肺癌患者血清多肽特异性抗原、癌胚抗原、糖链抗原242和解整合素金属蛋白酶8水平变化及其临床意义

目的分析肺癌患者血清多肽特异性抗原(TPS)、癌胚抗原(CEA)、糖链抗原242(CA242)、解整合素金属蛋白酶8(ADAM8)水平变化及其临床意义。方法选取2011年7月—2013年7月在广州医科大学附属第二医院经病理学检查证实的肺癌患者100例,其中腺癌45例,鳞癌39例,小细胞肺癌16例;Ⅰ期21例,Ⅱ期12例,Ⅲ期54例,Ⅳ期13例。另选取同期收治的肺部良性病变患者40例。比较不同病理类型肺癌患者血清TPS、CEA、CA242和ADAM8水平及其阳性率,肺部良性病变患者、不同分期肺癌患者血清TPS、CEA、CA242和ADAM8水平及其阳性率,不同治疗效果肺癌患者血清TPS、CEA、CA242和ADAM8水平。结果鳞癌患者血清TPS、CA242水平高于腺癌及小细胞肺癌患者(P0.05),而腺癌与小细胞肺癌患者血清TPS、CA242水平比较,差异均无统计学意义(P0.05);腺癌患者血清CEA水平高于鳞癌及小细胞肺癌患者(P0.05),而鳞癌与小细胞肺癌患者血清CEA水平比较,差异无统计学意义(P0.05)。不同病理类型肺癌患者血清ADAM8水平比较,差异无统计学意义(P0.05)。鳞癌患者TPS阳性率高于腺癌及小细胞肺癌患者,腺癌患者TPS阳性率高于小细胞肺癌患者(P0.05);腺癌患者CEA阳性率高于鳞癌及小细胞肺癌患者,小细胞肺癌患者CEA阳性率高于鳞癌患者(P0.05);小细胞肺癌患者CA242阳性率高于鳞癌及腺癌患者,鳞癌患者CA242阳性率高于腺癌患者(P0.05);小细胞肺癌患者ADAM8阳性率高于鳞癌及腺癌患者,腺癌患者ADAM8阳性率高于鳞癌患者(P0.05)。Ⅲ~Ⅳ期肺癌患者血清TPS、CEA、CA242和ADAM8水平高于肺部良性病变及Ⅰ~Ⅱ期肺癌患者,Ⅰ~Ⅱ期肺癌患者血清TPS、CA242和ADAM8水平高于肺部良性病变患者(P0.05);Ⅰ~Ⅱ期肺癌患者与肺部良性病变患者血清CEA水平比较,差异无统计意义(P0.05)。Ⅲ~Ⅳ期肺癌患者TPS、CEA、CA242和ADAM8阳性率高于肺部良性病变及Ⅰ~Ⅱ期肺癌患者,Ⅰ~Ⅱ期肺癌患者TPS、CEA和ADAM8阳性率高于肺部良性病变患者(P0.05);Ⅰ~Ⅱ期肺癌患者与肺部良性病变患者CA242阳性率比较,差异无统计意义(P0.05)。治疗有效的肺癌患者血清TPS、CEA、CA242和ADAM8水平均高于治疗无效的肺癌患者(P0.05)。结论肺癌患者血清TPS、CEA、CA242和ADAM8水平及阳性率明显升高,检测TPS、CEA、CA242和ADAM8有利于鉴别肺部良恶性病变,判断肺癌病理类型及治疗结果等。     

七项血清自身抗体联合检测在肺癌诊断中的价值

目的分析7项血清自身抗体P53、PGP9.5、SOX2、GAGE7、GBU4-5、MAGEA1和CAGE在肺癌患者中的临床诊断价值。方法采用ELISA法检测114例肺癌患者和194例肺部良性病变患者血清中7项自身抗体的表达水平并比较两组阳性表达率的差异,通过绘制ROC曲线比较7项自身抗体单项及联合检测在肺癌中的诊断效能,分别分析7项自身抗体与肺癌患者的临床病理特征的关系。结果肺癌组7项自身抗体表达水平及阳性率均明显高于非肺癌组,差异均具有统计学意义(P0.05),7项自身抗体联合检测诊断肺癌患者灵敏度为57.89%,特异度为82.13%,AUCROC为0.69,其灵敏度和AUCROC均高于各自身抗体单项检测,并且GAGE7、MAGEA1和CAGE与肺癌患者的TNM分期具有相关性(χ~2=11.897,χ~2=8.720,χ~2=9.146;P=0.008,P=0.033,P=0.027)。结论 7项血清自身抗体联合检测可有效提高肺癌辅助诊断水平。     

