上海地区多个肿瘤标志物正常参考值的初步确定

目的通过回顾分析初步建立上海地区健康人群多个肿瘤标志物的参考区间,可为临床应用肿瘤标志物提供依据。方法选择2012年3月至2013年4月期间在复旦大学附属华山医院进行健康体检样本共计604例,采用流式荧光发光法检测血清中甲胎蛋白（AFP）、糖类抗原125（CA125）、细胞角蛋白19片段（CYFRA21-1）癌胚抗原（CEA）、神经元烯醇化酶（NSE）、糖类抗原19-9（CA19-9）、总前列腺特异性抗原（tPSA）浓度值,对浓度值做统计分析。结果 AFP参考值：男性〈10.32ng/mL,女性〈8.12ng/mL;CA125参考值：〈27.02U/mL;CEA参考值：男性〈4.3ng/mL,女性〈3.74ng/mL;NSE参考值：女性青年组（〈45岁）〈11.64ng/mL,女性中老年组（≥45岁）〈15.20ng/mL,男性青年组（〈45岁）〈18.47ng/mL,男性中老年组（45岁）〈20.04ng/mL;CA199参考值：〈20.73U/mL;tPSA参考值：〈1.48ng/mL。结论已经初步建立上海地区各个肿瘤标志物参考区间。     

CEA、CA125和NSE联合检测在肺癌诊治中的应用

为探讨CEA、CA125和NSE三种肿瘤标志物联检在肺癌诊治中的应用及同时测定胸水与血清中三者的水平在肺癌诊断中的差异,采用化学发光免疫分析法分别测定58例肺癌、37例肺良性疾病患者血清和胸水中CEA、CA125和NSE水平.结果显示,肺癌患者胸水中CEA为60.6±23.5ng/mL,CA125为243.4±120.5 U/mL,NSE为33.4±24.5ng/mL,显著高于本组血清中(P<0.01)和肺良性疾病组的血清或胸水中的水平(P<0.01).胸水中三项标志物对肺癌的敏感性分别为67.2%、70.7%、55.2%,而血清中相对应的为51.7%、65.5%、41.4%.胸水中三项联检对肺癌的敏感性达87.1% ,而对应的血清中三项联检对肺癌的敏感性则为81.0%.联合检测CEA、CA125和NSE三项标志物可提高肺癌诊断的敏感性,对诊断和鉴别诊断良、恶性胸水有重要临床价值,测定胸水标志物比血清更有意义.     

12项肿瘤标志物联合检测在卵巢癌诊断中的应用分析

探讨多肿瘤标志物联合检测在卵巢癌的诊断和鉴别诊断中的应用价值.应用多肿瘤标志物蛋白芯片检测33例卵巢癌患者血清12项肿瘤标志物(CA19-9、NSE、CEA、CA242、Ferritin、β- HCG、AFP、PSA、PSA、CA125、HGH及CA15-3),以24例其他妇科恶性肿瘤患者和25例妇科良性病变患者作为对照,分析和比较肿瘤标志物在不同组患者血清中的水平以及各组单项指标及联合检测的阳性率.结果表明:①卵巢癌组的血清CA125、CA19-9、CEA、Ferritin、HGH和CA15-3水平显著高于良性病变组(P＜0.05);其它妇科恶性肿瘤组的血清CA19-9、CEA、Ferritin和CA15-3水平显著高于良性病变组(P＜0.05);②卵巢癌组CA19-9、CEA、Ferritin和 CA125的单项检测阳性率显著高于良性病变组,其中以Ferritin(51.52 %)和CA125(45.45 %)的阳性率最高,单项指标中阳性率在10%以上的6项标志物(CA19-9、CEA、CA242、Ferritin、CA125及CA15-3)的组合检测阳性率 (81.82%)和12项标志物联合检测阳性率(84.85%)均较单项检测有显著提高;其它妇科恶性肿瘤组的CEA和Ferritin的单项检测阳性率显著高于良性病变组 (P＜0.05), 6项标志物组合检测阳性率(83.33 % )及12项标志物联合检测阳性率(87.5 %)均显著高于良性病变组(P＜0.05);③卵巢癌组与其它恶性肿瘤组相比,血清12项标志物水平、各单项指标检测阳性率、6项标志物组合检测阳性率以及12项标志物联合检测阳性率均无显著性差异 (P＞0.05).结论:多肿瘤标志物联合检测有助于提高卵巢癌的检出率和诊断性能,有助于卵巢癌和妇科良性病变的鉴别诊断,但对于卵巢癌与其他妇科恶性肿瘤的鉴别诊断意义不大.     

