恶性胸腔积液患者血管内皮生长因子表达水平与疗效相关性研究  

Correlation between vascular endothelial growth factor(VEGF)expression levels and therapeutic outcomes in patients with malignant pleural effusion

作　　者：常丽 任宏 关雪晴 庞有铨 甄春英 边楠楠 孙素芹[3] Chang Li;Ren Hong;Guan Xueqing;Pang Youquan;Zhen Chunying;Bian Nannan;Sun Suqin(Department of Tumor 1,Harbin Chest Hospital,Harbin 150056,China;Respiratory Ward 2,Harbin Chest Hospital,Harbin 150056,China;Department of Pulmonary Disease,Hanan Branch of the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150066,China)

机构地区：[1]哈尔滨市胸科医院肿瘤一病区,哈尔滨150056 [2]哈尔滨市胸科医院呼吸二病区,哈尔滨150056 [3]黑龙江中医药大学附属第二医院哈南分院肺病一科,哈尔滨150066

出　　处：《结核与肺部疾病杂志》2024年第6期533-539,共7页Journal of Tuberculosis and Lung Disease

基　　金：黑龙江省卫生健康委科研课题(20210303100078)。

摘　　要：目的:探讨恶性胸腔积液中血管内皮生长因子(vascular endothelial growth factor,VEGF)表达水平与顺铂联合恩度胸腔局部灌注疗效的相关性,以及其他潜在影响因素。方法:将哈尔滨市胸科医院2022年1月6日至2024年1月18日收治的拒绝全身化疗仅同意胸腔局部治疗的恶性胸腔积液患者60例纳入研究组;采用随机数字表法按照2∶1的比例随机抽取同期收治的良性胸腔积液患者30例纳入对照组。研究组经胸腔闭式引流术充分引流后采用顺铂联合恩度局部灌注,根据胸腔积液控制情况分为有效组34例(56.67%)和无效组26例(43.33%),进行治疗前后胸腔积液中血管内皮生长因子、癌胚抗原和总蛋白检测,将胸腔积液中血管内皮生长因子和癌胚抗原值按照中位数进行高低表达的划分,同时搜集患者临床资料,以客观缓解率为应变量,对可能影响疗效的因素进行单因素分析,将差异有统计学意义的变量进行多因素logistic回归分析。结果:采用顺铂联合恩度胸腔局部灌注可明显降低恶性胸腔积液中血管内皮生长因子和癌胚抗原值,治疗前血管内皮生长因子和癌胚抗原值分别为792.96(473.69,959.45)pg/ml和59.89(4.92,389.53)ng/ml,治疗后分别为454.46(353.97,558.40)pg/ml和11.94(3.64,46.47)ng/ml,两者比较差异均具有统计学意义(Z=5.703,P<0.001;Z=3.290,P<0.001);对患者年龄、性别、原发肿瘤、病理类型、治疗分类、远处转移、腔内治疗史、血性积液、卡氏(KPS)评分、胸腔积液中血管内皮生长因子值、胸腔积液中癌胚抗原值、胸腔积液中总蛋白值,进行影响恶性胸腔积液疗效的单因素分析;结果显示:原发肿瘤(Fisher精确概率法,P=0.023)、病理类型(Fisher精确概率法,P=0.034)、治疗分类(χ^(2)=8.688,P=0.003)、远处转移(χ^(2)=10.259,P<0.001)、腔内治疗史(χ^(2)=7.330,P=0.007)、血性积液(χ^(2)=5.831,P=0.016)、胸腔积液中血管内皮生长因子值(Z=5.057,P<0.001)、Objective:To investigate the correlation between the expression level of VEGF in malignant pleural effusion and the therapeutic effect of local cisplatin combined with endostar perfusion in the thoracic cavity,as well as to explore other potential influencing factors.Methods:From January 6,2022,to January 18,2024,60 patients with malignant pleural effusion who declined systemic chemotherapy and consented only to local thoracic treatment were included in the study group.Additionally,30 patients with benign pleural effusion treated during the same period were randomly selected using a 2∶1 ratio via a random number table to form the control group.After complete drainage via closed thoracic drainage,the study group was categorized into an effective group(34 cases,56.67%)and an ineffective group(26 cases,43.33%)based on pleural effusion control.Levels of VEGF,carcinoembryonic antigen(CEA),and total protein in pleural effusion were measured before and after treatment.The VEGF and CEA levels in pleural effusion were stratified into high and low expression groups according to the median values.Concurrently,clinical data were collected,with the objective response rate serving as the dependent variable.Univariate analysis was conducted to identify factors potentially influencing treatment efficacy,followed by multivariate logistic regression analysis on variables found to be statistically significant.Results:The use of cisplatin combined with endostar for local thoracic perfusion significantly reduced the levels of VEGF and CEA in malignant pleural effusion.Pre-treatment median levels of VEGF and CEA were 792.96(473.69,959.45)pg/ml and 59.89(4.92,389.53)ng/ml,respectively.Post-treatment levels were 454.46(353.97,558.40)pg/ml for VEGF and 11.94(3.64,46.47)ng/ml for CEA.The differences were statistically significant(Z=5.703,P<0.001;Z=3.29,P<0.001).Univariate analysis of factors such as patient age,gender,primary tumor,pathological type,history of systemic treatment,distant metastasis,endovascular treatment history,presence

关 键 词：胸腔积液 恶性 药物疗法 联合 血管内皮生长因子 癌胚抗原 因素分析 统计学 

分 类 号：R730.6[医药卫生—肿瘤] Q591.2[医药卫生—临床医学]