肺癌患者红细胞免疫功能与外周血T淋巴细胞亚群的改变及其相关因素研究

 目的 为了观察肺癌患者红细胞免疫功能及T淋巴细胞亚群的变化.方法 采用检测55例肺癌患者红细胞免疫功能及T淋巴细胞亚群,并与15例肺良性肿瘤患者和20例正常人对照.结果 (1)肺癌组红细胞C3 b受体花环率(RBC-C 3 bRR)、CD 3<'+>、CD4<'+>、CD 8<'+>、CD4<'+>/CD8<'+>比值低于正常人(P<0.05～0.01),红细胞免疫复合物花环率(RBC-ICR)依次高于肺良性肿瘤组、正常人(P<0.05～0.01).(2)肺癌RBC-C 3 bRR与CD4<'+>/CD 8<'+>成直线正相关(P<0.01,r=0.9131).(3)Ⅲa、Ⅲb期肺癌,RBC-C 3 bRR、CD 3<'+>、CD4<'+>、CD 4<'+>/CD 8<'+>比值低于Ⅰ、Ⅱ期肺癌患者、正常人(P<0.05～0.01),而RBC-ICR高于正常人(P<0.01).Ⅰ、Ⅱ期病人CD3<'+>、CD 4<'+>、CD 8<'+>低于正常人(P<0.01).RBC-ICR高于正常人(P<0.01).(4)术后10～14 d,根治组与术前比较:RBC-C 3 bRR、CD 3<'+>、CD 4<'+>/CD 8<'+>比值显著升高(P<0.01),而RBC-ICR、CD 8<'+>显著降低(P<0.01);术后与正常人比较:RBC-C 3 bRR、CD4<'+>/CD 8<'+>比值无显著差异(P>0.05).姑息组与术前比较:RBC-C 3 bRR、CD 4<'+>、CD 4<'+>/CD 8<'+>比值显著升高(P<0.05～0.01),而RBC-ICR显著下降(P<0.01),CD 3<'+>、CD 8<'+>无明显改变,术后与正常人比较:RBC-C 3 bRR、CD4<'+>/CD 8<'+>比值无显著差异(P>0.05).探查组与术前比较:两者指标无显著差异(P>0.05).结论 肺癌患者RBC免疫和T细胞亚群的检测及其相关性分析,对肺癌的诊断,治疗及病情预后估计有一定价值.     

肾细胞癌患者手术前后外周血T淋巴细胞亚群的变化及其临床意义

目的通过检测外周血T淋巴细胞亚群的水平,观察肾细胞癌患者治疗前后免疫功能的变化规律,探讨其在诊断及疗效判断上的意义。方法选取2006～2009年肾细胞癌（renal cell carcinoma,RCC）患者39例,应用流式细胞技术检测术前及术后外周血CD3＋、CD4＋、CD8＋、CD4＋/CD8＋,并与健康对照组进行对比研究。结果肾细胞癌患者术前CD3＋、CD4＋、CD4＋/CD8＋低于健康对照组,术后患者CD3＋、CD4＋、CD4＋/CD8＋较术前明显升高。结论肾细胞癌患者术前细胞免疫功能受到不同程度的抑制,检测外周血T淋巴细胞亚群,对评估患者的细胞免疫功能状况、疾病的诊断和疗效观察具有积极的临床意义。     

肝动脉化疗栓塞术对原发性肝癌患者T淋巴细胞亚群的影响

目的探讨肝动脉化疗栓塞术(TACE)前后原发性肝癌(PHC)患者T细胞亚群的变化。方法采用流式细胞术(FCM)检测PHC患者TACE术前1 d与术后1、2、3和4周外周血CD3、CD4、CD8 T细胞及CD4/CD8、CD4CD25/CD4的比值变化。结果 PHC患者术前外周血T细胞亚群CD3、CD4、CD4/CD8比值显著低于健康对照组,CD8则明显高于健康对照组(P<0.05);治疗1周后外周血T细胞亚群指标较治疗前明显下降(P<0.05),而4周后外周血T细胞亚群CD3、CD4、CD8及CD4/CD8比值较治疗前显著增高(P<0.05)。PLC患者外周血中CD4CD25/CD4 T细胞的比例显著高于健康对照组,与术前比较,术后1、2周外周血CD4CD25/CD4 T细胞的比例明显升高,术后4周外周血CD4CD25/CD4 T细胞的比例显著下降。结论 TACE可以改善PHC患者的免疫状况。     