痰中增殖诱导配体mRNA定量测定对非小细胞肺癌的诊断价值

目的 建立实时荧光定量聚合酶链反应(RFQ-PCR)检测非小细胞肺癌(NSCLC)患者痰中增殖诱导配体(APRIL)mRNA含量的方法,探讨痰脱落细胞APRIL mRNA表达在NSCLC诊断中的意义.方法 对2007年8月至2008年5月南通大学附属医院71例NSCLC患者和62例肺部良性病变患者痰中APRIL mRNA进行检测,同时取65名健康成人痰做对照.用RFQ-PCR技术实时检测PCR产物的荧光强度,由软件自动计算出待测样本中靶基因mRNA的准确含量,以靶基因和内参β2-微球蛋白(β2-M)mRNA含量的比值作为评价其表达水平的指标,并与细胞学检查结果进行比较.计量资料采用t检验,所得结果用x±s表示;对计数资料采用X2检验.结果 RFQ-PCR法检测APRIL mRNA含最的线性范围为38～3.8×106copies/ul,批内和批间变异系数(CV)分别为8.5%和13.6%.NSCLC组痰中APRIL mRNA表达水平显著高于肺部良性病变组和健康对照组(t值为10.50和11.32,P<0.01);良性病变组与健康组比较差异无统计学意义(t=0.379,P>0.05).以健康组APRIL mRNA的x±2s为cut-off值,肺癌组APRIL mRNA表达的阳性率为81.7%(58/71),明显高于肺部良性病变组的3.2%(2/62)和健康对照组的1.5%(1/65).NSCLC组痰中APRIL mRNA的表达与性别、年龄、吸烟史、TNM分期及淋巴结转移尤关(t值分别为1.700、1.014、1.484、1.298及1.186,均P>0.05),与病理分型和肿瘤部位有关(t值为1.650和1.873,均P<0.05).RFQ-PCR阳性率为82%(58/71),高于细胞形态学阳性率的14%(10/71),差异有统计学意义(X2=67.68,P<0.01).结论 RFQ-PCR检测痰中APRIL mRNA含量具有较高的敏感度和特异度,有助于NSCLC的临床诊断.     

肿瘤标志物对肺癌的诊断价值研究

目的探讨肿瘤标志物对肺癌的诊断价值。方法选取2013年12月—2016年5月连云港市赣榆区人民医院收治的肺癌患者50例作为肺癌组,肺部良性病变患者50例作为良性病变组,健康体检者50例作为对照组。检测并比较3组受试者细胞角蛋白21-1片段(CYFRA21-1)、癌胚抗原(CEA)、神经元神经特异性烯醇化酶(NSE)、糖类抗原125(CA125)及胃泌素释放肽前体(Pro-GRP)水平,并分析其对肺癌的诊断价值。结果肺癌组患者CYFRA21-1、CEA、NSE、CA125、Pro-GRP水平高于良性病变组、对照组,良性病变组患者CYFRA21-1、Pro-GRP水平高于对照组(P0.05)。CYFRA21-1诊断肺癌的灵敏度、阳性预测值及有效性高于其他肿瘤标志物(P0.05)。结论肿瘤标志物对肺癌的诊断价值较高,其中以CYFRA21-1诊断肺癌的灵敏度最高。     

