The Relationship Between T-helper Type 1/t-helper Type 2 Cytokines And The Efficacy Of Intrapleural Pingyangmycin Treatment For Malignant Pleural Effusion

Object:To study the relationship between T-helper type 1/T-helper type 2 cytokines and the efficacy of intrapleural pingyangmycin treatment for malignant pleural effusion (MPE).Methods:In this prospective clinical research, Since February 2009 to February 2010, 24 patients of non-small cell lung cancer with MPE (confirmed by pathology or cytology) were recruited for the study. And they were selected according to the following conditions: 1) more than middle-volume pleural effusion (proved by B ultrasound or X ray); 2) not receiving chemotherapy or radiotherapy within one month; 3) using sequential treatment pattern, with intrepleurally administrate pingyangmycin (PYM) at first and then perform systemic chemotherapy of GP, TP or NP after a week; 4) quality of life score (KPS)≥60; 5) without pneumonia and pleural infection; 6) without diabetes, asthma and autoimmune diseases; 7) signing an informed consent. Each patient underwent the closed thoracic drainage, and the daily drainage was not more than 1~1.5L, with the speed control below 500ml/h. When the drainage of pleural fluid was less than 150ml/d or lung was reexpansion proved by chest X-ray, it was granted to treat MPE by intrapleural administration of pingyangmycin 24 ~ 32mg. Before and 24h, 72h after the intrepleural administration PYM, both 5ml pleural effusion and 5ml fresh blood samples were collected to detect the concentrations of T-helper type 1 cytokines (Th1 cytokines) including interferon-γ(IFN-γ), tumor necrosis factor-α(TNF-α) and T-helper type 2 cytokines (Th2 cytokines) including interleukin -4 (IL-4).According to uniform standards of WHO, treatment of MPE was evaluated a month later. The concentrations of IFN-γ, TNF-αand IL-4 in pleural effusion and peripheral blood samples were detected, using double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). Then according to the efficacy, 24 patients were divided into effective group and void group, data were ready for statistical analysis.Results: 24 qualified cases were recruited. The concentrations of IFN-γand TNF-αwere significantly higher in pleural effusion 24h, 72h after teatment than in those before therapy (P <0.05), and the concentrations of IFN-γin pleural effusion were significantly higher 72h after treatment than 24h (P <0.05); while the concentrations of IL-4 in pleural effusion had no statistical differences before and after administration (P> 0.05). The concentrations of TNF-αwere higher in plasma 72h after treatment than those before and after 24h (P <0.05); while the IFN-γand IL-4 concentrations had no significant change in plasma before and after injection (P> 0.05). A month later, the total effective rate of MPE control was 75% (effective group: 18 cases), without obvious side effects. In effective group, the concentrations of IFN-γand TNF-αin pleural fluid 24h, 72h after the administration increased evidently than those before the injection (P <0.05), while the concentrations of IL-4 were lower in pleural fluid 72h after injection than before treatment (P <0.05). In void group, the concentrations of IFN-γ, TNF-αand IL-4 in pleural fluid had no difference before and after treatment (P<0.05).Conclusion: Pingyangmycin pleurodesis is a safe and effective treatment for MPE. Pingyangmycin can stimulate the increase of IFN-γ, TNF-αand the decline of IL-4 in order to promote the pleurisy followed by forming the pleural fibrosis. The increase of Th1 cytokines and the decrease of Th2 cytokines in pleural cavity may be related to the efficacy of pingyangmycin pleurodesis.