长期微波辐照对大鼠脾脏淋巴细胞的影响

目的 观察不同强度微波长期辐照对大鼠脾脏淋巴细胞的影响,探讨长期微波辐照对脾脏淋巴细胞的损伤效应及其机制.方法 雄性清洁级Wistar大鼠90只,按平均微波辐照功率密度随机均分为0(对照)、2.5、5、10mW/cm2四组(n=25),连续辐照1个月(6min/d,5d/周).于辐照结束后1、30、60、180d取材,观察大鼠体重、脾脏指数及脾脏T、B淋巴细胞亚群的变化.结果 辐照后7～180d各辐照组大鼠体重明显低于对照组.辐照后1d,2.5和5mW/cm2组脾脏系数均显著升高(P<0.05),辐照后30d 5mW/cm2组脾脏系数显著降低(P<0.05),至辐照后60d和180d各辐照组脾脏系数基本恢复到对照组水平.辐照后1、30、60d,各组大鼠脾脏T细胞亚群均无明显改变;辐照后180d,各辐照组大鼠脾脏T细胞亚群明显降低,其中2.5mW/cm2组CD3+T细胞明显减少,SmW/cm2组CD3+、CD4+、CD8+T细胞明显减少,10mW/cm2组CD4+和CD8+T细胞明显减少、CD4+/CD8+比值明显降低(P<0.05或P<0.01).CD45RA+B细胞未见明显改变.结论 大鼠经长期低剂量微波辐照后早期脾脏淋巴细胞亚群改变不明显,晚期(辐照后180d)脾脏T淋巴细胞各亚群均显著降低,表现为明显的免疫抑制.     

部分性脾栓塞术对地中海贫血患儿免疫功能的影响

目的探讨部分性脾栓塞术(PSE)对地中海贫血患儿免疫功能的影响。方法分别采用比浊法、APAAP法对40例地中海贫血患儿PSE术前、术后及健康人血液免疫球蛋白及T细胞亚群进行检测,并比较患儿PSE术前、术后的免疫学指标。结果术后1周患儿IgG显著下降(P<0.01),第3周时恢复至术前水平。患儿术前、术后IgAI、gM无显著性差异。术前CD3、CD4、CD4/CD8比值较正常人显著降低(P值均<0.01);术后CD3、CD4、CD4/CD8比值回升(P值均<0.01),第3周时达正常水平。结论PSE术有助于改善地中海贫血患儿的免疫功能。     

淋巴细胞亚群对儿童EB病毒感染所致传染性单核细胞增多症的诊断意义

目的 研究EB病毒(epstein-barr virus,EBV)感染导致传染性单核细胞增多症(infectious mononucleosis,IM)患儿T细胞亚群的变化,为临床诊治提供参考.方法 选择空军特色医学中心2014年10月—2019年10月90例EBV感染致传染性单核细胞增多症患儿作为研究组,以年龄、性别配对的同期健康体检儿童80人作为对照组,空腹抽取外周静脉血CD3+、CD4+、CD8+数量及EBV-DNA水平.结果 病例组CD3+、CD8+高于对照组(P<0.001),差异有统计学意义.结论 儿童感染EBV致IM后机体会产生大量的T淋巴细胞,引起外周血中CD3+、CD8+浓度升高,检测IM患儿外周血淋巴细胞亚群表达变化对IM的诊断及治疗有一定的指导意义.     

