Influencia de los mediadores de inflamación sobre la degradación de la fibrina en los derrames pleurales infecciosos
Background: The response of the fibrinolytic system to inflammatory mediators is not evaluated in complicated parapneumonic pleural effusions.
Methods: We prospectively analyze 100 patients: 25 complicated parapneumonic effusions, 22 tuberculous, 28 malignancy and 25 transudates. Inflammatory mediators: TNF-µ, IL-8 and polymorphonuclear elastase were measured in serum and pleural fluid. Fibrinolytic system parameters: plasminogen, t-PA and u-PA, PAI 1 Ag, PAI 2 Ag and PAI 1 Act were quantified in plasma and pleural fluid. The Wilcoxon signed-rank test were used to compare plasmatic vs pleural values and to compare pleural values according to the etiology of the fluid. The Pearson correlation coefficient was used to assess the relationship between fibrinolytic and inflammatory markers in pleural fluid.
Results: Significant differences were found between pleural and plasmatic fibrinolytic system values. Exudates had higher pleural fibrinolytic system values than trasudates. Among exudates, tuberculous and complicated parapneumonic pleural effusions had higher pleural PAIs level than malignancy, whereas t-PA was lowest in complicated parapneumonic pleural effusions. PAIs associated with TNF-µ, IL-8 and polymorphonuclear elastase when all exudative effusions were analyzed but the association was not mantained in complicated parapneumonic effusion. The negative association between t-PA with IL-8 and polymorphonuclear elastase in exudative effusions was stronger in complicated parapneumonic effusions.
Conclusions: The blockage of the fibrin clearance in complicated parapneumonic effusions is associated to both enhanced levels of PAIs and depressed levels of t-PA. Pleural t-PA is down regulated by IL-8 and polymorphonuclear elastase.
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Advisor:Fernández de Sevilla, Tomás; Alegre Martín, José
School:Universitat Autónoma de Barcelona
Source Type:Master's Thesis
Keywords:417 departament de medicina
Date of Publication:12/14/2000