纤维支气管镜活检病变组织标本和痰标本Survivin基因的检测对肺癌的诊断价值

目的明确纤维支气管镜(以下简称纤支镜)活检病变组织和痰标本中SurvivinmRNA的检测在肺癌诊断中的意义。方法应用逆转录聚合酶链反应(RT PCR)法检测41例肺癌手术标本癌组织、癌旁组织和9例良性肺疾病病变组织手术标本,80例肺癌和30例良性肺疾病纤支镜活检病变组织标本及所有(160例)患者痰标本SurvivinmRNA表达情况,并与病理组织学、刷检细胞学和痰细胞学检查结果比较。结果肺癌手术切除标本癌组织SurvivinmRNA的阳性率为70.7%(29/41),高于癌旁组织[17.1%(7/41)]和良性肺疾病组织(1/9),差异有统计学意义(χ2值分别为23.97和10.93,P均<0.05),而癌旁组织与肺良性疾病组织相比,差异无统计学意义(χ2=0.20,P>0.05);纤支镜活检肺癌组织标本SurvivinmRNA的阳性率为63.8%(51/80),高于良性肺疾病的13.3%(4/30,χ2值为22.18,P<0.05);肺癌患者癌组织SurvivinmRNA表达与否及表达水平与患者年龄、性别及肿瘤的病理分型、分级、部位及转移情况均无明显相关性(P均>0.05)。肺癌患者痰标本SurvivinmRNA的阳性率是59.5%(72/121),癌细胞的检出率是47.1%(57/121);痰Survivin mRNA检测联合痰细胞学检查诊断肺癌的敏感性为80.2%(97/121),高于单独痰细胞学及单独痰SurvivinmRNA检测的敏感性(P均<0.05)。手术标本、纤支镜活检标     

肺癌患者丝裂原活化蛋白激酶1(MAPK1)表达水平及临床意义

目的检测肺癌患者血浆中丝裂原活化蛋白激酶1(MAPK1/ERK2)表达水平及探讨其与肺癌类型、临床分期、TNM分期的关系。方法用ELISA法分别检测肺癌组(n=78),良性肺部疾病组(n=27),健康对照组(n=14)血浆中MAPK1/ERK2的水平含量。结果肺癌患者血浆中MAPK1/ERK2的含量高于良性肺部疾病组和健康对照组(P<0.05),良性肺部疾病组高于健康对照组(P<0.05)。肺癌患者血浆中MAPK1/ERK2的表达与性别,年龄,吸烟状况,肿瘤病理类型,临床分期,TNM分期无显著性差异。结论 MAPK1/ERK2对肺癌的辅助诊断有一定的临床价值,可作为一项新的肺癌生物标志物应用。     

PDCD5与P53在非小细胞肺癌患者血清中的表达及意义

目的研究非小细胞肺癌(NSCLC)患者血清中PDCD5及P53蛋白的表达及其与临床病理特征的关系。方法选择肺疾病患者200例,采用酶联免疫吸附法(ELISA)测定患者血清中PDCD5及P53蛋白的表达。结果男性患者血清PDCD5蛋白平均值为(131.18±110.12)ng/ml,女性患者血清PDCD5蛋白平均值为(296.78±243.91)ng/ml,差异具有统计学意义(t=-2.640,P<0.05)。按肺部良性及恶性病变,分为肺癌未化疗组、肺部良性病变组,肺癌未化疗组患者血清PDCD5蛋白平均值为(168.22±146.42)ng/ml,肺部良性病变组PDCD5蛋白平均值为(255.67±194.84)ng/ml,差异具有统计学意义(t=-2.731,P<0.05);肺癌未化疗患者血清P53蛋白平均值为(349.07±426.34)ng/ml,肺部良性病变组患者血清P53蛋白平均值为(919.73±902.09)ng/ml,差异具有统计学意义(t=-2.481,P<0.05)。将肺癌患者分为吸烟组、不吸烟组,肺鳞癌、肺腺癌组,肺癌化疗前患者、肺癌化疗后患者,肺癌I^Ⅱ期患者、肺癌ⅢⅡ期患者、肺癌Ⅲ^Ⅳ期患者,肺癌远处淋巴结转移患者、肺癌远处淋巴结未转移患者,血清PDCD5、P53含量均无统计学意义(P>0.05)。结论 NSCLC患者血清中PDCD5蛋白可能与抑制肺癌细胞生长、促进肿瘤细胞凋亡有关,与性别有关。NSCLC患者血清中PDCD5与P53蛋白的表达,与肿瘤分期、淋巴结转移、吸烟、肺癌的病理类型、化学治疗与否可能无关,并可能成为NSCLC治疗的新的方向。     