老年胆总管结石患者开腹术后降钙素原T淋巴细胞亚群的变化及临床意义

 目的 探讨开腹手术对老年总管结石患者术后T淋巴细胞亚群的影响及降钙素原的变化。方法 将老年组与中青年组患者按胆总管结石分类分别行胆管切开取石、T管引流术或胆管空肠吻合术。于术前1 d和术后1、3、7 d分别测定外周血血常规、降钙素原、T淋巴细胞及其亚群的数量等指标,进行分析。结果 老年组降钙素原比中青年组各组均明显增加(P＜0.05),老年组组内第1、3 、7 天比术前均明显增加(P＜0.05),中青年组组内第1 、3 天比术前均明显增加(P＜0.05);老年组比中青年组CD3⁺细胞各组间明显减少(P＜0.05),老年组组内第3天比术前明显减少(P＜0.05);老年组比中青年组CD8+细胞组间术前及术后第7 天明显减少(P＜0.05);老年组与中青年组CD4⁺细胞组间术前、术后第1 、7 天明显减少(P＜0.05),老年组组内第3 天与术前明显减少(P＜0.05);中青年组组内术后第7天与术前明显减少(P＜0.05);老年组与中青年组CD4⁺/CD8⁺细胞各组间均明显减少(P＜0.05),老年组组内第3天与术前明显减少(P＜0.05)。结论 老年患者降钙素原比中青年增加,老年患者T淋巴细胞亚群数量减少,开腹手术对老年与中青年胆管结石患者免疫功能影响存在差异。     

动脉栓塞联合冷冻消融对晚期肾癌患者免疫功能的影响

目的探讨选择性肾动脉栓塞术(transcatheter renal arterial embolization,TRAE)联合氩氦冷冻消融治疗对晚期肾癌患者外周血CD4+、CD25+调节性T细胞(Treg)的影响及临床意义。资料与方法晚期肾癌患者44例,分别于治疗前、后1～6个月取外周血,流式细胞仪检测外周血T淋巴细胞亚群(CD3+T、CD4+T、CD8+T、CD4+T/CD8+T、NK细胞、Treg细胞)变化情况;术后1个月采用增强MRI或CT或正电子发射体层摄影(PET-CT)评价肿瘤坏死情况。结果治疗后3个月Treg细胞比例[(3.36±1.12)%]与术前[(4.75±1.66)%]比较明显降低,差异具有统计学意义(t=16.865,P<0.01);CD3+T、CD4+T、CD4+T/CD8+T、NK细胞比例较术前明显增高,CD8+T细胞比例明显降低(P<0.01)。治疗后3～6个月CD3+T、CD4+T、CD4+T/CD8+T、NK、CD8+T、Treg细胞比例无明显变化,呈稳定趋势(P>0.05)。治疗后Treg细胞比例下降程度与肿瘤负荷下降程度呈正相关(r=0.944,P<0.01)。结论晚期肾...     

乙型肝炎患者外周血和肝组织FoxP3的检测及其意义

目的探讨乙型肝炎患者外周血和肝组织浸润淋巴细胞中FoxP3的表达及其意义。方法分别用流式细胞仪分析、时实定量RT-PCR和免疫组化法检测急性乙型肝炎(AHB)、慢性乙型肝炎(CHB)、慢性重症乙型肝炎(CSHB)和正常人(对照)的外周血和(或)肝组织中FoxP3的表达水平。结果FoxP3mRNA和蛋白均较特异地在CD4 CD25 调节性T细胞内表达,外周血CD4 T细胞的FoxP3mRNA表达水平与CD4 CD25 调节性T细胞频率检测结果一致。CSHB患者外周血CD4 T细胞FoxP3mRNA的相对表达值(0.199±0.174)显著高于AHB患者(0.053±0.017,P<0.05)、CHB患者(0.059±0.053,P<0.05)和正常人对照(0.056±0.021,P<0.05);CSHB患者肝组织浸润FoxP3 细胞数(32.4±13.5/lpf)显著高于CHB患者(10.0±8.6/lpf,P<0.01)和正常人对照(0.6±0.5/lpf,P<0.01),并在肝组织中伴有大量CD8 、CD4 细胞浸润。CHB患者肝组织浸润淋巴细胞中FoxP3 细胞和CD8 、CD4 T细胞的数量较正常人也有显著增高(P<0.05),但显著低于CSHB患者(P<0.01)。结论慢性乙型肝炎患者FoxP3的表达水平与病情轻重有关,肝组织浸润淋巴细胞中FoxP3 细胞增高可能是机体调节过度免疫反应的一种机制。     

