Value of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in diagnosis and differential diagnosis of pleural effusion

Abstract

Objective To explore the role of matrix metalloproteinase-9(MMP-9)and tissue inhibitor of metalloproteinase-1(TlMP-1)in the pathogenesis of tuberculous and tumorous pleural effusion,and to assess the value of MMP-9,TIMP-1 and MMP-9/TIMP-1 in the diagnosis and differential diagnosis of these two kinds of pleural effusion.Methods MMP-9 and TIMP-1 in the pleural fluid were detected by enzyme-linked immunosorbent assay in 36 patients with tuberculous pleuritis,38 patients with malignant tumor and 14 patients with transudates.Results ①MMP-9,TIMP-1 and MMP-9/TIMP-1 in tuberculous pleural effusion were higher than those in malignant pleural effusion and transudates(all P＜0.05).MMP-9.TIMP-1 and MMP-9/TIMP-1 in malignant pleural effusion were higher than those in transudates(all P＜0.05).②MMp-9 and MMP-9/TIMP-1 in malignant pleural effusion with positive cytological findings were higher than those with negative cytological findings(all P＜0.05) ,while TIMP-1 was lower in the former than that in the latter( P ＜0.05). ③MMP-9 positively correlated with TIMP-I( r =0. 239, P =0. 025). MMP-9 and MMP-9/TIMP-1 positively correlated with lactate dehydrogenase, adenosine deaminase, protein, total white blood cells and lymphocyte ratio in pleural effusion(all P＜0.01),and negatively correlated with glucose and chloride in pleural effusion (all P＜(0.01). TIMP-1 positively correlated with lactate dehydrogenase, adenosine deaminase, protein and lymphocyte ratio in pleural effusion(all P＜0.01 ). ④In diagnosing tumorous pleural effusion, the sensitivities of MMP-9, TIMP-1 and MMP-9/TIMP-1 were respectively 63.2%, 71.1% and 65.8%, the specificities were respectively 83.3%, 63.9% and 80.6%. However, in the diagnosing process, the sensitivity and specificity were 39.5% and 91.7% when MMP-9 and TIMP-1 were combined in a series way, 94.70% and 55.6% in a parallel way.Conclusions MMP-9 and TIMP-1 are closely related to the tuberculous and tumorous pleural effusion. MMP-9/TIMP-1 plays a great role in the pathogenesis of tuberculous and tumorous pleural effusion. Detection of MMP-9, TIMP-1 and MMP-9/TIMP-1 in pleural effusion contributes to the differential diagnosis of tuberculous pleurisy and malignant pleural effusion. Key words: Lung tumor; Tuberculosis; Pleural effusion; Matrix metalloproteinase-9; Tissue inhibitor of metalloproteinase-1