Objective To investigate the pleural effusion lymphocyte subsets in patients with pneumonia complicated with pleural effusion and its relationship with the occurrence of critical illness. MethodsPatients with pneumonia complicated with pleural effusion (246 cases) admitted to our hospital from January 2020 to June 2022 were selected as the research subjects. According to the severity of pneumonia, they were divided into a critical group (n=150) and a non-critical group (n=96). After 1:1 matching by propensity score matching method, there were 60 cases in each group. The general data of the two groups were compared. CD3+, CD4+, CD8+, CD4+/CD8+ ratio were detected by flow cytometry. Multivariate logistic regression was used to analyze the risk factors of critical pneumonia, and a nomogram prediction model was constructed and evaluated. The relationship between PSI score and lymphocyte subsets in pleural effusion was analyzed by local weighted regression scatter smoothing (LOWESS). Results After matching, the differences between the two groups of patients in the course of disease, heat peak, heat course, atelectasis, peripheral white blood cell count (WBC), C-reactive protein (CRP), D-dimer (D-D), procalcitonin (PCT) and hemoglobin were statistically significant (P<0.05). Compared with the non-critical group, the proportion of CD3+, CD4+, CD4+/CD8+ cells in critical group was lower (P<0.05), and the proportion of CD8+ cells was higher (P<0.05). Combined atelectasis, increased course of disease, fever peak and fever course, increased WBC, CRP, D-D, CD8+ and PCT levels, and decreased CD3+, CD4+, CD4+/CD8+ and Hb levels were independent risk factors for the occurrence of critical pneumonia (P<0.05). The nomogram prediction model based on independent influencing factors had high discrimination, accuracy and clinical applicability. There was a certain nonlinear relationship between pneomonia severity index and CD3+, CD4+, CD8+ and CD4+/CD8+. Conclusions Lymphocyte subsets in pleural effusion are closely related to the severity of pneumonia complicated with pleural effusion. If CD3+, CD4+, CD8+ and CD4+/CD8+ are abnormal, attention should be paid to the occurrence of severe pneumonia.
Objective To evaluate the clinical efficacy and safety of pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion. Methods Twenty-three patients with malignant tumor confirmed by biopsy or postoperative pathology, complicated with malignant pleural effusion confirmed by exfoliative cytology, were treated between March 2013 and June 2014. All the 23 patients underwent thoracic puncture and catheter drainage for the removal of contraindications for chemotherapy. Then, pleural infusion chemotherapy was performed with docetaxel (40 mg/m2), normal saline (250 mL) and dexamethasone (10 mg), 21 days as a cycle. Before pleural infusion chemotherapy with docetaxel, all the patients were given standard pretreatment with dexamethasone, cimetidine/ranitidine or promethazine. The efficacy and safety of the treatment were evaluated in each cycle. Results Among the 23 selected patients, 6 were evaluated as complete remission and 11 as partial remission, with an effective rate of 73.91%. All the patients had acceptable tolerance in the process of the treatment. The most common side effects were bone marrow suppression (78.26%), and nausea and vomiting (82.61%). No such complications as allergy, fluid retention, cardiac toxicity or degree-Ⅳ adverse reactions were detected. Conclusion Pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion is effective with mild adverse reactions, which is worthy to be popularized.
