的影响  

The effect of intrapleural pingyangrnycin administration on activity of fibrinolytic system and transforming growth factor-β1 in malignant pleural effusion

作　　者：祝清清[1] 孙耕耘[1] 

机构地区：[1]安徽医科大学第一附属医院呼吸内科,合肥230022

出　　处：《中华结核和呼吸杂志》2009年第9期674-678,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的观察平阳霉素胸膜腔内注射后对外周血及胸腔积液中纤溶酶原激活剂抑制物1（PAI-1）、组织型纤维蛋白溶酶原活化剂（t-PA）及转化生长因子β1（TGF-β1）水平的影响，探讨胸膜腔内注射平阳霉素治疗恶性胸腔积液（MPE）的机制。方法2008年2—9月对26例MPE患者胸膜腔内注射平阳霉素，检测注药前后外周血及胸腔积液中PAI-1、t-PA、TGF-β1的水平及白细胞计数。1个月后根据WHO制定的统一标准评价疗效，其中完全缓解（胸腔积液完全消失并维持1个月以上）和部分缓解（胸腔积液减少50％以上）者归为有效组；胸腔积液减少后再次增加且30d内需再次抽液者，归为无效组。结果1个月后15例（15／26例）胸腔积液控制；注射平阳霉素后24h外周血中自细胞计数[有效组为（9．2±2．0）×10^9／L，无效组为（9．4±3．8）×10^9／L]、中性粒细胞计数[有效组为（7．9±2．1）×10^9／L，无效组为（8．1±3．3）×10^9／L]与注药前外周血白细胞计数[有效组为（6．6±1．4）×10^9／L，无效组为（5．6±0．9）×10^9／L]和中性粒细胞计数[有效组为（4．5±1．3）×10’／L，无效组为（4．2±1．0）X10’／L]比较差异有统计学意义（时间效应的F值分别为30．80和46．08，P均〈0．01），血巾PAI-1、t-PA和TGF-β1在注药前后比较无明显差异。胸腔积液中PAI-1在注药后24h[有效组为（2195±861）μg／L，无效组为（1099±568）μg／L]、注药后72h[有效组为（1688±703）μg/L，无效组为（1383±797）μg／L]与注药前[有效组为（1054±1039）μg／L，无效组（1027±955）μg／L比较差异有统计学意义（时间效应的F=6．29，P=0．01）；胸腔积液中t-PA在注药后24h[有效组为（49±49）μg／L，无效组为（53±40）μg／L]、注药后72h[有效组为（17±20）μg/L，无效组为（28±22）μg／L]与注药前[有效组为（42±33）μg／L，无效组为（54±2Objective To observe the changes of the concentrations of plasminogen activator inhibitor-1 （ PAI-1 ）, tissue-type plasminogen activator（ t-PA）, transforming growth factor-β1 （ TGF-β1 ） in peripheral blood and pleural effusion before and after intrapleural pingyangmyein administration, and therefore to investigate the mechanism by which pingyangmycin produces pleurodesis. Methods Since February to September 2008, a total of 26 patients with malignant pleural effusion （ MPE ） underwent intrapleural pingyangmycin administration. The concentrations of PAI-1, t-PA, TGF-[31 and the number of leucocytes in peripheral blood and plenral effusion before and after treatment were detected. The pleurodesis efficacy according to WHO standard was evaluated 1 month later. Patients who showed complete disappearance of pleural effusion lasting more than 1 month and reduction of pleural effusion more than 50% were classified as the effective group, while the others were classified as the failure group. Results One month after intrapleural pingyangmycin administration, the total response rate of MPE control was 57.7% （effective group = 15 cases ）. The number of leucocytes and neutrophils in peripheral blood were significantly higher after intrapleural pingyangmycin administration [ the number of leucocytes： effective group （9. 2 ±2.0）×10^9/L, failure group （9. 4 ±3.8） ×10^9/L; neutrophil count： effective group （7.9 ± 2. 1 ）×10^9/L, failure group （ 8. 1 ± 3.3 ） ×10^9/L than in those before[ the number of leucocytes ： effective group （6. 6 ± 1.4）×10^9/L, failure group （5.6 ±0. 9）×10^9/L; neutrophil count： effective group （4.5 ± 1.3） ×10^9/L, failure group （4. 2 ± 1.0）×10^9/L. F = 30. 80,46.08 respectively, all P 〈 0. 01 ]. However, the concentrations of PAl-l, t-PA and TGF-[51 in the peripheral blood showed no significant difference before and after treatment（ P 〉 0. 05 ）. The concentrations of PAI-1 were significantly lower in the pleural effusion

关 键 词：胸膜固定术 转化生长因子Β1 纤溶酶原灭活剂 组织型纤溶酶原激活物 平阳霉素 

分 类 号：R686[医药卫生—骨科学]