Objective To investigate the significance of hypoxia inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) in differential diagnosis of tuberculous and lung cancer with malignant pleural effusion.Methods From 108 patients with pleural effusion in our hospital from January 2012 to December 2013,45 patients were enrolled and divided into lung cancer with pleural effusion (CA group,n=25) and tuberculous pleural effusion group (TB group,n=20) according to the pleural effusion property.The levels of HIF-1 a and VEGF in serum and pleural fluid were measured in two groups,and the ratio of hydrothorax to serum VEGF (hydrothorax/serum VEGF) and the ratio of hydrothorax to serum HIF-1α (hydrothorax/serum HIF-1α) were calculated.The receiver operating characteristic curve (ROC) was used to analyze the efficacy of HIF-1a,VEGF,hydrothorax/serum HIF-1a and hydrothorax/serum VEGF in differentiating lung cancer with malignant pleural effusion from tuberculous pleural effusion.The sensitivity,specificity and diagnostic accuracy of the different combination patterns of hydrothorax HIF-1a,serum HIF-1a,hydrothorax VEGF and serum VEGF were analyzed.Results The hydrothorax level of HIF-1a in the CA group was (2.29±0.89) ng/ml,higher than (0.88 ±0.69) ng/ml in TB group,and the difference was statistically significant (P＜0.01).The serum level of HIF-1a in CA group was (2.00±1.00) ng/ml,similar with (1.85±0.77) ng/ml in TB group (P＞0.05).The level of hydrothorax levels of VEGF were (1035.31±687.64) pg/ml and (732.97±493.61) pg/ml and serum levels of VEGF were (491.25±278.33) pg/ml and (463.42± 288.15) pg/ml in CA group and TB group (P＞0.05).The level of hydrothorax/serum HIF-1α in CA group was 1.26±0.49,higher than 0.56±0.55 of TB group,and the difference was statistically significant (P＜0.01).The levels of hydrothorax/serum VEGF were 2.85±2.73 and 2.02±1.58 in CA group and TB group,and the difference was not statistically significant (P＞0.05).In differential diagnosing malignant and tuberculous pleural effusion,the sensitivity and specificity were 88％ and 85％ for HIF-1α alone,92％ and 85％ for hydrothorax/serum HIF-1α alone,and 64％ and 100％ for HIF-1α and VEGF in serum and pleural effusion.Conclusion Both levels of HIF-1α in pleural effusion and pleural effusion/serum HIF-1α have certain value in the differential diagnosis of malignant and tuberculous pleural effusion.The joint detection HIF-1α and VEGF in serum and pleural effusion can improve specificity.%目的 探讨缺氧诱导因子-1α(HIF-1α)和血管内皮生长因子(VEGF)在结核性胸腔积液与肺癌伴癌性胸腔积液鉴别诊断中的意义.方法 从本院2012年1月至2013年12月的108例胸腔积液患者中筛选出符合要求的45例患者,根据胸腔积液性质分为肺癌伴癌性胸腔积液组(CA组)25例和结核性胸腔积液组(TB组)20例,检测两组血清及胸水中HIF-1α、VEGF水平并计算胸水与血清VEGF比值(胸水/血清VEGF)和胸水与血清HIF-1α比值(胸水/血清HIF-1α),采用受试者工作特征曲线(ROC)分析HIF-1α、VEGF、胸水/血清HIF-1α和胸水/血清VEGF鉴别肺癌伴癌性胸腔积液和结核性胸腔积液的效能,分析胸水HIF-1α、血清HIF-1α、胸水VEGF及血清VEGF两两联合及四者联合的敏感度、特异度和诊断符合率.结果 CA组胸水HIF-1α水平为(2.29±0.89) ng/ml,高于TB组的(0.88±0.69) ng/ml,差异有统计学意义(P＜0.01);CA组血清HIF-1α水平为(2.00±1.00) ng/ml,TB组为(1.85±0.77)ng/ml,差异无统计学意义(P＞0.05).CA组和TB组胸水VEGF水平分别为(1035.31±687.64) pg/ml和(732.97±493.61) pg/ml,血清VEGF水平分别为(491.25±278.33) pg/ml和(463.42±288.15) pg/ml,差异无统计学意义(P＞0.05).CA组胸水/血清HIF-1α水平为1.26±0.49,高于TB组的0.56±0.55,差异有统计学意义(P＜0.01);CA组和TB组的胸水/血清VEGF水平分别为2.85±2.73和2.02±1.58,差异无统计学意义(P＞0.05).在结核性胸腔积液与肺癌伴癌性胸腔积液的鉴别诊断中,单独检测胸水HIF-1α的敏感度为88％,特异度为85％,单独检测胸水/血清HIF-1α的敏感度为92％,特异度为85％,而联合检测血清及胸水HIF-1α和VEGF的敏感度为64％,特异度为100％.结论 胸水HIF-1α和胸水/血清HIF-1α水平对于结核性胸腔积液与肺癌伴癌性胸腔积液鉴别诊断有一定临床意义.联合检测血清HIF-1α、胸水HIF-1α、血清VEGF和胸水VEGF可提高特异度.
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