Objective To evaluate the effect of mediastinal drainage tube placed in the left thoracic cavity after partial resection of the mediastinum pleura in robot-assisted McKeown esophagectomy for esophageal carcinoma, and to compare it with the traditional method of mediastinal drainage tube placed in mediastinum. MethodsWe retrospectively analyzed clinical data of 96 patients who underwent robot-assisted McKeown esophagectomy for esophageal carcinoma by the surgeons in the same medical group in our department between July 2018 and March 2021. There were 78 males and 18 females, aged 52-79 years. Left mediastinum pleura around the carcinoma during operation was resected in all patients. Patients were divided into two groups according to the method of mediastinal drainage tube placement: a control group (placed in mediastinum) and an observation group (placed through the mediastinal pleura into the left thoracic cavity with several side ports distributed in the mediastinum). The incidence of left thoracentesis or catheterization after surgery, anastomotic fistula and anastomotic healing time, other complications such as pneumonia and postoperative pain score were also compared between the two groups. Results There was no statistical difference in baseline data or surgical parameters between the two groups. The percentage of patients in the observation group who needed re-thoracentesis or re-catheterization postoperatively due to massive pleural effusion in the left thoracic cavity was significantly lower than that in the control group (5.6% vs. 21.4%, P=0.020). The incidence of anastomotic leakage (3.7% vs. 7.1%, P=0.651) and the healing time of anastomosis (18.56±4.27 d vs. 24.33±5.48 d, P=0.304) were not statistically different between the two groups, and there was no statistical difference in other complications such as pulmonary infection. Moreover, the postoperative pain score was also similar between the two groups. Conclusion For patients whose mediastinal pleura is removed partially during robot-assisted McKeown esophagectomy for esophageal carcinoma, placing the drainage tube through the mediastinal pleura into the left thoracic cavity can reduce the risk of left-side thoracentesis or catheterization, which may promote the postoperative recovery of patients.
ObjectiveTo systematically review the efficacy and safety of brucea javanica oil emulsion with/without cisplatin in the treatment of malignant pleural effusion (MPE). MethodsWe electronically search PubMed, The Cochrane Library (Issue 6, 2013), EMbase, CBM, WanFang Data, VIP and CNKI to collect randomized controlled trial about brucea javanica oil emulsion for MPE from the establishment dates to June 2013. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1 software. ResultsA total of twenty-five RCTs involving 1 620 patients were included. The results of meta-analysis showed that:compared with using cisplatin alone, brucea javanica oil emulsion plus cisplatin could improve clinical efficiency (RR=1.45, 95%CI 1.34 to 1.57, P < 0.000 01) and patients' quality of life (RR=1.36, 95%CI 1.18 to 1.56, P < 0.000 1), and relieved the incidences of bone marrow depression (OR=0.31, 95%CI 0.22 to 0.42, P < 0.000 01) and digestive tract reaction (OR=0.36, 95%CI 0.24 to 0.54, P < 0.000 01, ) and fever (OR=0.18, 95%CI 0.08 to 0.40, P < 0.000 1). ConclusionCurrent evidence indicates that brucea javanica oil emulsion could improve chemotherapy effects MPE. However, due to the limited quality of the included studies, more high quality studies with large sample size are needed to verify the conclusion.
The management of malignant pleural effusion remains a clinical challenge. In November 2018, American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology summarized the recent advances and provided 7 recommendations for clinical problems of the management of malignant pleural effusion. This paper interprets these recommendations to provide references for management and research on malignant pleural effusion.
Objective To overview the systematic reviews of recombinant human endostatin combined with platinum compounds for malignant pleural effusion (MPE). Methods According to the inclusion and exclusion criteria and searching strategies, we screened the systematic reviews of recombinant human endostatin combined with platinum compounds for the treatment of MPE by searching the Embase, PubMed, Clinical Trials, Cochrane Library, China National Knowledge Infrastructure, CQVIP Database and Wanfang Database. The searching time was from January 1999 to December 2021. The methodological quality was evaluated using AMSTAR 2 tool, the report quality was evaluated using PRISMA statement, and the evidence quality of the outcome indicators was graded according to the GRADE system. Finally, RevMan 5.3 software was used to quantitatively merge and analyze the original research effect values of the main outcome indicators with low level of evidence. Results A total of 9 systematic reviews/meta-analyses involving 8 outcome indicators and totally 50 outcomes were included. The average PRISMA scale score was 22.28±1.37, with 6 reports being relatively complete and 3 reports having certain reporting defects. The overall methodological quality of the 9 systematic reviews was extremely low. Most of the 50 outcomes were graded as “low” (31 outcomes) or “intermediate” (18 outcomes) quality. The results of 9 systematic reviews all showed that the clinical efficacy of dual therapy was more satisfactory than that of platinum-based preparations in the treatment of MPE, and re-quantitative analysis also confirmed that there was no statistically significant difference in the incidence of adverse events between the two treatments (P>0.05). Conclusions Considering the existing evidence and the results of meta-analysis, the dual therapy composed of recombinant human endostatin and platinum compounds is more effective in the treatment of MPE, and there is no difference in the incidence of related adverse events. However, because of its poor methodological quality and the low level of evidence, the above conclusions can only provide a certain reference and need to be confirmed by further research.
