| The first partThe retrospective study on clinical data of uncomplicated parapneumonic pleural effusion and complicated parapneumonic pleural effusion patients over the past 4 yearsPurpose:To analyze the clinical features of uncomplicated parapneumonic pleural effusion and complicated parapneumonic pleural effusion patients,and to study the differences between them.Method:This part of the study retrospectively analyzed the data of uncomplicated parapneumonic pleural effusion and complicated parapneumonic pleural effusion patients who were hospitalized in the Department of respiratory of the affiliated hospital of hebei university from January 2012 to December 2015 period.The data of the two groups were analyzed in terms of population distribution,distribution of pathogenic bacteria,length of hospitalization,hospitalization expense,fever time and prognosis.Result:A total of 215 patients were investigated in the study,including 145 in uncomplicated parapneumonic pleural effusion group and 70 in complicated parapneumonic pleural effusion group.The average age was 49.42±14.04 years old for uncomplicated parapneumonic pleural effusion group and 53.76±14.16 years old for complicated parapneumonic pleural effusion group;the t value was 2.12,p<0.05,which was statistically significant.The effective rate was 88.97%for uncomplicated parapneumonic pleural effusion group and it was 74.29%for complicated parapneumonic pleural effusion group;the result of chi square test was 7.64,p<0.05,which was statistically significant.The average inpatient days was 13.64±2.24 for uncomplicated parapneumonic pleural effusion group and it was 16.11±3.14 days for complicated parapneumonic pleural effusion group;t value was 5.28,p<0.01,which was statistically significant.The average hospitalization cost of patients was 11417.33±1474.98 yuan for uncomplicated parapneumonic pleural effusion group and it was 13228.62±1738.29 yuan for complicated parapneumonic pleural effusion group;the t value was 7.95,p<0.01,which was statistically significant.The average days of having fever was 6.13±1.42 days for uncomplicated parapneumonic pleural effusion group and was 7.54±1.62 days for complicated parapneumonic pleural effusion group;t value was 6.49,p<0.01,which was statistically significant.The detection rate of pathogenic bacteria in the uncomplicated parapneumonic pleural effusion group was 28.37%,the detection rate of the pathogenic bacteria in the complicated parapneumonic pleural effusion group was 47.14%,and the chi-square test value was 17.99,which was statistically significant.Conclusion:Compared with uncomplicated parapneumonic pleural effusion group,complicated parapneumonic pleural effusion group has a large age,many basic diseases,serious condition,and poor treatment effect.Whether there is a pleural cavity infection may be an important feature of both.The second partThe study of ET-1,sTREM-1 and PCT in the serum and pleural effusion of complicated parapneumonic pleural effusion and uncomplicated parapneumonic pleural effusion patientsPurpose:To study the difference of vascular endothelium damage,the degree and the type of inflammation in pleural cavity of complicated parapneumonic pleural effusion and uncomplicated parapneumonic pleural effusion,and to search for novel markers that can predict complex parapneumonic pleural effusion.Method:This part study collected the uncomplicated parapneumonic pleural effusion group of 15 people,complicated parapneumonic pleural effusion group of 15 people,and 10 control group patients(hypoalbuminemia with pleural effusion),from January 2016 to December 2016,Department of respiratory of the affiliated hospital of hebei university.The pleural effusion were collected and the expression changes of ET-1,sTREM-1 and PCT in serum and pleural effusion were detected by enzyme-linked immunosorbent assay.Result:1.The detection results of ET-1 in pleural effusion were 28.43±4.41ug/L in control group;49.61±9.45ug/L in uncomplicated parapneumonic pleural effusion group;64.10±12.32ug/L in complicated parapneumonic pleural effusion group,F value in variance analysis was 49.55,p<0.01,which was statistically significant.The ROC curve of ET-1 in pleural effusion of uncomplicated parapneumonic pleural effusion group and complicated parapneumonic pleural effusion group was analyzed:AUC was 0.84,the sensitivity was 73.33%and the specificity was 86.67%when the cutoff value was taken for 58.79ug/L.The serum ET-1 in control group was 28.70±5.51ug/L;uncomplicated parapneumonic pleural effusion group was 55.11±1.51ug/L;complicated parapneumonic pleural effusion group was 58.24±12.27ug/L;variance analysis F value was 33.56,p<0.01,which was statistically significant.The ROC curve of ET-1 in serum of uncomplicated parapneumonic pleural effusion group and complicated parapneumonic pleural effusion group was analyzed:AUC was 0.69,the sensitivity was 60%and the specificity was 60%when the cutoff value was taken for 55.81ug/L.2.STREM-1 detection in pleural effusion:the control group was 70.10±10.35ng/L;the uncomplicated parapneumonic pleural effusion group was 145.7±23.86ng/L,and the complicated parapneumonic pleural effusion group was 258.5±43.63ng/L.The F value of variance analysis was 68.13,p<0.01,which was statistically significant.The ROC curve of sTREM-1 in pleural effusion of uncomplicated parapneumonic pleural effusion group and complicated parapneumonic pleural effusion group was analyzed:AUC was 0.94,the sensitivity was 80%and the specificity was 93.33%when the cutoff value was taken for 168.8ng/L.The results of sTREM-1 in serum were 67.93±9.98ng/L in control group;141.00 ± 24.31ng/L in group uncomplicated parapneumonic pleural effusion and 146.01±32.47ng/L in group complicated parapneumonic pleural effusion.Variance analysis F value was 68.13,p<0.01,so there was a significant difference.The ROC curve of sTREM-1 in serum