脓毒症及脓毒性休克患者T淋巴细胞亚群变化研究

目的探讨脓毒症及脓毒性休克患者T淋巴细胞亚群的变化以及对疾病预后的影响。方法选择2015—2016年本溪市中心医院重症医学科收治的35例脓毒症及20例脓毒性休克患者为研究对象。分别于发病4、7 d检测T淋巴细胞亚群(CD3~+,CD4~+,CD8~+),同时记录患者的生命体征变化和预后转归。同期20例健康志愿者作为对照组。结果脓毒症组患者发病4 d内的CD4~+T淋巴细胞计数较对照组和脓毒性休克组明显升高,组间比较,差异均有统计学意义(P<0.05)。发病7 d,复测T淋巴细胞亚群,死亡组CD3~+、CD4~+、CD8~+T淋巴细胞计数均明显低于存活组,组间比较,差异均有统计学意义(P<0.05)。结论脓毒症患者T淋巴细胞亚群的变化在疾病的不同阶段表现不同,随着病情进展,T淋巴细胞亚群(CD3~+,CD4~+,CD8~+)持续低下,预示了疾病预后不良。     

Adjuvante und neoadjuvante Therapie des Rektumkarzinoms

Background

The Consensus Conference of the German Cancer Society (CAO/AIO/ARO, 1. 7. 1998) has recently updated recommendations for patients with rectal cancer. Instead of a former reservation regarding the indication of adjuvant therapy for rectal cancer the actual version of the consensus particularly emphasizes the role of postoperative radiochemotherapy for stage-II/III tumors. This article reviews the most recent and ongoing trials of adjuvant and neoadjuvant therapy of rectal cancer.

Results

To avoid local recurrence is the most important aspect in the primary treatment of rectal cancer. In some series, e. g. the results of the Surgical Department of the University of Erlangen, a significant correlation between local control and survival was noted. The final results of the Swedish Rectal Cancer Trial with 1168 randomized patients not only confirmed the potential of radiotherapy to reduce local recurrence-rate, but also demonstrated a significant survival advantage for patients receiving short-course preoperative radiation therapy. Postoperative combination therapy is usual in the United States and in most European countries since the publication of two randomized trials of the Gastrointestinal Tumor Study Group (GITSG) and the North Central Cancer Treatment Group (NCCTG). The survival advantage resulting from an adjuvant radiotherapy with conventional doses and concurrent fluorouracil-based chemotherapy as compared to surgery alone was recently confirmed in a Norwegian trial. Protracted venous 5-fluorouracil infusion should further improve, treatment results. Numerous phase-II studies have demonstrated the efficacy of preoperative radiochemotherapy with high rates of pathological response. Thus, neoadjuvant radiochemotherapy is recommended for patients with locally advanced tumor primarily not amenable to curative surgery. Prospective randomized trials are ongoing to clarify the role of preoperative versus postoperative combined treatment for patients with resectable rectal cancer.

Conclusion

Radiochemotherapy for rectal cancer is recommended as standard treatment outside clinical trials for Stage II/III patients after curative treatment and for patients with T4-tumor prior to surgery. The optimal use of chemotherapy and the sequence of treatment modalities remains to be elucidated.     

Computed tomographic evaluation of thickness of perirectal fascia in rectal cancer treated by preoperative radiotherapy--diagnostic value for prediction of local recurrence

Perirectal fascia was examined by computed tomography before and after preoperative radiotherapy in thirty-six patients with rectal cancer. CT measurement showed that perirectal fascia tend to increase in thickness during preoperative radiotherapy in proportion to tumor extension into perirectal fat tissue. The fascial thickening more than 7 mm after preoperative radiotherapy was suggestive of local recurrence to develop. Preoperative or intraoperative boost irradiation would be recommended for such high-risk patients.     

