| Background : Malignant pleural effusion(MPE) are a common complication of advanced tumors. They often progress to cause disabling symptoms, reduced activity levels, and decreased overall quality of life. Now, the recommend treatment of MPE is pleurodesis which is intrapleural injection of sclerosing agent causing pleural adhesions. There are a lot of drugs can be used for intrapleural injection in clinical applications. It has now been demonstrated that pingyangmycin is an effective drug in pleurodesis. So far, the studies about the mechanism of pleural adhesion have found that the release of cytokine and the change of fibrinolytic system may be involved in. The aim of this study was to investigate the mechanism by which pingyangmycin produces pleurodesis through the research about cytokine and fibrinolytic system factor.Methods:In this clinical prospective study, since February to September 2008, patients who are confirmed MPE by pathology or cytology, and more than middle-volume pleural effusion, KPS score≥50, expected survival time>1 month were recruited for the study. For each recruited patient, upon the patient's informed consent, 5 ml pleural effusion and 5 ml plasma before and after intrapleural pingyangmycin administration would be saved simultaneously for detecting the concentrations of plasminogen activator inhibitor-1(PAI-1), tissue-type plasminogen activator(t-PA), transforming growth factor-β1(TGF-β1), and the number of leucocyte test. One month later, we will evaluate the pleurodesis efficacy according to WHO standard. Given the patient's informed consent or qualified specimens unavailable, this case would then be excluded. As did if the case was lost at follow-up study. For each eligible case, the PAI-1, t-PA, TGF-β1 levels of pleural fluid and plasma were detected simultaneously using enzyme immunoassay, the number of leucocyte, neutrophil in plasma were tested by Automatic Blood Monitor, the leucocyte in pleural effusion were tested by Microscope direct counting method. Only after completion of all the tests of PAI-1, t-PA, TGF-β1 and the number of leucocyte and clinical data collection, we analyzed the results of PAI-1, t-PA, TGF-β1 test and the number of leucocyte in accordance with those of reference standard. Followed by statistical analysis, the mechanism of pleurodesis which produced by pingyangmycin was assessed.Results:Finally, 26 qualified cases were recruited. The concentrations of PAI-1 were significantly lower in pleural effusion before treatment than in those 24h or 72h after treatment(P<0.05). The levels of t-PA were significantly lower in pleural effusion 72h after treatment than in those before and 24h after treatment(P<0.05). Before and after intrapleural pingyangmycin administration, the levels of TGF-β1 in pleural effusion have no significant difference(P>0.05). The number of leucocyte, neutrophil in peripheral blood and leucocyte in pleural effusion were significantly higher after intrapleural pingyangmycin administration than in those before(P<0.05). However, the concentrations of PAI-1, t-PA and TGF-β1 in peripheral blood have no significant difference during the treatment(P>0.05). One month later, the total response rate of MPE control was 57.7%(effective group: 15 cases), there are no obvious side effects. The concertrations of PAI-1 in pleural effusion 24h after treatment were higher in effective group than in void group(P<0.05).Conclusion:These findings suggest that intrapleural pingyangmycin administration is a safe and effective treatment for MPE. The mechanism of pleurodesis which produced by pingyangmycin relates to inhibiting the activity of plasminogen in pleural cavity.
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