超检测限AFP、CA19-9稀释后的检测结果对监测原发性肝癌栓塞治疗疗效的临床意义

目的探讨超过检测上限的AFP和CA19-9进行稀释后的检测值对观察肝癌患者栓塞疗效的临床价值。方法将本院2013年1月至2017年12月明确诊断为原发性肝癌,进行栓塞治疗,且AFP或CA19-9治疗前后均超过检测上限的住院患者纳入本研究。将标本进行稀释,AFP稀释100倍,CA19-9稀释10倍,治疗前、后各检测一次。比较AFP和CA19-9治疗前后差异是否有统计学意义。结果治疗有效组AFP、CA19-9治疗前、后结果分别为53217.4±16395.7ng/mL、2949.7±862.5U/mL和36152.8±17614.9ng/mL、1508.7±485.9U/mL,治疗无效组AFP、CA19-9治疗前、后结果分别为58143.5±20345.1ng/mL、2649.8±793.4U/mL和62672.8±23546.2ng/mL、2815.6±827.4U/mL,经过统计学分析,治疗有效组AFP、CA19-9治疗后水平明显降低,差异有统计学意义(P<0.01),治疗无效组AFP、CA19-9治疗后水平差异无统计学意义(P>0.05)。结果部分肝癌患者栓塞治疗前后AFP>1210ng/mL或CA19-9>1000U/mL,超过检测上限,无法判断疗效,将标本进行稀释检测出具体值对观察肝癌患者栓塞疗效的判断具有重要的临床意义。     

四种肿瘤标志物联合检测对胃癌的诊断价值

对已确诊的胃癌患者于术前测量其相关血清肿瘤标志物,分析不同的联合检测对胃癌的诊断价值,选出临床诊断胃癌敏感性最佳的组合。用电化学发光免疫分析法和酶联免疫法测定56例胃癌患者及30名健康对照组的血清CEA、CA19-9、CA72-4、MG7-Ag(胃癌抗原)。结果显示,对照组CEA为2.1±0.8μg/L,CA19-9为14.5±7.3U/mL,CA72-4为4.2±1.3mU/L,MG7-Ag为2.8±1.0μg/L。胃癌患者术前CEA为28.4±91.2μg/L,CA19-9为35.9±71.9U/mL,CA72-4为9.8±40.8U/mL,MG7-Ag为3.6±4.4μg/L。胃癌患者术前血清4项肿瘤标志物中的CEA和CA72-4较对照组有明显增高,有显著性差异(P<0.05)。经分析,4项血清肿瘤标志物的组合中,第11、9、8组合(见正文表3)的敏感性分别是69.6%、63.9%、63.6%。结论是CEA、CA72-4联合检测对胃癌诊断有意义,CEA与CA72-4、MG7-Ag的组合为首选。     

血清肿瘤标志物在胃癌诊断中的临床价值

目的：探讨血清肿瘤标志物在胃癌良恶性诊断的价值。方法选择2012年5月~2014年5月来我院就诊胃部疾病患者115例,其中胃癌患者62例,良性胃病患者53例,同时选择同时期在本院做健康检查的患者100例作为对照组。采用化学发光法检测并比较分析三组的血清肿瘤标志物(癌胚抗原(CEA),糖链抗原19-9(CA19-9),糖链抗原125(CA125),糖链抗原72-4(CA72-4))的表达水平。结果胃癌组患者血清CEA、CA19-9、CA125和CA72-4四种肿瘤标志物表达水平均高于良性胃病组和对照组,差异具有统计学意义(<0.05)。血清肿瘤标志物CEA、CA19-9、CA125和CA72-4对恶性胃部疾病诊断,单独检测灵敏度、特异性以及有效率相对较低,CA72-4单独检测,有效率最高,可达75.88%。而四种指标联合检测灵敏度(83.72%)和特异性(95.63%)较高,有效率可达87.21%。结论血清肿瘤标志物CEA、CA19-9、CA125和CA72-4在胃癌诊断具有较高的临床辅助诊断价值,四种标志物联合应用,具有较高的特异性、灵敏度和诊断有效率,能够有效的应用于胃癌的鉴别诊断。     