64排螺旋 CT 低剂量在高危人群早期肺癌筛查和诊断中的应用价值

目的：探讨64排螺旋 CT 低剂量在高危人群早期肺癌筛查和诊断中的应用价值。方法以本院2013年1月至2015年12月期间我院体检中心体检的1036例高危人群作为研究对象,分别采用 X 光机和 CT 机进行早期肺部癌症筛查。获得 DR 胸片和 CT 影像后由2位医师采用双盲法对影像进行观察并作出诊断。记录肺部结节数量、大小和最终诊断结果。结果采用 CT 扫描出肺部结节病灶共169例,检出率为16.31%;而采用 DR 胸片共检出76例,检出率为7.34%。2种方法在肺部结节检出率之间的差异有统计学意义(χ2=40.0360,P <0.05),CT 扫描检出率优于 DR 胸片检出率。2种方法在检出肺部不同大小结节数之间的差异有统计学意义(χ2=9.6688,P <0.05)。2种方法在>10 mm 结节检出率之间的差异有统计学意义(χ2=4.6677,P <0.05)。在1036例样本中,CT扫描确诊肺癌20例(1.93%),DR 胸片确诊肺癌6例(0.58%)。2种方法在肺癌筛查确诊率之间的差异有统计学意义(χ2=6.5826,P <0.05),CT 扫描检出肺癌率要优于 DR 胸片检查。结论针对肺癌高危人群的早期筛查工作,64排螺旋 CT 低剂量扫描对筛查肺部结节和确诊疾病并及时制定临床救治方案具有指导意义,适于推广与应用。     

奎屯地区居民健康体检脂肪肝的调查

目的了解新疆奎屯地区居民脂肪肝患病情况及危险因素,为疾病预防和治疗提供依据。方法对1 456名社区居民进行血压、血脂、血糖、肝功能和腹部B超等项目检查。结果 1 456名受检者中,检出脂肪肝776例、占53.3%,其中男性374例、占男性受检者53.4%,女性402例、占女性受检者53.1%,差异无统计学意义(χ~2=0.01,P>0.05);男性和女性均以40岁^(χ^2=2.11)和50岁^(χ^2=0.01)组所占比例最高,差异无统计学意义(均P>0.05),30岁~组(χ~2=3.88)男性高于女性,60岁^(χ^2=6.72)和70岁^(χ^2=4.50)组女性高于男性,差异均有统计学意义(均P<0.05);ALT,TG和TC检出构成比分别为14.3%(111/776,χ~2=19.47),37.6%(292/776,χ~2=25.80)和21.8%(169/776,χ~2=4.80),以TG最高,差异均有统计学意义(均P<0.01),且男性均高于女性,差异有统计学意义(χ~2=4.77,P<0.05);脂肪肝病例饮酒史,并发高血脂(χ~2=143.00)、高血压(χ~2=26.90)和高血糖(χ~2=26.00)所占比例高于非脂肪肝病例,差异有统计学意义(均P<0.05)。结论社区居民脂肪肝所占比例较高,需加强健康教育,倡导健康生活方式,预防或减少脂肪肝的发生,减少发生心、脑血管疾病的风险。     

痰液脱落细胞k-ras基因检测对肺癌诊断的临床价值

目的通过痰脱落细胞k-ras基因点突变的检测探讨其对肺癌诊断的临床应用价值。方法应用多聚合酶链反应结合限制性长度片段多态性分析法(PCR-RFLP),检测50例肺癌(其中腺癌22例,鳞癌24例,小细胞癌4例)和48例肺部良性疾病患者痰标本中k-ras基因第12密码子的突变情况,检测结果进行对比分析。结果k-ras基因在肺癌组的突变检出率为24.00%(12/50),非肺癌组突变检出率为2.08%(1/48),二者有显著性差异(P<0.01)。其中腺癌突变率40.90%(9/22),鳞癌突变率12.50%(3/24),小细胞癌未检出突变。在肺癌早期(Ⅰ期和Ⅱ期)中,k-ras基因突变明显高于肺良性病变组,且肺癌组中,吸烟者k-ras基因突变率34.48%(10/29)高于非吸烟者9.52%(2/21),两者有统计学差异(P<0.05)。k-ras基因突变与年龄、性别和临床分期无明显关系。结论k-ras基因突变与肺癌的发生存在一定的相关性,痰液脱落细胞中R-ras基因检测突变有助于肺癌的临床诊断,对早期诊断亦有一定的意义。     

