Résumé
Objective To study the clinical value of isolated or combined detection of pro-gastrin-releasing peptide (ProGRP) and cytokeratin 19 fragment (CYFRA21-1) in pleural effusion in diagnosis for malignant hydrothorax caused by lung cancer. Methods Totally, 75 cases with malignant hydrothorax caused by lung cancer were divided into small cell lung carcinoma ( SCLC) group (n = 36) and non-small cell lung carcinoma ( NSCLC) group ( n = 39 ) , with 37 cases of benign hydrothorax as control. Isolated or combined ProGRP and CYFRA21-1 in pleural effusion were detected for them in diagnosis for malignant hydrothorax. Results Positive rate of ProGRP detection in pleural effusion was 91. 7% , 2. 6% and 2.7% for SCLC group, NSCLC group and benign group, respectively. Sensitivity of detection for malignant hydrothorax caused by SCLC was 91.7%, 55.6%, 82.1% and 13.5% by isolated CYFRA21-1, by isolated ProGRP, by combined ProGRP and CYFRA21-1 (in series) and by combined ProGRP and CYFRA21-1 (in parallel) in pleural effusion, respectively, and specificity of that was 97. 3% , 86. 5% , 97.3% and 83.8%, respectively, with Youden index of 0.889 6, 0.420 4, 0.473 0 and 0.782 3, respectively. Sensitivity of detection for malignant hydrothorax caused by NSCLC was 2. 6% , 82. 1 % , 2.6% and 82. 1% by isolated CYFRA21-1, by isolated ProGRP, by combined ProGRP and CYFRA21-1 (in series) and by combined ProGRP and CYFRA21-1 (in parallel) in pleural effusion, respectively, and specificity of that was 97.3%, 89.2%, 97.3% and 86.5%, respectively, with Youden index of -0. 0014, 0. 7124, -0. 0014 and 0. 6854, respectively. Sensitivity of detection for malignant hydrothorax caused by all lung cancer was 45. 3% , 69. 3% , 40. 0% and 98. 7% by isolated CYFRA21-1, by isolated ProGRP, by combined ProGRP and CYFRA21-1 (in series) and by combined ProGRP and CYFRA21-1 (in parallel) in pleural effusion, respectively, and specificity of that was 97.3%, 86.5%, 97.3% and 83.8%, respectively, with Youden index of 0.426 3, 0.558 2, 0.373 0 and 0.824 5, respectively. Conclusions Detection of ProGRP and CYFRA21-1 in pleural effusion was optimal choice of tumor markers for diagnosis of malignant hydrothorax caused by SCLC and NSCLC. Detection of both ProGRP and CYFRA21-1 in pleural effusion in parallel showed a better value in clinical diagnosis for malignant hydrothorax caused by lung cancer.
Résumé
Objectives To investigate current status in asthma education in the remote suburban districts and counties of Beijing and to provide basis to draw up and modify the work plan for asthma education. Methods Ten district or county hospitals in the remote suburban areas of Beijing were investigated, and 81 professionals in respiratory disease subspecialty of internal medicine were selected to answer the questionnaire and their practical performance was observed, including 35 residents, 27 attending physicians and 19 chief or deputy chief physicians. Results Only 8.6% (7/81) of them could correctly answer the question "What is the GINA?" And, 55.6% (45/81) of them could correctly answer the question "Is the Guidelines for Prevention and Treatment of Asthma in China formulated by Chinese Society of Respiratory Disease, Chinese Medical Association? " About one fifths of the interviewee (22.2% , 18/81) could correctly master the six steps in manipulation of metered-dose inhaler. Nearly two thirds of the interviewee (31.7% , 50/81) could correctly answer that "Inhalation of glucocosteroids is the most important treatment to control persistent episodes and chronic symptoms in asthma patients and to prevent asthma attack. About two thirds of physicians (61.7% ,50/81) did not attend any lectures or workshops on asthma during the recent year, and only 22 of them attended lectures or workshops on asthma sponsored by the medical association, reflecting its influence in asthma education. Only 15 of 81 physicians (18.5%) could instruct a few patients to use the peak airflow meter to monitor their conditions, and other 81.5% of the physicians "never heard about peak airflow meter" or "having ever heard about it but never instructed the patients to use it". Conclusions Asthma education by the respiratory disease specialists in the hospitals at remote suburban districts and counties hasn't improved obviously. It is worthy to have a try in changing and modifying asthma education model and going round the remote suburban districts and counties to provide asthma education.