肝癌患者血清可溶性肿瘤坏死因子受体Ⅰ的表达及临床意义

用ＥＬＩＳＡ方法测定了３０例肝癌患者血清可溶性肿瘤坏死因子受体Ⅰ（ｓＴＮＦＲ－Ⅰ）水平。结果表明，肝癌患者血清ｓＴＮＦＲ－Ⅰ水平明显高于正常人（ｐ＜０．０１），且血清ｓＴＮＦＲ－Ⅰ水平与临床分期相关。治疗有效者，血清ｓＴＮＦＲ－１水平均明显下降（ｐ＜０．０１）．治疗后２～８月，３例无癌生存者，血清ｓＴＮＦＲ－１水平降至正常，而７例局部未控或复发转移者，血清ｓＴＮＦＲ－１水平则进行性上升。提示，血清ｓＴＮｌＦＲ－Ⅰ测定对肝癌患者的诊断、疗效观察及预后判断可能有一定的参考价值。     

检测血清和胸液E—选择素对鉴别良恶性疾病的意义

目的 通过检测结核性胸膜炎及癌性胸液患血清及胸液的Ｅ－选择素水平，探讨其对鉴别良恶性疾病的意义。方法 采用酶联免疫吸附法（ＥＬＩＳＡ）检测２５例结核性胸膜炎及２１例癌性胸液患血清及胸液的Ｅ－选择素水平。结果 结核性胸膜炎患血清Ｅ－选择素水平为４４±５μｇ／Ｌ、胸液Ｅ－选择素水平２４±３μｇ／Ｌ。明显高于癌性胸液患血清（２７±４μｇ／Ｌ）及胸液（１１±３μｇ＋Ｌ），且重叠性很小。此外，结核性     

胃癌患者可溶性白细胞介素-2受体与肿瘤坏死因子-α水平的临床观察

为观察可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）和肿瘤坏死因子－α（ＴＮＦ－α）对胃癌的诊断及估计预后的价值，应用酶联免疫双抗夹心法对７８例胃癌患者及对照者血清检测上述两种成分，进行临床观察。结果发现：胃癌患者血清ｓＩＬ－２Ｒ和ＴＮＦ－α水平明显高于胃良性疾病和正常人（均Ｐ＜０．０１）；胃癌Ⅲ、Ⅳ期高于Ⅰ、Ⅱ期（均Ｐ＜０．０１）；手术切除后（根治性或姑息性）ｓＩＬ－２Ｒ和ＴＮＦ－α显著下降（均Ｐ＜０．０１）；手术后复发或转移患者血清中ｓＩＬ－２Ｒ和ＴＮＦ－α含量升高（均Ｐ＜０．０１）；如果患者血清ｓＩＬ－２Ｒ含量高于１０００ｋＵ／Ｌ同时伴有ＴＮＦ－α持续高于１２０μｇ／Ｌ，预兆生存期短。提示监测胃癌患者血清ｓＩＬ－２Ｒ和ＴＮＦ－α水平对临床诊断、病情估计和预后有重要意义     

胃癌患者可溶性白细胞介素—2受体与肿瘤坏死因子—α水平？…

为观察可溶性白细胞介素」－２受体（ｓＩＬ－２Ｒ）和肿瘤坏死因子－α（ＴＮＦ－α）对胃癌的诊断及估计预后的价值，应用酶联免疫双抗夹心法对７８例胃癌患者及对照者血清检测上述两种成分，进行临床观察。结果发现：胃癌患者血清ｓＩＬ－２Ｒ和ＴＮＦ－α水平明显高于胃良性疾病和正常人（均Ｐ〈０．０１）；胃癌Ⅲ、Ⅳ期高于Ⅰ、Ⅱ期（均Ｐ〈０．０１）；手术切除后（根治性或姑息性）ｓＩＬ－２Ｒ和ＴＮＦ－α显著下降（均Ｐ〈     