Bronchoscopically Obtained Volatile Biomarkers in Lung Cancer

Background  

The exhaled breath of lung cancer patients contains volatile organic compounds (VOCs) that differ from those in healthy individuals. These VOCs can be detected with methods such as ion mobility spectrometry (IMS); their origin remains unknown.     

Application of laser spectroscopy for measurement of exhaled ethane in patients with lung cancer

There is increasing interest in ethane (C(2)H(6)) in exhaled breath as a non-invasive marker of oxidative stress (OS) and thereby a potential indicator of disease. However, the lack of real-time measurement techniques has limited progress in the field. Here we report on a novel Tunable Diode Laser Spectrometer (TDLS) applied to the analysis of exhaled ethane in patients with lung cancer. The patient group (n=52) comprised randomly selected patients presenting at a respiratory clinic. Of these, a sub-group (n=12) was subsequently diagnosed with lung cancer. An age-matched group (n=12) corresponding to the lung cancer group was taken from a larger control group of healthy adults (n=58). The concentration of ethane in a single exhaled breath sample collected from all subjects was later measured using the TDLS. This technique is capable of real-time analysis of samples with accuracy 0.1 parts per billion (ppb), over 10 times less than typical ambient levels in the northern hemisphere. After correcting for ambient background, ethane in the control group (26% smokers) ranged from 0 to 10.54 ppb (median of 1.9 ppb) while ethane in the lung cancer patients (42% smokers) ranged from 0 to 7.6 ppb (median of 0.7 ppb). Ethane among the non-lung cancer patients presenting for investigation of respiratory disease ranged from 0 to 25 ppb (median 1.45 ppb). We conclude that, while the TDLS proved effective for accurate and rapid sample analysis, there was no significant difference in exhaled ethane among any of the subject groups. Comments are made on the suitability of the technique for monitoring applications.     

血清HE4、NSE、CYFRA21-1水平变化对肺癌的诊断价值

目的探讨血清HE4、NSE、CYFRA21-1水平变化对肺癌的诊断价值。方法采用电化学发光法检测88例肺癌患者和70例肺良性疾病患者及50例健康对照者血清中的HE4、NSE、CYFRA21-1水平。结果肺癌组血清HE4、NSE、CYFRA21-1水平明显高于肺良性疾病组和健康对照组(P0.05);腺癌、鳞癌、小细胞肺癌分别以HE4、CYFRA21-1、N SE检测敏感性最高(P0.05);HE4、NSE、CYFRA21-1联合检测较单项检测诊断敏感性显著提高(P0.05)。结论 HE4、NSE、CYFRA21-1水平变化有助于肺癌的诊断和鉴别诊断,三项肿瘤标志物联合检测优于各项目单独检测。     

The application of statistical methods using VOCs to identify patients with lung cancer

In this work, an attempt was made to determine a group of lung cancer biomarkers. For this study, breath samples collected from 137 patients with confirmed lung cancer were analyzed by the SPME-GC/MS method. As a reference group, exhaled air from 143 healthy volunteers with different smoking habits (active smokers, passive smokers and nonsmokers) was applied. Statistical methods such as discriminant analysis (DA) and the CHAID model tree were used for data processing and evaluation. In the breath of patients with lung cancer, increased concentration of ethanol, acetone, butane, dimethyl sulfide, isoprene, propanal, 1-propanol, 2-pentanone, furan, o-xylene and ethylbenzene was observed in comparison to healthy nonsmokers. Furthermore, pentanal, hexanal and nonane were identified only in the breath of people who suffered from cancer. DA confirmed the importance of these compounds and allowed us to identify patients with lung cancer from healthy volunteers. In the exhaled air of healthy smokers (passive and active), a higher concentration of acetonitrile, benzene and furan derivatives was observed than in nonsmokers. DA revealed that in order to recognize healthy volunteers with different smoking habits by breath analysis, butyrolactone, carbon disulfide and dimethyl sulfide have to be considered.     