Objective By comparing the clinical characteristics, etiological characteristics, laboratory examination and prognosis of community acquired pneumonia (CAP) patients with and without pleural effusion (PE), the risk factors affecting the 30-day mortality of CAP patients with PE were analyzed. Methods The clinical data of inpatients with CAP in 13 hospitals in different regions of China from January 1, 2014 to December 31, 2014 were analyzed retrospectively. According to the imaging examination, the patients were divided into two groups: PE group (with pleural effusion) and non-PE group (without pleural effusion). The clinical data, treatment, prognosis and outcome of the two groups were compared. Finally, multivariate analysis was used to analyze the risk factors of 30-day mortality in patients with PE. Results Of the 4781 patients with CAP, 1169 (24.5%) were PE patients, with a median age of 70 years, and more males than females, having smoking, alcoholism, inhalation factors, long-term bed rest, complicated with underlying diseases and complications, such as respiratory failure, acute respiratory distress syndrome (ARDS), cardiac insufficiency, septic shock, acute renal failure and so on. The hospitalization time was prolonged; the intensive care unit (ICU) occupancy rate, mechanical ventilation rate, mortality within 14 days and mortality within 30 days in the PE group were higher than those in the non-PE group. Multivariate analysis showed that the risk factors affecting 30-day mortality in the patients with PE were urea nitrogen >7 mmol/L (OR=2.908, 95%CI 1.095 - 7.724), long-term bed rest (OR=4.308, 95%CI 1.128 - 16.460), hematocrit <30% (OR=4.704, 95%CI 1.372 - 16.135), acute renal failure (OR=5.043, 95%CI 1.167 - 21.787) and respiratory failure (OR=6.575, 95%CI 2.632 - 16.427), ARDS (OR=8.003, 95%CI 1.852 - 34.580). ConclusionsThe hospitalization time and ICU stay of PE patients are prolonged, the risk of complications increases, and the hospital mortality increases significantly with the increase of age, complication and disease severity. The independent risk factors affecting 30-day mortality in PE patients are urea nitrogen >7 mmol/L, long-term bed rest, hematocrit <30%, acute renal failure, respiratory failure, and ARDS.
ObjectiveTo analyze the clinical characteristics of patients with tuberculous pleural effusion and malignant pleural effusion and explore the value of laboratory indexes of pleural effusion in the differential diagnosis of tuberculous pleural effusion and malignant pleural effusion.MethodsThe clinical data and laboratory indexes of pleural effusion of patients with tuberculous pleural effusion and patients with malignant pleural effusion hospitalized in West China Hospital of Sichuan University between January and December 2017 were analyzed retrospectively. Those examinations with statistical significance were selected to establish a binary logistic regression model for diagnosing malignant pleural effusion from tuberculous pleural effusion. Hosmer-Lemeshow test was used to assess the goodness of fit of the logistic model, and a receiver operating characteristic (ROC) curve was plotted to assess the diagnostic value of the model.ResultsThe average age of the 128 patients with tuberculous pleural effusion was (51.60±21.02) years, and the average age of the 164 malignant pleural effusion was (63.52±11.87) years. Patients with tuberculous pleural effusion were prone to getting symptoms of cough, expectoration, fever, chest pain and tightness in breathing, with statistical significance (P<0.05). The level of adenosine deaminase in patients with tuberculous pleural effusion was (23.06±21.29) U/L, higher than that in malignant pleural effusion; the difference was statistically significant (P<0.05). The levels of albumin, glucose, carbohydrate antigen (CA) 125, CA19-9, carcinoembryonic antigen (CEA) and cyto-keratin 19 fragment antigen 21-1 in patients with malignant pleural effusion were higher than those in patients with tuberculous pleural effusion (P<0.05). Logistic regression analysis showed that CA125, CEA and glucose were introduced to model as the main effect. The area under the ROC curve was 0.914 [95% confidence interval (0.864, 0.964)], with an improved diagnostic efficiency.ConclusionsThe clinical manifestations of tuberculous pleural effusion and malignant pleural effusion are multifarious with low specificity. A joint detection of CA125, CEA and glucose in pleural effusion and the joint diagnostic model can identify tuberculous pleural effusion and malignant pleural effusion better.