肝病患者血清TNFα和sTNFαR的相关关系及临床意义初探

采用ＥＬＩＳＡ双抗体夹心法和＾３Ｈ－ＴｄＲ释放法分别对１７６例各种肝病患者及３６例正常人血清ＴＮＦα和ｓＴＮＦαＲ进行测定。结果发现各种肝病患者血清ＴＮＦα和ｓＴＮＦαＲ均明显高于正常对照组（Ｐ〈０．０５），ＴＮＦα和ｓＴＮＦαＲ呈明显正相关。ＰＨＣ和ＣＡＨ患者血清ｓＴＮＦαＲ１／ｓＴＮＦαＦαＲ２比值明显升高；而ＭＨＣ和ＣＰＨ患者血清ｓＴＭＦαＲ／ｓＴＮＦ－Ｒ呃比值则明显减小（Ｐ〈０．０５）。疗     

胸腔积液患者可溶性肿瘤坏死因子受体的检测

血清可溶性肿瘤坏死因子受体 (ｓｏｌｕｂｌｅｔｕｍｏｒｎｅｃｒｏｓｉｓｆａｃｔｏｒｒｅｃｅｐｔｏｒ,ｓＴＮＦＲ)是肿瘤坏死因子特异性受体 (ＴＮＦＲ)脱落下来的胞外区活性片段 ,包括ｓＴＮＦＲ Ⅰ和ｓＴＮＦＲ Ⅱ。ｓＴＮＦＲ通过与ＴＮＦＲ竞争结合肿瘤坏死因子 (ＴＮＦ)而抑制其生物学作用。本研究通过检测胸腔积液患者胸水和血清中ｓＴＮＦＲ及ＴＮＦ的浓度 ,探讨其间的相关性。一、对象和方法1.对象 :癌性组 :癌性胸腔积液患者 36例 ,男 2 6例 ,女10 ,平均年龄 49 7岁。感染组 :感染性胸腔积液患者 42例 ,男 31例 ,女 11例 ,平均…     

肝癌患者血清可溶性肿瘤坏死因子受体I的表达及临床意义

用ＥＬＩＳＡ方法测定了３０例肝癌患者血清可溶性肿瘤坏死因子受体Ｉ（ｓＴＮＦＲ－Ｉ）水平。结果表明，肝癌患者血清ｓＴＮＦＲ－Ｉ水平明显高于正常人（ｐ〈０．０１），且血清ｓＴＮＦＲＩ水平与临床分期相关。治疗有效者，血清ｓＴＮＦＲ－Ｉ水平均明显下降（ｐ〈０．０１）。治疗后２￣８月，３例无癌生存者，血清ｓＴＮＦＲ－Ｉ水平降至正常，而７例局部未控或复发转移者，血清ｓＴＮＦＲ－Ｉ水平则进行性上升。提示，血清ｓ     

肝病患者的可溶性肿瘤坏死因子受体测定

本文用自行建立的双单抗夹心ＥＬＩＳＡ检测了６６例正常成人及１１例急性肝炎、１７例肝硬化、７１例原发性肝细胞癌、１６例继发性肝癌、１例肝血管瘤患者血清中ｓＴＮＦＲⅠ水平及其中部分病人血清的ｓＴＮＦＲⅡ水平，同时还测定了１０份腹水中ｓＴＮＦＲⅠ浓度，并动态观察了治疗对肝癌患者血清ｓＴＮＦⅠ浓度的影响。     

细胞角质蛋白19片段与癌胚抗原联合检测对良恶性胸腔积液的鉴别 …

目的 探讨细胞角质蛋白１９片段（ＣＹＦＲＡ２１－１）与癌胚抗原（ＣＥＡ）检测对结核性胸水与癌性胸水的鉴别诊断价值。方法 对胸水患者１０８例（癌性６８例,结核性４０例）分别测定其血清,胸中中ＣＹＦＲＡ２１－１和ＣＥＡ浓度。结果 １两种肿瘤标记物浓度在恶性胸水中明显地结核性胸水;２．癌性胸水中ＣＹＦＲＡ２１－１浓度明显高于血清浓度,而胸水中ＣＥＡ浓度与血清中浓度相比无显著性差异;３．胸水ＣＹＦＲＡ２１     

