الفهرس 
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Abstract
The etiological diagnosis of pleural effusion is frequently a problem in clinical practice, especially in the differentiation between malignant and benign pleural effusions, due to the significant difference in the treatment and prognosis involved. The majority of neoplasms can cause pleural effusion during their progression . Diagnosis of malignant pleural mesothelioma may be suspected with chest X-ray and CT scan, and is confirmed by thoracoscopy and pleural biopsy. There have been a number of studies attempting to define biomarkers that could predate symptoms in a “high risk for malignant pleural mesothelioma” population and also distinguish malignant pleural mesothelioma from other malignancies. This study aimed to assess the value of Ang-1 as a serum and pleural effusion biomarker for malignant pleural mesothelioma. The present study was carried out in the Chest department, Menoufia University Hospital, on 45 patients diagnosed as pleural effusion during the period from January 2014 to April 2015.
There were 15 patients with MPM with age ranging from 33 to 71 years (8 males and 7 females) (group I), 15 patients with malignant pleural effusion due to metastatic adenocarcinoma with age ranging from 20 to 75 years (10 females and 5 males) (group II) and 15 patients with non malignant pleural effusion with age ranging from 26 to 72 years (11 males and 4 females) (group III). There were no significant differences regarding sex and age between all groups.
In the present study there was a significant increase in the level of serum Ang-1 in malignant groups (47516.46±13049.19pg/ml) compared to non malignant group (16110.86±3047.10pg/ml). Also, there was a significant increase in pleural fluid Ang-1 level in malignant groups (1385.74±922.50pg/ml) compared to non malignant group (334.84±63.01pg/ml).
There was a significant increase in the level of serum Ang-1 in MPM group (58788.0± 8108.6pg/ml) compared to metastatic pleural effusion group (36244.8± 3837.7pg/ml), and non malignant group (16110.8± 3047.1pg/ml).
Also, there was a statistically significant increase in pleural effusion Ang-1 level in MPM group,(1897.66± 1088.67pg/ml) in comparison to metastatic pleural effusion group (873.82± 126.68pg/ml), and non malignant effusion group(334.8± 63.0pg/ml).
There was a statistically insignificant difference in Ang-1 serum and pleural effusion levels among epitheliod , sarcomatiod and biphasic types of mesothelioma, The mean angiopoietin-1 level in serum and pleural effusion of epitheliod group was (51925.0±3157.3pg/ml) and (1351.2±397.4pg/ml) respectively; the mean angiopoietin-1 level in serum and pleural effusion of sarcomatoid group was (59662.2±8058.4pg/ml) and (2038.75±798.18pg/ml) respectively, while the mean angiopoietin-1 level in serum and pleural effusion of biphasic group was (62210.2±8389.7pg/ml) and (2129.2±1446.7pg/ml) respectively.
Both serum and pleural Ang-1 levels were significantly increased in patients with MPM (58788.0± 8108.6pg/ml, 1897.66± 1088.67pg/ml respectively) compared with levels in patients with bronchogenic carcinoma (37406.87± 2661.90pg/ml, 873.42± 119.67pg/ml respectively).Also, Both serum and pleural Ang-1 levels were significantly increased in patients with MPM (58788.0± 8108.6pg/ml, 1897.66± 1088.67pg/ml respectively) compared with levels in patients with metastatic adenocarcinoma (34950.5± 2381.9pg/ml, 921.5± 131.5 pg/ml respectively).
Also, Both serum and pleural Ang-1 levels were significantly increased in patients with MPM (58788.0± 8108.6pg/ml, 1897.66± 1088.67pg/ml respectively) compared with levels in patients with T.B effusion (16603.25± 3748.28pg/ml, 293.62±15.73 pg/ml respectively). Our study demonstrated that serum Ang-1 levels were significantly higher than pleural Ang-1 levels among all patients, mean serum Ang-1 level was (37047.9±18421.3pg/ml), while the mean Ang-1 level in pleural effusion was (1035.4±901.7pg/ml).
This study demonstrated that the cut-off point of serum Ang-1 level for diagnosis of MPM was 42300 pg/ml, with sensitivity, specificity, PPV, NPV and accuracy of 100%. While the cut-off point of pleural effusion Ang-1 level for diagnosis of MPM was 998 pg/ml, with sensitivity, specificity, positive, negative predictive values and accuracy were, 100%, 93.3%, 88.2%, and 100%, 98.7% respectively.
from these results we conclude that malignant pleural mesothelioma was strongly associated with elevated serum and pleural Ang-1 levels and determination of its level could be beneficial in early diagnosis of the disease.