The Effect Of Intrapleural Pingyangmycin Administration On Activity Of Coagulation-anticogulation In Malignant Pleural Effusion

Objective: Malignant pleural effusion(MPE) are a common complication of advanced tumors. Pleurodesis is the recommend treatment of MPE, pingyangmycin(PYM) is a commonly used drug in pleurodesis. So far, the studies about the mechanism of pleural adhesion have found that the change of coagulation-anticogulation activity may be involved in. Through the research about the changes of the concentrations of fibrinopeptide A(FPA) and the activity of antithrombinⅢ(ATⅢ) in MPE before and after intrapleural pingyangmycin administration, the aim of this study was to investigate the mechanism by which PYM produces pleurodesis.Methods: In this clinical prospective study, since October 2009 to August 2010, A total of 31 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. Each recruited patient, upon the patient's informed consent, underwent intrapleural PYM administration. the concentrations of FPA(ELISA), the activity of ATⅢ(chromogenic substrate) in pleural effusion, the number of leucocytes in pleural effusion and peripheral blood, were detected before and after treatment. For failing to return to qualified specimens ,this case would then be excluded, As did if the case was lost at follow-up study. One month later, we will evaluate the pleurodesis efficacy according to WHO standard. The group which complete disappearance of pleural effusion to maintain more than four weeks and reduction of pleural effusion more than 50% were classified as an effective group; the others were classified as invalid. Results: the total response rate of MPE control was 58.1%(effective group = 18 cases). The pleural concentrations of FPA in effective group were significantly high at 6h[(143.86±11.44)pmol/ml] after intrapleural PYM administration, then fall-off at 24h[(55.54±6.85)pmol/ml],48h[(31.35±4.64)pmol/ml ]; invalid group had the same tendency, they were(62.80±2.22)pmol/ml,(30.92±1.35)pmol/ml,(16.75±0.78)pmol/ml at 6h,24h,48h. The concentrations of FPA showed no significant difference between effective and invalid group before intrapleural PYM administration(P> 0.05), however, they were significantly higher in effective group than in invalid one after treat(P<0.05). The activity of ATⅢin pleural effusion showed no significant difference before and after treat in two groups(P= 0.05), it also showed no significant difference between effective and invalid group(P> 0.05). The number of leucocytes in both pleural effusion and peripheral blood were significantly higher after intrapleural PYM administration than those before (all P< 0.05), but there was no significant difference between two groups(all 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 increasing coagulative activity in the pleural cavity.