Preliminary Investigation of the Clinical Value of Vascular Endothelial Growth Factor and Hypoxia-Inducible Factor-1α in Pericardial Fluid in Diagnosing Malignant and Tuberculous Pericardial Effusion

Abstract

Objectives: To investigate the clinical value of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor-1α (HIF-1α) in diagnosing malignant and tuberculous pericardial effusion. Methods: Eighty patients with exudative pericardial effusion undergoing pericardiocentesis and drainage were divided into 2 groups, namely those with malignancy and those with tuberculosis. The levels of HIF-1α, VEGF, lactate dehydrogenase (LDH) and adenosine deaminase (ADA) in pericardial fluid and serum were measured. Routine and cytological examination of pericardial fluid, clinical characteristics and some blood parameters were compared between the 2 groups. Results: There were 33 patients with tuberculous pericardial effusion and 47 with malignant pericardial effusion. The levels of VEGF and HIF-1α in pericardial fluid in the malignancy group were significantly higher than those in the tuberculosis group (p < 0.01), and there was a moderate positive correlation between the levels of VEGF and HIF-1α (r = 0.79, p < 0.01). The sensitivity and specificity of combining VEGF and HIF-1α were 90.8 and 88.3%, respectively. The 2 groups showed no differences with regard to gender distribution, occurrence of fever, erythrocyte sedimentation rate or the levels of hemoglobin, LDH, ADA, serum HIF-1α and VEGF. Conclusions: Both VEGF and HIF-1α in pericardial fluid have determinative value in the differential diagnosis of malignant and tuberculous pericardial effusion.

Causes of moderate to large pericardial effusion requiring pericardiocentesis in 140 Han Chinese patients

“…Exudative pericardial effusion can be divided into malignant and nonmalignant types, and it is usually necessary to perform pericardiocentesis. Although tuberculosis is rare in developed countries, tuberculosis is still the major etiology of the nonmalignant type of pericardial effusion in China [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17].…”

“…In our study, there were many similarities between the patients in these two groups with regard to clinical characteristics, routine pericardial fluid parameters, and classical biochemical parameters. There are a number of patients who have malignant pericardial effusion but show no evidence of cancer cells or primary tumor lesions, making it easy to misdiagnose tuberculous pericardial effusion [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]. Malignant pericardial effusion is generally caused by cancerometastasis; however, primary pericardium tumors such as mesothelioma, sarcoma, and cardiac hemangioma are rare [18].…”

“…The most important rescue procedure is pericardiocentesis. The therapy and prognosis of pericardial effusion are mainly dependent on the underlying diseases [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17]. While modern medicine has made great progress, there are still many patients with exudative pericardial effusion, in particular bloody pericardial effusion, who cannot be diagnosed early and correctly, which delays the required treatment.…”

Local Ischemia and Increased Expression of Vascular Endothelial Growth Factor Following Ocular Dissemination of Mycobacterium tuberculosis

“…Greater VEGF levels have been documented in exudative pleural effusions due to TB as compared to transudates secondary to congestive heart failure [36]. On the other hand, malignant pleural [37], [38] and pericardial [39] effusions were found to have even higher levels of VEGF than TB-related effusions. Greater antigen-stimulated levels of VEGF in combination with other cytokines in the supernatant of interferon-γ release assays were found to accurately differentiate active disease from latent TB infection in one study [40].…”

Study on hypoxia-inducible factor and its roles in immune system

“…HSP90 binds to HIF-1a thorough PAS domain in the cytosol but cannot transport to the nucleus. Minet demonstrated for the first time that HSP90 is essential for HIF-1a function in hypoxia, which can be inhibited by ansamycin derivatives [33]. Antibiotics, such as geldanamycin, novobiocin, and radicicol, reduce chaperone activity of HSP90 by binding to it and result in downregulation of the HIF-1a expression.…”