The Clinical Study On The Levels Of VEGF-A, VEGF-C,PEDF And CEA In Pleural Effusions And Correlation With Syndrome Types Of TCM

Objective:To evaluate VEGF-A, VEGF-C, PEDF and CEA in pleural effusion from patients to help make diagnosis of malignant pleural effusion, and explore the function and relationship of VEGF-A/PEDF or VEGF-A/VEGF-C in pleural effusion. Try to assay if VEGF-A、VEGF-C、 PEDF or CEA would be valuable in the TCM system diagnosis of pleural effusion.Methods:We evaluated VEGF-A, VEGF-C, PEDF and CEA in pleural effusion from patients (n=121), including malignant pleural effusion (n=53), benign effusions (n=68), using the enzyme-linked immunosorbent assay kits. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity. The samples were distributed into three groups according to TCM system to analyze.Results:the mean levels of VEGF-A, and CEA were higher in MPE compared with benign effusions (p<0.01), VEGF-C in MPE is higher than that in benign group (P<0.05), and PEDF level in MPE showed significantly lower than that in benign group (p<0.01). VEGF-A, VEGF-C, PEDF and CEA showed great diagnosis value with sensitivity84.9%,47.2%,71.7%,81.3%,and specificity82.4%,78.9%,88.2%,92.4%, respectively. CEA and PEDF provided a useful way with the best sensitivity and specificity,92.4%and88.2%respectively. VEGF-A, VEGF-C, PEDF didn’t show any significant difference between adenocarcinoma and squamous cell carcinoma except CEA. There is a negtive correlation (r=-0.447, P<0.01) between VEGF-A and PEDF in pleural effusion meanwhile a positive correlation (r=0.324, P<0.01) was also found between VEGF-A and VEGF-C.Among different Syndrome Types of TCM, the VEGF-A level in Phlegm and blood stasis group was significantly higher than that in yin asthenia generating intrinsic heat group and fluid-retention in the chest and hypochondrium group (P<0.01), but there was no difference between yin asthenia generating intrinsic heat group and fluid-retention in the chest and hypochondrium group (P>0.05); the PEDF level in Phlegm and blood stasis group was significantly lower than that in yin asthenia generating intrinsic heat group and fluid-retention in the chest and hypochondrium group (P<0.01), but there was no difference between yin asthenia generating intrinsic heat group and fluid-retention in the chest and hypochondrium group (P>0.05); CEA and VEGF-C didn’t show any difference amnong the three Syndrome Types of TCM (P>0.05). The correlation between VEGF-A and PEDF can’t be proved Among different Syndrome Types of TCM (P>0.05), meanwhile positive correlations (P<0.01) were found between VEGF-A and VEGF-C.in each syndrome type (P<0.01)Among different syndrome types of TCM in MPE, the VEGF-C and PEDF level in phlegm and blood stasis group was lower than that in yin asthenia generating intrinsic heat group (P<0.01),but there was no difference between fluid-retention in the chest and hypochondrium group and phlegm and blood stasis group or between yin asthenia generating intrinsic heat group and fluid-retention in the chest and hypochondrium group (P>0.05). VEGF-A or CEA didn’t show significance among the the three groups in MPE. None of CEA. VEGF-A. VEGF-C. PEDF Showed significance among the the three groups in benign effusions.Conclusion:The combined test of PEDF and CEA showed great differ diagnosis value in malignant pleural effusion, providing the sensitivity of92.4%and specificity88.2%respectively. The imbalance between VEGF-A and PEDF was one of the important mechanisms in pleural effusion. Among different syndrome types of TCM, VEGF-A and PEDF were useful biomarkers in differ diagnosis phlegm and blood stasis type in pleural effusion, and VEGF-A and PEDF were important matrial basement in phlegm and blood stasis type of TCM.