对结核性与恶性胸液鉴别的临床观察

通过检测结核性胸膜炎及癌性胸液患者胸液中染色体，间皮细胞、腺苷脱氨酶、溶菌酶、癌胚抗原的水平，探讨其对结核性与恶性胸液鉴别的意义。方法：采用Ａｎｓｓｏｎｏ法检测染色体，Ｈａｎｓｉｎ法检测间皮细胞记数，Ｈａｎｓｓｏｎ法检测腺苷脱氨酶，Ｏｓｓｅｒｍａｎ等人比浊法检测溶菌酶放联免疫吸附法检测癌胚抗原。结果染色体异常均为恶性胸水，无一例假阳性；间皮细胞记数恶性胸液明显高于结核性胸液；腺苷脱氨酶结核性胸水显     

心钠素测定在良恶性胸腔积液鉴别中的价值

目的探讨胸腔积液心钠素水平在良、恶性胸腔积液鉴别中的价值。方法采用放射免疫直接测定法,测定３０例结核性和２６例癌性胸腔积液患者胸腔积液及血清心钠素水平。结果结核性、癌性胸腔积液心钠素水平分别为（７５±９）ｎｇ／Ｌ、（１５７±４５）ｎｇ／Ｌ,两者有极显著性差异（Ｐ＜０．００１）;结核性胸腔积液心钠素水平［（７５±９）ｎｇ／Ｌ］明显低于血清心钠素水平［（１７０±３７）ｎｇ／Ｌ］,差异有极显著性意义（Ｐ＜０００１）;结核性与癌性胸腔积液患者胸腔积液与血清心钠素水平之比值分别为０４７±０１７、０９９±０４６,两者差异有极显著性意义（Ｐ＜０００１）;其对恶性胸腔积液诊断的敏感性及特异性分别为８１％和１００％。结论测定胸腔积液心钠素水平是良、恶性胸腔积液鉴别的重要方法之一     

Vasoactive mediators (VEGF and TNF-alpha) in patients with malignant and tuberculous pleural effusions

OBJECTIVE: Vascular endothelial growth factor (VEGF) is a potent endothelial cell-specific mitogen that promotes angiogenesis, vascular hyperpermeability, and vasodilatation by autocrine mechanisms involving nitric oxide (NO). This study was undertaken to determine the potential role of VEGF in the pathogenesis of pleural effusions, and its relationship with tumour necrosis factor (TNF)-alpha and NO in the pleural fluid and serum of patients with tuberculous and malignant pleural effusions. METHODOLOGY: Pleural fluid and serum (SE) VEGF, TNF-alpha and NO levels were measured in 30 patients with exudative pleural effusion (15 with malignancies and 15 with tuberculosis). Control pleural fluid was obtained from 10 patients with transudative pleural effusion due to congestive heart failure and control serum samples were obtained from 10 healthy individuals. VEGF and TNF-alpha were measured by enzyme-linked immunosorbent assay and NO by a colorimetric method. Pleural biopsy, cytology or microbiological methods were used to make the final diagnosis. RESULTS: In patients with exudative pleural effusions, the mean pleural fluid and serum VEGF levels and their ratios (P < 0.0001 for all) and TNF-alpha levels (P < 0.01, P < 0.0001 and P < 0.05) were significantly elevated compared to those with transudative pleural effusion. In malignant effusions, pleural fluid and serum VEGF levels were significantly elevated (P < 0.001 and P < 0.0001) while pleural fluid, and serum levels and their ratios of TNF-alpha (P < 0.001, P < 0.01 and P < 0.05) were significantly lower than those in tuberculosis. NO levels did not distinguish between tuberculous and malignant effusions. CONCLUSIONS: In patients with malignant pleural effusions, levels of VEGF were significantly higher, while levels of TNF-alpha were significantly lower, than in patients with tuberculous effusions. In malignant pleural effusions, the elevated pleural fluid levels of VEGF and TNF-alpha are noteworthy. Our data support the hypothesis that blockade of VEGF, might benefit cancer patients with recurrent ascites or pleural fluid accumulation.     