Dependence of exhaled breath composition on exogenous factors, smoking habits and exposure to air pollutants

Non-invasive disease monitoring on the basis of volatile breath markers is a very attractive but challenging task. Several hundreds of compounds have been detected in exhaled air using modern analytical techniques (e.g. proton-transfer reaction mass spectrometry, gas chromatography-mass spectrometry) and have even been linked to various diseases. However, the biochemical background for most of compounds detected in breath samples has not been elucidated; therefore, the obtained results should be interpreted with care to avoid false correlations. The major aim of this study was to assess the effects of smoking on the composition of exhaled breath. Additionally, the potential origin of breath volatile organic compounds (VOCs) is discussed focusing on diet, environmental exposure and biological pathways based on other's studies. Profiles of VOCs detected in exhaled breath and inspired air samples of 115 subjects with addition of urine headspace derived from 50 volunteers are presented. Samples were analyzed with GC-MS after preconcentration on multibed sorption tubes in case of breath samples and solid phase micro-extraction (SPME) in the case of urine samples. Altogether 266 compounds were found in exhaled breath of at least 10% of the volunteers. From these, 162 compounds were identified by spectral library match and retention time (based on reference standards). It is shown that the composition of exhaled breath is considerably influenced by exposure to pollution and indoor-air contaminants and particularly by smoking. More than 80 organic compounds were found to be significantly related to smoking, the largest group comprising unsaturated hydrocarbons (29 dienes, 27 alkenes and 3 alkynes). On the basis of the presented results, we suggest that for the future understanding of breath data it will be necessary to carefully investigate the potential biological origin of volatiles, e.g., by means of analysis of tissues, isolated cell lines or other body fluids. In particular, VOCs linked to smoking habit or being the results of human exposure should be considered with care for clinical diagnosis since small changes in their concentration profiles (typically in the ppt(v)-ppb(v)?range) revealing that the outbreak of certain disease might be hampered by already high background.     

OSAHS患者呼出气冷凝液中MMP-9的变化

目的观察阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者呼出气冷凝液(EBC)中基质金属蛋白酶9(MMP-9)的变化。方法选取男性40例OSAHS患者为实验组,30例年龄、体重指数等均相匹配的健康查体者为对照组,用ELISA检测EBC中MMP-9水平。结果和对照组比较,OSAHS组EBC中MMP-9明显升高,有显著统计学意义(P0.05)。MMP-9与AHI呈正相关,与最低SaO2负相关(P均0.05)。结论OSAHS患者EBC中MMP-9水平可反映OSAHS病情的严重程度。     

Breath condensate nitrite correlates with hyperinflation in chronic obstructive pulmonary disease

Estimating the degree of pulmonary hyperinflation in chronic obstructive pulmonary disease (COPD) is not always straight forward. Standard pulmonary function tests provide only a crude estimate of this important aspect of COPD. In addition, good patient cooperation cannot always be achieved and therefore adds to the uncertainties with regard to the extent of hyperinflation of the lung. The aim of this investigation was to characterize exhaled breath condensate nitrite in volunteers, healthy smokers, and stable COPD (GOLD-stages 0-4) and to compare this parameter with inflammatory markers in exhaled breath condensate and with lung function in order to test the hypothesis that elevated exhaled breath condensate nitrite reflects hyperinflation in COPD. We found a logarithmic correlation of exhaled breath condensate nitrite to residual volume (r=0.75, p<0.0001), total lung capacity (r=0.51, p<0.0001), and thoracic gas volume (r=0.71, p<0.0001) but no correlation of exhaled breath condensate nitrite concentrations with levels of inflammatory cytokines in exhaled breath condensate (interleukin (IL)-8, IL-1beta, IL-6, IL-10, IL-12, and tumor necrosis factor-alpha). Analysis of COPD subgroups revealed a logarithmic correlation of EBC nitrite to residual volume, total lung capacity, and intrathoracic gas volume exclusively for patients characterized by GOLD classes 2, and higher. Our results confirm a relation of exhaled breath condensate nitrite levels and hyperinflation measured by conventional pulmonary function tests. Investigations using isolated lung models and cells stretched in culture also provide insight into this relation. Exhaled breath condensate nitrite may be a biochemical indicator of pulmonary overdistension.     