临床Ⅲ期食管癌患者放疗前后免疫功能及外周血炎症指标对预后的影响分析

目的探讨临床Ⅲ期食管癌患者放疗前后免疫功能指标及外周血炎症指标与预后的关系。方法回顾性分析2010年5月至2012年4月河北医科大学第四医院接受根治性放疗的临床Ⅲ期(T4N1M0)食管癌患者84例,通过检测患者放疗前、后外周血T淋巴细胞亚群CD3、CD4、CD8、CD4/CD8、CD56免疫指标及外周血中性粒细胞与淋巴细胞比值(NLR),监测并随访观察其近期疗效、复发及死亡原因等。所有患者均采用调强放疗,处方剂量56~66 Gy,1.8~2.0 Gy/次,5次/周。检测放疗前后免疫指标变化并进行单因素和多因素预后分析。结果84例患者1年、3年、5年总生存率分别为78.57%、34.52%、19.59%,中位生存时间22.60个月;1年、3年、5年无进展生存率分别为69.05%、27.38%、12.09%,中位无进展生存时间21.20个月。近期疗效评价:完全缓解(CR)11例,部分缓解(PR)41例,疾病稳定(SD)24例,疾病进展(PD)8例,客观缓解率为61.90%(52/84)。单因素预后分析:放疗前NLR水平、免疫指标放疗后CD3、CD4、CD4/CD8水平与总生存及无进展生存预后均显著相关(总生存:χ^2=7.851、4.443、8.381、5.972,P<0.05;无进展生存:χ^2=7.475、6.290、9.659、8.738,P<0.05)。多因素预后分析:放疗前NLR、放疗后CD4和CD4/CD8水平为影响患者总生存预后的独立因素(χ^2=10.464、4.292、5.507,P<0.05);放疗前NLR、放疗后CD4/CD8水平均为影响患者无进展生存的独立因素(χ^2=10.835、8.548,P<0.05)。结论放射治疗可影响食管癌患者的免疫功能,放疗前NLR水平及放疗后CD4/CD8水平是评估食管癌患者预后方面的重要指标。     

Differences in toxicity across gender in patients treated with chemoradiation for rectal cancer

The primary objective was to prospectively investigate the efficacy and toxicity of bolus 5-fluorouracil (5-FU) chemotherapy compared with the infusional 5-FU in combination with preoperative radiation in patients with locally advanced rectal cancer. Furthermore, in light of previous reports, toxicity profiles between men and women were also compared. Eighty-four consecutive patients with rectal adenocarcinoma were prospectively treated. There were no differences in tumour response, local recurrence or survival between bolus versus infusional groups or gender groups. In locally advanced rectal cancer, preoperative infusional chemotherapy combined with radiation was found to be less toxic than bolus chemotherapy and radiotherapy. Both regimens produced more toxic effects in women compared with men.     

Neoadjuvant oxaliplatin and 5-fluorouracil with concurrent radiotherapy in patients with locally advanced rectal cancer: a singleinstitution experience

Purpose

The aim of this study was to evaluate the rate of pathological response (PR), disease control and safety of neoadjuvant chemotherapy using oxaliplatin (OX) and 5-fluorouracil (5-FU) with concurrent radiotherapy for treating locally advanced rectal cancer.

Materials and methods

Between November 2002 and December 2010, 90 patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy (CRT) were retrospectively analysed. All patients underwent preoperative radiotherapy (45 Gy in 1.8-Gy fractions) with concurrent OX (80 mg/m2 i.v., day 1) and a 120-h continuous infusion of 5-FU (1,000 mg/m² per day). Surgery was performed within 6 weeks after completion of CRT treatment.

Results

Complete pathological response was obtained in six patients (6.7%), and 39 (43.3%) had their disease downstaged. The median follow-up period was 4.7 years (6 months to 9 years). Local recurrence occurred in two patients (2.2%), one of whom developed also liver metastases. Distant metastases not associated with local relapse occurred in 23 (25.6%) patients. Overall (OS) and disease-free (DFS) survival were 62.9% and 52.8%, respectively. CRT was well tolerated, with only one grade 3 (1.2%) haematological toxicity (neutropaenia).

Conclusions

Neoadjuvant systemic chemotherapy based on OX and 5-UC associated with radiotherapy is well tolerated, with good results in terms of pathological response, disease control and survival, in rectal cancer patients.     