胸水N-末端脑钠肽前体在胸腔积液患者中的诊断价值

目的 探讨检测胸液中N-末端脑钠肽前体(NT-proBNP)对于胸腔积液的鉴别诊断价值.方法 选取在本院因胸腔积液而进行诊断性胸腔穿刺的患者126例,根据临床表现、胸液常规检验结果及细胞学分为充血性心力衰竭胸腔积液33例(心源性组)和非心源性组93例(恶性胸腔积液18例、结核性胸腔积液22例、肾功能衰竭性胸腔积液19例、肝硬化腹水伴胸腔积液15例、肺炎性胸腔积液19例).检测2组患者胸水及血浆中NT proBNP水平,分析血浆NT proBNP水平与胸水NT-proBNP的相关性,并采用受试者工作曲线(ROC)计算用于判别胸水性质的最佳界值.结果 心源性组胸水及血浆中的NT-proBNP水平显著高于非心源性组、恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组,且差异均具有统计学意义(P＜0.05);恶性组、结核组、肾功能衰竭组、肝硬化组和炎症组胸水及血浆中NT proBNP水平差异均无统计学意义(P＞0 05);胸水中NT proBNP水平与血浆中NT-proBNP水平呈显著正相关(r=0.894,P＜0.01).绘制ROC曲线结果显示,当胸水中NT-proBNP水平为1 500 ng/L时,鉴别心源性和非心源性胸水具有最大诊断指数(1.757 3),此时敏感度为89.19％、特异度为86.54％.结论 心源性胸腔积液患者胸水中NT-proBNP水平显著升高,与血浆水平呈显著正相关,以1 500 ng/L为界值时,具有鉴别诊断心源性胸水的最高价值.     

C反应蛋白在结核性及恶性胸腔积液鉴别诊断中的价值

目的　探讨 C反应蛋白 (CRP)测定在结核性及恶性胸腔积液鉴别诊断中的价值。方法　对 32例结核性或恶性胸腔积液患者的胸水、血清 CRP浓度及胸水 CRP/血清 CRP进行对比分析。结果　结核性胸液组胸水CRP浓度、血清 CRP浓度、胸水 CRP/血清 CRP均高于恶性胸液组 (分别为 P<0 .0 0 1,P<0 .0 1,P<0 .0 5 )。结论　 CRP测定有助于对结核性与恶性胸腔积液的鉴别。     

Transforming growth factor beta-1 level in pleural effusion

OBJECTIVE: Transforming growth factor-beta1 is an important immunomodulator. The diagnostic role of TGF-beta1 has not been systematically investigated in pleural effusion. METHODOLOGY: A prospective clinical study of 45 patients (23 men, 22 women; mean age 49 +/- 21 years) with pleural effusion was performed. Of these patients, 19 had malignant pleural effusion, 14 had tuberculous pleural effusion, seven had empyema/parapneumonic pleural effusion, and five had transudative pleural effusion due to congestive heart failure. The concentrations of TGF-beta1 were measured by ELISA in all pleural fluid samples and in serum samples only from patients with malignant and tuberculous pleural effusions. RESULTS: The median TGF-beta1 levels of malignant, tuberculous and empyema/parapneumonic pleural effusions were 7.25 ng/mL, 7.81 ng/mL, and 9.75 ng/mL, respectively. There was no significant difference between them. The median TGF-beta1 level was 5.62 ng/mL in the transudate pleural effusion group and it was significantly lower than that in the empyema/parapneumonic group (P < 0.05). The pleural fluid TGF-beta1 levels did not correlate with cell profiles of the pleural fluid. The median serum TGF-beta1 levels in malignant and tuberculous pleural effusion groups were 7.38 ng/mL and 7.38 ng/mL, respectively. There was no significant difference between the levels of TGF-beta1 in paired samples of serum and pleural fluid. CONCLUSIONS: This study shows that TGF-beta1 concentrations in exudative pleural effusions are higher than those in transudative effusions secondary to congestive heart failure but TGF-beta1 concentrations do not assist in differentiating exudative effusions.     