肺癌患者D-二聚体水平的临床分析

目的 探讨肺癌患者D-二聚体水平的临床意义.方法 测定60例肺部良性疾病患者、80例肺癌患者及30例正常对照组的D-二聚体水平,分别进行比较分析.结果 肺癌组D-二聚体水平均明显高于肺部良性疾病组及正常对照组（P＜0.05）,肺癌组临床分期Ⅲ-Ⅳ期患者D-二聚体水平明显高于Ⅰ-Ⅱ期患者（P＜0.05）,肺癌转移组D-二聚体水平明显高于无转移组（P＜0.05）.结论 D-二聚体的测定对肺癌与良性疾病的鉴别诊断、临床分期、有无转移及预后具有一定参考价值.     

Detection of lung cancer with volatile markers in the breath

STUDY OBJECTIVES: To evaluate volatile organic compounds (VOCs) in the breath as tumor markers in lung cancer. Alkanes and monomethylated alkanes are oxidative stress products that are excreted in the breath, the catabolism of which may be accelerated by polymorphic cytochrome p450-mixed oxidase enzymes that are induced in patients with lung cancer. DESIGN: Combined case-control and cross-sectional study. SETTING: Five academic pulmonary medicine services in the United States and the United Kingdom. Patients and participants: One hundred seventy-eight bronchoscopy patients and 41 healthy volunteers. INTERVENTION: Breath samples were analyzed by gas chromatography and mass spectroscopy to determine alveolar gradients (ie, the abundance in breath minus the abundance in room air) of C4-C20 alkanes and monomethylated alkanes. MEASUREMENTS: Patients with primary lung cancer (PLC) were compared to healthy volunteers, and a predictive model was constructed using forward stepwise discriminant analysis of the alveolar gradients. This model was cross-validated with a leave-one-out jackknife technique and was tested in two additional groups of patients who had not been used to develop the model (ie, bronchoscopy patients in whom cancer was not detected, and patients with metastatic lung cancer [MLC]). RESULTS: Eighty-seven of 178 patients had lung cancer (PLC, 67 patients; MLC, 15 patients; undetermined, 5 patients). A predictive model employing nine VOCs identified PLC with a sensitivity of 89.6% (60 of 67 patients) and a specificity of 82.9% (34 of 41 patients). On cross-validation, the sensitivity was 85.1% (57 of 67 patients) and the specificity was 80.5% (33 of 41 patients). The stratification of patients by tobacco smoking status, histologic type of cancer, and TNM stage of cancer revealed no marked effects. In the two additional tests, the model predicted MLC with a sensitivity of 66.7% (10 of 15 patients), and it classified the cancer-negative bronchoscopy patients with a specificity of 37.4% (34 of 91 patients). CONCLUSIONS: Compared to healthy volunteers, patients with PLC had abnormal breath test findings that were consistent with the accelerated catabolism of alkanes and monomethylated alkanes. A predictive model employing nine of these VOCs exhibited sufficient sensitivity and specificity to be considered as a screen for lung cancer in a high-risk population such as adult smokers.     

非小细胞肺癌患者呼出气冷凝液中p53基因突变检测的研究

目的 探讨非小细胞肺癌(NSCLC)患者呼出气冷凝液(EBC)中p53基因突变检测的临床意义.方法 采用PCR结合DNA测序法,检测53例NSCLC患者(治疗前)EBC中p53基因第5、6、7、8外显子的突变情况,32名健康体检者EBC标本作为对照.结果 肺癌组(治疗前)EBC标本中扩增到p53基因26例,其中10例检...