肿瘤标志物联合检测对良恶性胸腔积液鉴别诊断的意义

目的探讨癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、CYFRA21-1和铁蛋白(Fer)在鉴别良恶性胸腔积液中的临床意义。方法应用化学发光法对53例恶性胸腔积液和41例良性胸腔积液中的CEA、CA19-9、CYFRA21-1和Fer进行含量检测,并对测定的结果进行比较。结果恶性胸腔积液组的四项指标高于良性组,差异具有统计学意义(P<0.01)。四项肿瘤标志物诊断恶性胸腔积液的阳性率分别为:CEA 75.47%,CYFRA21-1 77.35%,CA19-9 66.03%,Fer 52.8%。四项标志物联合检测阳性率可达90.1%。结论四项肿瘤标志物联合检测对良恶性胸腔积液的鉴别诊断有重要意义。     

肿瘤标志物联合检测对消化系统肿瘤的诊断价值

探讨甲胎蛋白（AFP）、癌胚抗原（CEA）、糖类抗原19-9（CA19-9）、糖类抗原125（CA-125）联合检测对消化系统恶性肿瘤的筛查作用及其适用人群。比较我院行AFP、CEA、CA19-9、CA-125榭则的恶性肿瘤患者和良性消化系疾病患者的四项肿瘤标志物的含量,计算并比较其灵敏度、特异性、准确性、阳性预测值及阴性预测值。结果发现,联合检测CA-125＋CA19-9能明显提高消化道空腔器官的恶性肿瘤诊断的灵敏度,但特异性及阳性预测值下降。联合检测更多的肿瘤标志物并不能使诊断准确性提高。对于消化系统实质器官的恶性肿瘤来说,联合检测肿瘤标志物无实际应用价值。去除肝硬化患者、良性胆道疾病及病毒性肝炎患者可明显提高特异性及灵敏度,联合检测CA-125＋CA19—9对于合适的患者有助于提高消化系统空腔器官恶性肿瘤的早期检出率。     

CEA、CA125、CA19-9联合检测在肺癌诊断中的临床意义

目的探讨CEA、CA125、CA19-9联合检测在肺癌诊断中的临床意义。方法选择本院306例确诊的肺癌患者为观察组,150例肺部良性病变患者为良性对照组,同期健康体检人群150例为正常对照组,观察3组的CEA、CA125、CA19-9血清水平,比较3种肿瘤标志物联合应用及单独应用的灵敏度差异,对结果进行统计学分析。结果观察组与其他两组间肿瘤单项标志物水平有显著差异,联合检测灵敏度比单项肿瘤标志物都高,达到66.3%,准确度达78.1%。结论联合检测CEA、CA125、CA19-9诊断肺癌敏感性好,准确度高,是临床肺癌早期诊断的重要指标。     

肺癌患者血清中游离DNA含量与肿瘤标志物相关性分析

通过对52例肺癌患者、8例肺部良性疾病患者和10名健康人血清游离DNA含量与肿瘤标志物(TM)CA19-9、CA125、CYFRA21-1、CEA和NSE的联合检测,对两种检测结果作相关性分析。将表皮生长因子受体(EGFR)作为肿瘤基因标志物,运用荧光定量RT-PCR方法检测血清游离DNA含量。结果显示,10名健康人血清游离DNA含量平均为18.81ng/mL(范围:0.17~54.64ng/mL)。若以19ng/mL作为血清游离DNA含量的阳性临界值,则87.5%的健康人低于此水平。8例肺部良性疾病患者游离DNA含量均值为76.86ng/mL(范围:5.33~189.7ng/mL),其中4例(50%)高于阳性临界值。52例肺癌患者游离DNA均值为107.6ng/mL(范围:6.39~1617ng/mL),37例(71.2%)的肺癌患者血清游离DNA含量高于正常值。血清游离DNA含量诊断肺癌的价值等同于肿瘤标志物五项指标联合检测。其灵敏度、特异性、准确性分别为:71.15%,50%,68.3%,提示血清游离DNA含量作为一项新颖肿瘤标志物具有潜在的临床诊断价值。     

Photoperiodicity and the function of the hypophysis and the adrenal cortex

Summary The ACTH content of the hypophysis of rats rises from a minimum in the morning to a maximum in the evening hours. These fluctuations are associated with the diurnal rhythm of light and darkness, and are abolished under conditions of continual light or darkness for 30 days. Rhythmic fluctuations of the ascorbic acid content of the adrenals are also found, with maximum values in the evening, and these are likewise abolished by maintenance under conditions of constant illumination.Presented by Active Member AMN SSSR V. V. Parin     

Characteristics of the topographic interrelation of the head of the pancreas and the duodenum and pathology of the organs of the pancreatoduodenal area

Seventy pancreatoduodenal complexes of 55 patients with chronic pancreatitis and tumours of this zone and 15 patients died from other diseases are studies histotopographically . The pieces of the pancreatic head tissue in the medial wall of the duodenum were found in 12 cases of the first group and in 4 control cases. The pancreatic tissue consisted either of all elements of this organ or cystically dilated ducts and seemed to infiltrate different layers of the duodenum wall. Three variants of the pancreatic head structure are suggested on the basis of anatomo-topographical interrelationships of the pancreatic head and duodenum. In 12 out of 14 cases chronic pancreatitis and carcinoma of organs of this zone were combined with the variants of the pancreatic head structure, in 2 cases there was a true heterotopy . Pathogenetic significance of these variants for the development of chronic pancreatitis is discussed.     