干扰素γ、白细胞介素12及腺苷脱氨酶同工酶对结核性胸腔积液的诊断价值

目的　研究胸腔积液中干扰素γ(IFN γ)和白细胞介素 12 (IL 12 )的浓度及腺苷脱氨酶同工酶 (ADA2 )的活性三者在结核性胸腔积液诊断中的临床价值。方法　以 2 0 0 2年 3月～ 2 0 0 3年2月期间在北京大学人民医院、北京胸科医院、北京结核病胸部肿瘤研究所等医院的未经治疗的胸腔积液患者为研究对象 ,其中结核性胸腔积液 14 1例、恶性胸腔积液 4 9例。应用酶速率法检测胸腔积液标本中腺苷脱氨酶 (ADA)、ADA2 的活性 ,酶联免疫吸附测定 (ELISA)检测IFN γ和IL 12的浓度。比较两组胸腔积液中ADA和ADA2 活性 ,以及IFN γ和IL 12浓度之间的区别。结果　 (1)结核性胸腔积液组ADA、ADA2 活性分别为 (5 1 6± 10 9)U/L和 (4 7 9± 6 9)U/L ,恶性胸腔积液组ADA、ADA2 活性分别为 (2 0 4± 4 4 )U/L、(13 2± 3 2 )U/L ,结核性胸腔积液组的ADA、ADA2 活性显著高于恶性胸腔积液组 (P <0 0 1)。结核性胸腔积液组IFN γ和IL 12浓度分别为 (112 1± 4 5 8)ng/L及 (10 4 3± 32 3)ng/L ,恶性胸腔积液组IFN γ和IL 12浓度分别为 (2 4 8± 5 9)ng/L和 (6 1 8±10 8)ng/L ,结核性胸腔积液组的IFN γ和IL 12浓度水平显著高于恶性胸腔积液组 (P <0 0 1,0 0 5 ) ;(2 )ROC曲线分析结果 ,IFN γ以 6 1 7ng/L为诊     

血清和胸水铜、锌、铁检测对结核性和癌性胸水的鉴别诊断价值

目的通过检测结核性和癌性胸水患者血清及胸水中铜、锌、铁水平,探讨其对鉴别良恶性胸水的意义。方法采用火焰原子吸收分光光度法(FAA S)检测32例结核性胸水和32例癌性胸水患者血清及胸水铜、锌、铁水平。结果癌性胸水组血清和胸水铜含量及铜/锌比值显著高于结核性胸水组,而血清和胸水锌含量显著降低(P<0.01)。癌性胸水组血清铁含量显著降低,而胸水铁含量显著高于结核性胸水组(P<0.01)。结论同时检测血清及胸水中铜、锌、铁水平对鉴别良恶性胸水有重要价值。     

