偵測肋膜積液中血管內皮生長因子協助區辨是否為良性或原發性及次發性惡性肋膜積液

目的：惡性肋膜積液常造成末期病患呼吸衰竭，其中又以肺癌及乳癌為最常見的病因，病患常需要放置引流管來改善呼吸困難，生活品質也受到相當大的影響。惡性肋膜積液常發生在癌症末期，部份病患在健康檢查時才意外發現肺部積水，經病理檢查才發現是癌症。本研究欲分析肋膜積液中細胞激素濃度與癌症的關係，以早期區辨是否為惡性肋膜積液。方法：本研究共收集75名病患，良性肋膜積液有34人，惡性肋膜積液有41人。以流式細胞儀來測量IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, TNF-α, IFN-γ, TGF-β1, GM-CSF, MCP-1及VEGF等細胞激素，同時計算total protein, LDH, Sugar, Neutrophil及Lymphocyte含量。利用迴歸分析找出預測惡性肋膜積液的危險因子。結果：迴歸分析找出三個因子為VEGF (OR=24.690, p=0.0001)、total protein (OR=7.983, p=0.0003)以及IFN-γ (OR=0.516, p=0.001)。若以VEGF濃度≥ 214 pg/mL合併total protein ≥3.35 g/dl作ROC曲線，可得曲線下的面積為84% (95% CI 75%-93%)，敏感度為92.6%，特異性為61.7%。結論：本研究證實測量肋膜積液中VEGF及total protein濃度可以協助預測是否為惡性肋膜積液，進而幫助病患早期診斷與治療。

關鍵字

血管內皮生長因子；惡性肋膜積液

並列摘要

Objective: Lung cancer and breast cancer are the most common cause of malignant pleural effusion (MPE). Patients often need to place the drainage tube to relieve dyspnea, the patient’s quality of life has also been a considerable impact. MPE always occurs in advanced stage, sometimes MPE is found accidentally by health examination. It always needs time to confirm cancer disease via pathological study. This study aim at analyzing the relationship between the pleural effusion cytokines and cancer for early detection of malignant pleural effusion. Methods: This study total collected 75 patients, 34 benign pleural effusion and 41 MPE patients. Flow cytometry was used to measure IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, TNF-α, IFN-γ, TGF-β1, GM-CSF, MCP-1 and VEGF. Total protein, LDH, Sugar, Neutrophil and Lymphocyte were also collected. Results: Regression analysis identify three factors : VEGF (OR=24.690), total protein (OR=7.983) and IFN-γ (OR=0.516). If VEGF concentration ≥ 214 pg /mL and total protein ≥3.35 g/dl, the area under the ROC curve was 84% (95% CI 75% -93%), sensitivity was 92.6% and specificity was 61.7%. Conclusion: This study confirms that pleural effusion VEGF and total protein level might help predict MPE, thus helping patients with early diagnosis.

並列關鍵字

VEGF ； malignant pleural effusion

參考文獻

1.Heffner JE. Diagnosis and management of malignant pleural effusions. Respirology 2008 Jan;13(1):5-20.

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