| Objective: By analyzing the related indexes of coagulation-anticoagulation-fibrinolysis and inflammatory reaction in benign and malignant pleural effusion,to study the difference of coagulation-anticoagulation-fibrinolysis mechanism in benign and malignant pleural effusion and the effect of inflammation,and to investigate the value of coagulation-anticoagulation-fibrinolysis mechanism in benign and malignant pleural effusion.Methods:According to the diagnosis criteria of benign and malignant pleural effusion,respectively screening for 20 cases patient that definite diagnosis of benign exudative pleural effusion(benign group)and malignant exudative pleural effusion(malignant group),to respective test the fibrinogen(FIB),fibrinopeptide A(FPA),antithrombin-III(AT-Ⅲ),Ddimer and C-reactive protein(CRP)from patients with pleural effusion.The differences of FIB,FPA,AT-III,D-dimer,AT-Ⅲ/FPA,CRP and CRP/ D-dimer in two groups pleural effusion were analyzed by SPSS 24.Simultaneously analyzed the correlation between CRP and FIB,FPA,AT-III,D-dimer.Results:1.The average age of patients in benign group(53.45±22.29)years old,the average age of malignant group(72.05±13.33)years old,and the average age of malignant group was higher than that in benign group(p<0.05).Benign group parcel,adhesion,pleural thickening patients 15 people,benign group of 2 people,the difference is statistically significant(p<0.05).There was no significant difference between the two groups of sex and the site of the effusion.2.The contents of FIB,FPA,AT-III,D-dimer and AT-Ⅲ / FPA in pleural effusion of the two groups were(5.599±1.211)g/L VS(5.490±0.757)g/L、(19.612±10.214)nmol/L VS(11.319±3.374)nmol/L、(11.212±5.700)ng/mL VS(14.288±5.206)ng/mL、(10.594±6.548)mg/L VS(23.465±8.485)mg/L、(0.647±0.322)VS(1.400±0.696).There was no significant difference in FIB and AT-III between two groups of pleural effusion.FPA in benign exudative pleural effusion was higher than those in malignant exudative pleural effusion.D-dimer and AT-Ⅲ/FPA in malignant exudative pleural effusion were higher than those of benign exudative pleural effusion(P<0.05).3.The contents of CRP and CRP/ D-dimer in pleural effusion of the two groups were(16.217±9.077)mg/L VS(8.925±5.819)mg/L、(3.043±2.776)VS(0.465±0.385).CRP and CRP/ D-dimer in benign exudative pleural effusion were higher than those in malignant exudative pleural effusion.The difference is statistically significant(P<0.05).In the two groups of pleural effusion,Analysis the relativity of CRP with FIB,FPA,AT-III,D-dimer,CRP had no correlation with FIB,FPA,AT-III,and CRP had a certain correlation with d-dimer,which showed negative correlation [benign group(r =-0.531,p<0.05);malignant Group(r =-0.549,p<0.05)],the D-dimer level decreased with the increase of CRP content in the pleural effusion.4.The diagnostic value of FPA、CRP、D-dimer、AT-Ⅲ/FPA in benign exudative pleural effusion and malignant exudative pleural effusion.The area under the ROC curve of FPA for the diagnosis of benign exudative pleural effusion is 0.803(AUC = 0.803),according to the ROC curve,the optimal critical value of FPA for the diagnosis of benign exudative pleural effusion was 13.863 nmol / L,the sensitivity and specificity were 70% and 80%.The area under the ROC curve of CRP for the diagnosis of benign exudative pleural effusion is0.725(AUC = 0.725),according to the ROC curve,the optimal critical value of CRP for the diagnosis of benign exudative pleural effusion was 14.44 mg/L,the sensitivity and specificity are 60% and 90%.The two combined to the diagnosis of benign exudative pleural effusion,that the sensitivity and specificity is 88% and 72%.The area under the ROC curve of D-dimer for the diagnosis of malignant exudative pleural effusion is 0.91(AUC = 0.91),according to the ROC curve,the optimal critical value of D-dimer for the diagnosis of malignant exudative pleural effusion was 14.75 mg/L,the sensitivity and specificity are 95% and 80%.The area under the ROC curve of AT-Ⅲ/FPA is 0.83(AUC = 0.83),according to the ROC curve,the optimal critical value of AT-Ⅲ/FPA was 0.805,the sensitivity and specificity are 85% and75%.The two combined to the diagnosis of malignant exudative pleural effusion,that the sensitivity and specificity is 99% and 60%.Conclusions:1.The coagulation ability of benign exudative pleural effusion is relatively strong,the ability of anticoagulation is relatively weak,and the ability of coagulation in malignant pleural effusion is relatively weak and the ability of anticoagulation is relatively strong,which can explain to some extent that benign exudative pleural effusion is easy to wrap,adhesion and pleural thickening,and malignant effusion pleural effusion has better fluidity and The reason why the pleural thickening degree is lighter.2.The inflammatory response in benign exudative pleural effusion is relatively stronger than that of malignant exudative pleural effusion.The inflammatory reaction in the pleural effusion may be the main effect of inhibiting the fibrinolytic activity,which can indirectly affect the ability of the pleural effusion,which leads to the difference in the packing,adhesion and pleural thickening.3.The indexes of FPA,AT-Ⅲ/FPA,D-dimer and CRP in pleural effusion have some value in the differential diagnosis of benign and malignant pleural effusion,and it may be a reference index to evaluate the curative effect in the treatment of benign and malignant pleural effusion. |
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