Th1/Th2免疫应答系统在结核性胸膜炎患者中的表达

目的分析结核性胸膜炎患者辅助T细胞(Th)亚型Th1样细胞因子γ干扰素(IFN-γ)、白细胞介素(IL)-2和Th2样细胞因子IL-4、IL-10在血清与胸腔积液中的分布特点,探讨系统及局部的Th1/Th2免疫应答在人类结核性胸膜炎病理生理过程中的可能作用.方法应用夹心酶联免疫吸附测定(ELISA)法检测51例结核性胸膜炎患者(胸膜炎组)血清及胸液标本中IFN-γ、IL-2、IL-4、IL-10的浓度,并与肺结核患者(肺结核组,36例)和健康人(健康人组,24名)比较.结果(1)3组受试者血清IFN-γ、IL-2、IL-4、IL-10浓度中位数分别为胸膜炎组为118.60 ng/L、0.00 ng/L、1.49 ng/L、0.00 ng/L;肺结核组为265.75 ng/L、18.03 ng/L、16.00 ng/L、0.00 ng/L;健康人组为221.70 ng/L、18.52 ng/L、16.00 ng/L、0.00 ng/L.3组受试者血清IFN-γ、IL-2浓度差异无显著性(K-W检验χ2值分别是1.15、4.68,P> 0.05).肺结核组和健康人组受试者血清IL-4、IL-10浓度差异无显著性 (Mann-Whitney 检验Z值分别为-0.27、-1.93, P>0.05),结核性胸膜炎患者血清IL-4浓度明显低于肺结核组(Mann-Whitney检验Z值-2.84,P<0.01).(2)3组受试者血清IFN-γ与IL-4浓度之比依次为胸膜炎组27.93,肺结核组21.72,健康人组10.82,经检验差异无显著性(K-W检验χ2值为4.18,P>0.05).(3)结核性胸腔积液细胞因子浓度(中位数)IFN-γ为832.70 ng/L,IL-2为43.76 ng/L, IL-4为26.00 ng/L, IL-10为38.69 ng/L, 与血清浓度相比较差异有显著性(Wilcoxon Signed Rank检验,Z值分别为-4.34、-2.82、-3.29、-5.15,P<0.05 ).结论免疫功能健全的肺结核和结核性胸膜炎患者其系统的Th1应答相似;而结核性胸膜炎患者系统Th2应答降低,系统Th1/Th2平衡有所上调.结核性胸膜炎患者胸膜局部的Th1/Th2应答较系统明显增强,这可能是结核性胸膜炎病理生理的特征.Th1/Th2免疫应答在结核性胸膜炎病理生理过程中起重要作用,但这种作用的因果关系尚待进一步研究.     

A simple C-reactive protein measurement for the differentiation between tuberculous and malignant pleural effusion

OBJECTIVE: The aim of this study was to determine the validity of pleural fluid C-reactive protein (CRP) concentrations and/or pleural fluid to serum CRP ratio for differentiating tuberculous pleuritis (TBP) from malignant pleural effusion (MPE) in patients presenting with lymphocytic exudative pleural effusions. METHODOLOGY: A cross-sectional study was conducted on 161 patients with pleural effusion who underwent diagnostic evaluation at Siriraj Hospital, Bangkok, Thailand, between April 2001 and March 2002. The complete biochemical analysis of pleural fluid, cultures of pleural fluid, and pathological examinations of pleural fluid and pleural tissue were performed. The CRP concentrations were then measured in stored sera and pleural fluid samples from patients with a lymphocytic exudative pleural effusion and with a definite diagnosis. RESULTS: Among the 148 patients with lymphocytic exudative pleural effusions, 55 were diagnosed with TBP, 60 with MPE, and 33 with non-specific pleuritis. Pleural fluid and serum CRP levels were significantly higher in the TBP group than in the MPE group (54.58 +/- 4.50 mg/L and 106.93 +/- 9.54 mg/L vs 12.66 +/- 3.52 mg/L and 49.66 +/- 8.84 mg/L, respectively, P < 0.001). The ratio of pleural fluid to serum CRP was significantly higher in the TBP group than in the MPE group (0.52 +/- 0.18 vs 0.30 +/- 0.16, P < 0.001). The optimum cut-off value for pleural fluid CRP level of > or =30 mg/dL had a sensitivity of 72% with 93% specificity, and the pleural fluid to serum CRP ratio cut-off value of 0.45 had a sensitivity of 60% with 89% specificity. A correlation between serum and pleural fluid CRP levels was observed in TBP patients but not in MPE patients. CONCLUSION: In patients presenting with lymphocytic exudative pleural effusion, a simple marker of raised pleural fluid CRP level may be helpful in discriminating between TBP and MPE.