3-T MRI with phased-array surface coil in the local staging of rectal cancer

Purpose

This study sought to evaluate the diagnostic accuracy of surface-coil 3T magnetic resonance (MR) imaging in the preoperative study of patients with rectal cancer.

Materials and methods

Thirty patients with histologically proven rectal cancer underwent surface-coil 3T MR imaging with sagittal, paracoronal and para-axial T2-weighted turbo spin echo (TSE) sequences. Slice thickness was 3 mm without gap, field of view 24 cm, matrix 400 × 512. Images were assessed for infiltration of the rectal wall, perirectal fat and pelvic structures. Tumours were staged according to the TNM system, and the MR imaging results were correlated with histopathology.

Results

In the patients who underwent MR imaging before and after radiotherapy (group 1), the diagnostic accuracy of 3T MR imaging was 88% for T2, 94% for T3 and 88% for T4 cancers. In those who underwent surgical treatment without preoperative radiotherapy (group 2), the diagnostic accuracy was 90% for T2, 87% for T3 and 87% for T4 cancers.

Conclusions

The high signal-to-noise ratio coupled with a large field of view enables surface-coil 3T MR imaging to achieve high levels of diagnostic accuracy in the local staging of rectal cancer, and in particular in assessing infiltration of mesorectum and mesorectal fascia.     

Sequential FDG-PET/CT reliably predicts response of locally advanced rectal cancer to neo-adjuvant chemo-radiation therapy

PURPOSE: Prediction of rectal cancer response to preoperative, neo-adjuvant chemo-radiation therapy (CRT) provides the opportunity to identify patients in whom a major response is expected and who may therefore benefit from alternative surgical approaches. Traditional morphological imaging techniques are effective in defining tumour extension in the initial diagnostic and staging work-up, but perform poorly in distinguishing residual neoplastic tissue from scarring post CRT, when restaging the patient before surgery. Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is a promising tool for monitoring the effect of anti-tumour therapy. The aim of this study was to prospectively assess the value of sequential FDG-PET scans in predicting the response of locally advanced rectal cancer to neo-adjuvant CRT. METHODS: Forty-four consecutive patients with locally advanced (cT3-4) primary rectal cancer and four patients with pelvic recurrence of rectal cancer were enrolled in this prospective study. Treatment consisted of external beam intensified radiotherapy (50 Gy to the posterior pelvis, 56 Gy to the tumour), chemotherapy (in most cases PVI 5-FU at 300 mg/m(2) per day) and, 8-10 weeks later, surgery with curative intent. All patients underwent FDG-PET/CT both before CRT and 5-6 weeks after completing CRT. One patient died before surgery because of acute myocardial infarction, and was therefore excluded from further analysis. Semi-quantitative measurements of FDG uptake (SUV(max)), absolute difference (DeltaSUV(max)) and percent SUV(max) difference (Response Index, RI) between pre- and post-CRT PET scans were considered. Results were correlated with pathological response, assessed both by histopathological staging of the surgical specimens (pTNM) and by the tumour regression grade (TRG) according to Mandard's criteria (patients with TRG1-2 being defined as responders and patients with TRG3-5 as non-responders). RESULTS: Following neo-adjuvant CRT, of the 45 patients submitted to surgery, 23 (51.1%) were classified as responders according to Mandard's criteria (8 TRG1 and 15 TRG2), while the remaining 22 (48.9%) were non-responders (9 TRG3 and 13 TRG4-5). Considering all patients, the mean pre-CRT SUV(max) was 15.6, significantly higher than the mean value of 5.4 post CRT (p < 0.001). Nevertheless, when stratifying patients according to response to CRT (using Mandard's criteria), the mean RI was significantly higher in responders than in non-responders (75.9% versus 46.9%,p = 0.0015). Using a 66.2% SUV(max) decrease as the cut-off value (identified by ROC analysis) for defining response to therapy, the following parameters were obtained: 79.2% specificity, 81.2% sensitivity, 77% positive predictive value, 89% negative predictive value and 80% overall accuracy. CONCLUSION: The results suggest the potential utility of FDG-PET as a complementary diagnostic and prognostic procedure in the assessment of neo-adjuvant CRT response of locally advanced rectal cancer. DeltaSUV(max) and RI seem the best predictors of CRT response.     

