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2010年英国胸科协会胸膜疾病指南解析:恶性胸腔积液的处理
2010年英国胸科协会在杂志上颁布了“Management of a malignant pleural effusion:British Thoracic Society Pleural Disease Guideline 2010[1]”。指南就恶性胸腔积液的病因、临床表现以及处理等方面进行了全面阐述。本文重点解读指南的临床实践部分,读者如需全面了解指南,请阅读全文。
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胸腔内温热蒸馏水灌洗治疗恶性胸腔积液的临床护理研究
有研究表明,温热具有抗肿瘤的作用[1].对恶性胸腔积液进行热灌注治疗,可以利用水的流动性和良好的热载体特性,使温热与胸膜进行充分、均匀地接触,全面地杀伤胸膜转移癌细胞.蒸馏水无渗透压,可使癌细胞处于低渗状态,直接破坏其细胞膜,直至死亡.亦有报道表明,热疗可提高肿瘤病人的免疫力[2].我科经胸腔内热灌注治疗恶性胸腔积液,病人生活质量明显改善,不良反应发生率也较低,现介绍如下.
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胸液良恶性鉴别的实验室检查新进展
良、恶性胸液的鉴别一直是困惑临床医师的实际问题.在我国这两类疾病的代表即结核性胸膜炎与癌性(主要为肺癌)胸腔积液.笔者曾于1996年撰文评述其进展及临床应用价值[1],本文除进一步肯定某些有实用价值的指标外,主要阐述90年代后期以来的新进展.上述两类疾病除有明确肺结核(特别是具活动性)或原发肿瘤对胸腔积液的病因有提示作用外,确诊的金标准仍然是胸水中查到癌细胞、培养出结核菌,以及胸膜活检有相应的病理证据,但其阳性率均不能令人满意.因此,寻找直接或间接反映癌肿或结核菌引起炎症反应存在的指标,以及探讨联合检测的价值就成为近年研究热点.
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恶性胸腔积液的治疗进展
恶性胸腔积液(MPE)是由肺癌或其他恶性肿瘤累及胸膜或原发性胸膜肿瘤引起的胸腔积液,是晚期恶性肿瘤的常见并发症.MPE占整个胸腔积液的25%,病理类型以转移性腺癌为常见.MPE产生的机制复杂多样,常见的致病因素是壁层和(或)脏层胸膜肿瘤转移.
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可弯曲电子内科胸腔镜在恶性胸腔积液诊断中的应用
恶性胸腔积液多为恶性肿瘤进展所致,是恶性肿瘤晚期常见的并发症,诊断为恶性胸腔积液的病人预后差,尽早明确诊断可为治疗赢得时间,提高病人生活质量,改善病人预后.恶性胸腔积液常用的检查方法 有胸腔积液细胞学、胸部CT检查、免疫学、支气管镜检查、经皮闭式胸膜活检等,但是尽管经过上述检查,仍有超过20%的患者不能明确诊断.
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Objective: Soluble CD40 (sCD40) is a potential modulator for both antitumor responses and CD40-based immunotherapy;however the levels and significance of sCD40 in non-small cell lung cancer (NSCLC) patients with malignant pleural effusion are unknown. Methods: Forty-eight patients with lung cancer were treated in our institutions from January 2008 to January 2010. Peripheral blood and pleural effusion samples were collected from each subject. sCD40 levels in plasma and malignant pleural effusions supernatant were measured. The CD40L expression on CD3t T-cells was confirmed by flow cytometric direct immunofluorescence analysis. All patients were followed up after the study ended on January 1, 2010. Results: Patients with malignant pleural effusion of NSCLC had elevated circulating and pleural effusion levels of sCD40, and these elevated sCD40 levels were associated with advanced diseases and a poor prognosis. Conclusions: These findings indicate that elevated sCD40 may have a role in modulating antitumor responses and may also be a useful prognostic marker. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).