Study On The Predictive Value Of Mesothelial Cells Combined With Pleural Pressure On The Success Rate Of Pleural Pleurodesis

Background and purpose: Pleural effusion is a common clinical problem,which can be caused by many diseases,such as pneumonia,tuberculosis,metastatic tumors,and cardiac insufficiency.According to the etiology and nature of pleural effusion,it can be divided into benign pleural effusion and MPE.Benign pleural effusion can generally obtain a good prognostic,while MPE has a poor prognostic effect and a short survival period.Therefore,it is very necessary to determine the cause of patients with pleural effusion in time,especially for patients with MPE.The characteristics and nature of biochemical indicators of pleural effusion are important basis for judging the etiology of pleural effusion.Microtubule drainage is conducive to spontaneous pleural fixation in Patients with pleural effusion,and improves patient complications.It is an important method for the treatment of pleural effusion.Microtubule drainage also provides convenience for clinical medical staff to obtain fresh pleural effusion,but there is no relevant report at Present.Whether the characteristics of pleural effusion before and after drainage affect the etiology of Pleural effusion,especially for those patients whose cause is not clear,so there is no relevant report.It is necessary to explore the changes of pleural effusion before and after microtubule drainage,and to provide a theoretical basis for medical staff to diagnose the etiology of patients with pleural effusion.This will be an important part of this research.Pleurodesis is the main clinical treatment method for patients with pleural effusion.Researchers have been seeking new pleurodesis drugs on the one hand,and on the other hand,exploring the mechanism of pleurodesis and clarifying which patients can benefit from pleurodesis.Mesothelial cells are considered to be the key structure of pleural fixation.They mediate inflammation in the pleural cavity,regulate the coagulation cascade,promote the formation of fibrotic proteins,promote the formation of blood vessels in the pleural cavity,and participate in the various processes of pleural fixation.In this study,when investigating the etiology and nature of pleural effusion before and after drainage,the study found that mesothelial cells were high in MPE,but relatively low in inflammatory and infectious pleural effusion.Further analysis found that the number of mesothelial cells It is related to the effect of pleural fixation and adhesion.The more mesothelial cells,the worse the effect of pleurodesis and adhesion.This has attracted our attention.For a long time,biomarkers used to guide the success of pleural pleurodesis have been proved to be ineffective.Whether the initial number of mesothelial cells in pleural effusion can be used as an indicator to predict the success of pleural pleurodesis has not been reported.The change of pleural pressure is considered to be able to predict the success rate of pleurodesis to some extent.Therefore,based on the evaluation of the changes in the properties of pleural effusion before and after catheter drainage,the predictive value and the mechanism of mesothelial cells combined with pleural pressure in predicting the success rate of pleural pleurodesis were preemptively explored in this study.Methods: In the first part of this study,179 patients included with microtubule drainage were enrolled,including tuberculous pleural effusion patients,cardiac insufficiency pleural effusion patients,inflammatory pleural effusion patients and MPE patients.The etiological diagnosis met relevant standards.Then collect the pleural effusion before and after drainage,determine ADA,TP,LDH,GLU,WBC,monocytes,mesothelial cells,and multinucleated cells in the pleural effusion,and determine the nature of the pleural effusion and the effect of adhesion,and explore the pleural effusion before and after drainage.The change of fluid and the diagnosis effect on the cause of the disease,and the relationship between mesothelial cells and adhesion effect is analyzed.In the second part,51 MPE patients were enrolled and collected general information,underlying diseases,biochemical and tumor markers in pleural effusion,cells in pleural effusion and biochemical markers in blood,etc.,through analysis of pleurodesis whether there is a difference in the distribution of each marker between the success group and the failure group,further regression analysis is performed on the difference indicators to determine the degree of risk.The third part explores the effect of mesothelial cells combined with pleural pressure on pleural fixation and its possible mechanism by constructing an animal model of MPE.Results: The study showed that before and after drainage,each biological index declined to a certain extent,but most of the decline trends were not significantly different.The distribution trend of each biological index was basically consistent with the results of previous studies.However,studies have found that various biochemical or cellular indicators after drainage may be more accurate to determine the cause of patients with pleural effusion.It is recommended to use post-drainage pleural effusion to determine the cause or determine the cause through multiple sampling.In addition,it was confirmed that mesothelial cells are related to pleural adhesion.The higher the mesothelial cells,the worse the adhesion effect.The success rate of low-level mesothelial cells is 4.91 times that of high-level mesothelial cells.No other indicators in this study were found to be related to pleural adhesion.There is a relationship between the success of fixation.Through the study of the combined effect of mesothelial cells and pleural pressure,it is found that low-level mesothelial cells have a better successful effect on the pleura of MPE animal mice,and the effect of pressure is lower.This study found that mesothelial cells influence the success of Endo pleurodesis,which is not achieved through the regulation of VEGF,PAI1 or MMP9,and there may be other regulatory mechanisms.Conclusion: The time of specimen examination for pleural effusion has a certain influence on the judgment of the etiology of the effusion.It is recommended to use the effusion after drainage or multiple sampling.Mesothelial cells may be a predictor of success in pleurodesis.MPE animal model can be used to evaluate the formation of MPE by ultrasound.Thoracic infusion of Endo with MPE can reduce the levels of VEGF,PAI1 and MMP9 in the pleural cavity to a certain extent.There was no significant difference in the effect of mean pleural pressure and the difference between mesothelial cells on VEGF,PAI1 and MMP9,and the effect of mean pleural pressure on the success rate of pleurodesis was low.