of uncomplicated parapneumonic pleural effusion group and complicated parapneumonic pleural effusion group was analyzed:AUC was 0.56,the sensitivity was 40%and the specificity was 80%when the cutoff value was taken for 155.3ng/L.3.PCT test results of pleural effusion:the control group was 0.09±0.03ug/L;uncomplicated parapneumonic pleural effusion group was 1.68±0.35ug/L;complicated parapneumonic pleural effusion group was 1.82±0.39ug/L;variance analysis F value was 116.9,p<0.01,so there was statistically significant.The ROC curve of PCT in pleural effusion of uncomplicated parapneumonic pleural effusion group and complicated parapneumonic pleural effusion group was analyzed:AUC was 0.71,the sensitivity was 60%and the specificity was80%when the cutoff value was taken for 1.77ug/L.Serum PCT test results:the control group was 0.11±0.03ug/L;uncomplicated parapneumonic pleural effusion group was 1.58±0.29ug/L;complicated parapneumonic pleural effusion group was 2.03±0.48ug/L;variance analysis F value was 106.1,p<0.01,so there was statistically significant.The ROC curve of PCT in serum of uncomplicated parapneumonic pleural effusion group and complicated parapneumonic pleural effusion group was analyzed:AUC was 0.77,the sensitivity was 66.67%and the specificity was 86.67%when the cutoff value was taken for 1.94ug/L.Conclusion:The damage of the thoracic vascular endothelium was obvious,and the neutrophil-based inflammatory reaction was prominent in the complicated parapneumonic pleural effusion group,the contents of ET-1 and sTREM-1 in the pleural effusion could be used as an independent new marker for the prediction of complicated parapneumonic pleural effusion.The third partThe study of proteomics in pleural effusion in patients with uncomplicated parapneumonic pleural effusion and complicated parapneumonic pleural effusionPurpose:To investigate the proteomic differences in pleural effusion of patients with uncomplicated parapneumonic pleural effusion and complicated parapneumonic pleural effusion.Method:The pleural effusion of 5 uncomplicated parapneumonic pleural effusion patients and 5 patients of complicated parapneumonic pleural effusion groups were combined into group B and group C.After removing high abundance protein,the samples were analyzed by LC-MS mass spectrometry.Proteins of more than 1.5 fold difference were identified as differential proteins.The GO analysis and KEGG analysis were performed on two groups of differential proteins.Results:A total of 478 differential proteins were found in the two groups;there were 257 proteins shared between complicated parapneumonic pleural effusion and uncomplicated parapneumonic pleural effusion patients and were 200 peculiar proteins in complicated parapneumonic pleural effusion group and 21 peculiar proteins in uncomplicated parapneumonic pleural effusion group.Compared with uncomplicated parapneumonic pleural effusion group,complicated parapneumonic pleural effusion group up-regulated 38 proteins and down-regulated 29 proteins.The up regulated proteins in group complicated parapneumonic pleural effusion were manifested in the biosynthesis of monosaccharide,the process of glucose catabolism,the glycolysis process of fructose-6-phosphate,the glycolysis process of glucose-6-phosphoric acid,and the regeneration of NADH.The differential proteins down-regulated in the complicated parapneumonic pleural effusion group showed fibrinogen complexes,protein polymerization and hemagglutination.KEGG analysis showed that complicated parapneumonic pleural effusion increased protein expression in amino acid synthesis,HIF-1 signaling pathway,glycolysis/gluconeogenesis,and decreased in platelet activation and complement activation.Conclusion:38 up-regulated and 29 down-regulated proteins were found in pleural effusions in patients with complicated parapneumonic pleural effusion.At the same time,it was found that in the pleural effusion of patients with complicated parapneumonic pleural effusion,glucose,amino acid metabolism,HIF-1 signaling pathway and NADH regeneration were enhanced,while protein aggregation,hemagglutination,platelet activation,and complement activation were weakened.The fourth partThe therapeutic effect of thoracoscopy on parapneumonic pleural effusion patients with invalid conventional treatmentPurpose:To study the therapeutic effect of thoracoscopy on parapneumonic pleural effusion patients with invalid conventional treatmentMethod:The thoracoscopic surgery was performed on 22 patients with parapneumonic pleural effusion that were not responded to conventional anti-infection combined with chest drainage,the effective rate of treatment and the changes of the body temperature,WBC,CRP,PCT after the operation were observed.Result:The effective rate was 77.27%in 2 weeks and the total effective rate was 90.91%.The average body temperature before thoracoscopic treatment was 38.09±0.37 degrees,and the average body temperature after treatment was 36.75±0.48 degrees.The t value was 10.42,p<0.01,which was statistically significant.The serum CRP content was 122.45±27.13mg/L before the thoracoscopic treatment,and the serum CRP content was 44.55±9.77mg/L after treatment.The t value was 12.67,P<0.01,which was statistically significant.The serum PCT content was 2.18±0.65ug/L before the treatment of the thoracoscopy,and the serum PCT content was 0.99±0.33ug/L after treatment.The t value was 7.18,p<0.01,which was statistically significant.The WBC value of venous blood was(14.66±1.58)× 109/L before the medical thoracoscopy,and the WBC value of venous blood was(11.19±11.37)×109/L after treatment.The value of t was 7.76,p<0.01,which was statistically significant.Conclusion:Medical thoracoscopy can be used for parapneumonic pleural effusion patients who are not effective with conventional anti-infection and thoracic drainage. |
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