新辅助放化疗治疗低位进展期直肠癌的临床研究

目的探讨术前辅助放化疗对低位进展期直肠癌治疗效果。方法 47例低位进展期直肠癌患者（cTNMⅡ期和Ⅲ期）,进行术前联合放化疗。放疗每周5d,每次1.8～2Gy,总剂量45～60Gy。同时持续口服卡培他滨1250mg/m2化疗,休息4～8周进行手术。结果新辅助放化疗的急性毒副反应较小,一般为Ⅰ～Ⅱ度反应,全部患者均完成了治疗,其中施行了保肛手术44例（93.6%）,Miles手术3例。肿瘤分期降低明显,术后局部复发率明显下降,仅为4.3%。结论新辅助放化疗能使低位进展期直肠癌肿瘤降期,提高根治性切除率和保肛成功率,降低局部复发率,是低位进展期直肠癌综合治疗的一种有效方法。     

直肠上动脉化疗栓塞术治疗直肠癌肝转移17例

目的 探讨直肠上动脉化疗栓塞术治疗肝转移直肠癌的安全性及疗效.方法 对合并肝转移直肠癌17例患者行TACE后再进行直肠上动脉化疗栓塞术,经3F微导管超选择进入直肠上动脉后灌注5-Fu和草酸铂,再注入伊立替康和Lipiodol乳化栓塞剂.结果 17例患者治疗均获得成功,术后2～7d16例患者解黏液脓血便明显增加,有些患者可见明显坏死组织.3例腹痛患者2例在术后3d腹痛消失,1例5d消失.1周时有5例肛门胀痛消失,2例明显的改善.1周时7例患者里急后重感明显改善,4例改善不明显.长期随访未发现肠穿孔、局部感染患者.结论 直肠上动脉化疗栓塞术治疗合并肝转移直肠痛是安全有效的,其快速促进直肠肿瘤坏死的作用可以作为直肠癌综合治疗手段的一个重要组成部分.     

血清CD4+/CD8+、PCT及KL-6水平与局部晚期NSCLC放疗后放射性肺炎严重程度的相关性研究

目的 研究血清分化决定族抗原4+/分化决定族抗原8+（CD4+/CD8+）、降钙素原（PCT）及涎液化糖链抗原（KL-6）水平与局部晚期非小细胞肺癌（NSCLC）放疗后重症放射性肺炎相关性。方法 选取2019年5月至2021年3月海安市人民医院收治的103例局部晚期NSCLC患者,根据放疗后放射性肺炎评估结果分组：未发生放射性肺炎作为对照组,共54例;发生放射性肺炎且分级在1~2级作为轻症组,共31例;分级≥3级患者作为重症组,共18例。分别于放疗前后检测3组血清CD4+/CD8+、PCT及KL-6水平,采用Logistic回归模型分析重症放射性肺炎影响因素。结果 单因素分析发现,三组放疗前KPS评分、FEV1/FVC、照射剂量＜60Gy比例、放疗后CD4+/CD8+、放疗后PCT、放疗后KL-6比较,差异具有统计学意义（P＜0.05）。其中重症组放疗前KPS评分、FEV1/FVC、照射剂量＜60Gy比例及放疗后CD4+/CD8+低于对照组与轻症组,且轻症组放疗前KPS评分、FEV1/FVC、照射剂量＜60Gy比例及放疗后CD4+/CD8+低于对照组。而重症组放疗后PCT、放疗后KL-6高于对照组与轻症组,且轻症组放疗后PCT,放疗后KL-6高于对照组（P＜0.05）。Logistic回归分析显示,放疗后血清CD4+/CD8+下降、PCT、KL-6水平升高、照射剂量≥60Gy为重症放射性肺炎的独立危险因素（P＜0.05）。结论 放疗结束后局部晚期NSCLC患者血清CD4+/CD8+下降,PCT、KL-6水平上升,照射剂量≥60Gy对预测重症放射性肺炎发生具有重要价值。