ObjectiveTo systematically review the efficacy and safety of intrapleural injection of endostar combined with cisplatin in treatment of non-small cell lung cancer (NSCLC) with malignant pleural effusion. MethodsDatabases including PubMed, The Cochrane Library (Issue 2, 2016), EMbase, Web of Science, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about endostar combined with cisplatin for NSCLC with malignant pleural effusion from inception to February 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 10 RCTs involving 610 patients were finally included. The results of meta-analysis showed that: The overall response rate and the improvement rate of quality of life in the endostar combined with cisplatin group were higher than that of the cisplatin alone group (RR=1.71, 95%CI 1.49 to 1.95, P<0.00001; RR=1.68, 95%CI 1.44 to 1.96, P<0.00001, respectively). However, There were no significant differences between two groups in incidence of gastrointestinal reaction, incidence of leucopenia and incidence of thrombocytopenia (all P values>0.05). ConclusionCompared with cisplatin, intrapleural injection of endostar combined with cisplatin can improve the overall response rate and improve the quality of life of NSCLC patients with malignant pleural effusion. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo investigated the levels of aldolase A (ALDOA) in pleural effusion in patients with different pathological types of lung cancer and patients with tuberculous pleurisy,and the correlation between ALDOA and carcinoembryonic antigen (CEA),lactate dehydrogenase(LDH). Methods80 cases of pleural effusion samples were collected,of which 65 cases of lung cancer (malignant group) and 15 cases of tuberculous pleurisy (TB group). All the patients were not treated with anti-inflammatory or steroid therapy. ALDOA concentrations in pleural effusion were detected by ELISA and the contents of CEA and LDH in pleural fluid were detected by chemiluminescence assay. ResultsThe levels of ALDOA,CEA and LDH in the malignant group were 46.75±21.39 ng/mL,82.24±56.63 ng/mL,755.76±382.54 U/L respectively,and were 23.92±17.21 ng/mL,2.55±1.67 ng/mL,and 388.37±163.87 U/L in the TB group respectively. The levels of ALDOA,CEA and LDH in the malignant group were significantly higher than those in the TB group (P<0.01). The concentrations of ALDOA in malignant pleural effusion from different pathological types of lung cancer were 71.65±32.09 ng/mL(adenocarcinoma),22.43±18.23 ng/mL(small cell lung cancer),and 19.16±13.85 ng/mL(squamous cell carcinoma),respectively. The concentration of ALDOA in malignant pleural effusion from the adenocarcinoma patients was significantly higher than that in the other two types (P<0.05). The concentration of CEA was 112.40±62.71 ng/mL(adenocarcinoma),62.45±54.78 ng/mL(small cell lung cancer),and 71.87±52.4 ng/mL(squamous cell carcinoma),respectively. It was significantly higher in adenocarcinoma than that in other two types (P<0.05). The levels of LDH were 661.81±328.93 U/L(adenocarcinoma),737.62±315.41 U/L(small cell lung cancer),767.85±503.28 U/L(squamous cell carcinoma),respectively. There was no significant difference in three types(P>0.05). The concentrations of ALDOA in pleural effusion from the patients with lung cancer or tuberculous pleurisy were positively correlated with the concentrations of CEA and LDH (P<0.01 or 0.05). ConclusionThe levels of ALDOA,CEA and LDH in malignant pleural effusion from lung cancer patients were significantly higher than those in pleural effusion from patients with tuberculous pleurisy. The ALDOA and CEA levels in malignant pleural effusion from lung adenocarcinoma patients were significantly higher than those in small cell lung cancer and squamous cell carcinoma patients. There were highly positive correlation between ALDOA,CEA and LDH levels.