指背腱膜滑动与近侧指间关节屈曲关系及临床意义

目的:探讨指背腱膜滑动距离与近侧指间关节(PIP)屈曲关系,为临床修复提供解剖学基础。方法:男性成人新鲜尸体标本10侧30指(示、中、环指各10指),切除手指皮肤,不破坏腱鞘、屈肌支持带、伸肌支持带、内在肌及外在肌,使肌腱保持正常的生理状态,分别测量各指中央束(CS)、侧束(LB)在PIP屈曲45°和90°时的滑动距离。结果:当PIP屈曲45°时,CS滑动距离为(2.7±0.4)mm,LB滑动距离为(2.8±0.6)mm;当PIP屈曲90°时,CS滑动距离为(4.3±0.7)mm,LB滑动距离为(4.8±0.6)mm。结论:指背腱膜滑动距离减少,严重影响手指的屈曲功能。对于指背腱膜的新鲜性损伤应予以精确修复;对于陈旧性损伤的修复应确保指背腱膜的正常滑动范围。     

产后妇女全血钙和骨源性碱性磷酸酶（ABAP）活性的检测与分析

目的结合我院特点,测定来我院进行产后检查妇女的骨源性碱性磷酸酶（ABAP）活性以及全血钙。方法采用金标法测定产妇3031人骨源性碱性磷酸酶（ABAP）的活性,并从中随机选择855人采用BH-5100型多通道原子吸收光谱仪检测全血钙。结果经测定,3031名产妇中679人骨源性碱性磷酸酶（ABAP）的活性异常,异常者检出率为22.4%,其中83.5%的产妇轻度缺钙,而16.5%的产妇严重缺钙;而全血钙异常检出率为17.0%。结论ABAP活性检测方法比全血钙检测方法测定体内钙营养水平更具敏感性,可作为检测评价产妇钙营养状况的一种简易可靠的方法,为产后骨质疏松提供了一种可靠、便捷、科学合理的指标。     

Cycloversion and cyclovergence: the effects of the area and position of the visual display

Rotation of a display in the frontal plane evokes a conjugate nystagmic rotation of the eyes (cycloversion) about the visual axes, with slow phases in the direction of stimulus motion — a response known as torsional optokinetic nystagmus (TOKN). Antiphase rotation of large dichoptic displays evokes a disconjugate rotation of the eyes about the visual axes, a response known as cyclovergence. Using the scleral-coil technique for monitoring eye movements we recorded TOKN evoked by black-and-white sectored displays rotating about the visual axis at an angular velocity of 30°/s. The display was confined to central areas with diameters ranging from 5° to full field or with the central 5° to 75° occluded. A 5° central display evoked TOKN with 40% of the gain for the full-field display and gain increased as a function of the size of the display. The gain of TOKN decreased with increasing size of a central occluder. These characteristics of TOKN are similar to those of horizontal OKN. Cyclovergence was virtually absent with a 5° display but was immune to occlusion of the central 40°. Cyclovergence therefore differs from cycloversion in showing no preference for centrally placed stimuli. These effects are free from the influence of stationary edges, since these were concentric with the stimulus motion. The effects are also free from the influence of voluntary pursuit, since humans do not normally have voluntary control over torsional eye movements.     

Organization and distribution of the upper and lower esophageal motoneurons in the medulla and the spinal cord of the rat

The upper cervical esophagus is exerted on swallowing and peristalsis by somatic and visceral motoneurons, whereas the lower esophagus is exerted on only peristalsis by visceral motoneurons. We examined the origin of the esophageal motoneurons and whether there were any differences between the distributions of the upper and the lower esophageal motoneurons in the medulla and the spinal cord using cholera toxin subunit b (CTb) as the retrograde tracer. Following injection of CTb into the cervical esophagus resulted in heavy labeling of the neurons in the nucleus ambiguus including the compact (AmC), semicompact (AmS) and loose (AmL) formations, and the medial column of lamina IX at the C1-C5 levels of the cervical spinal cord corresponding to the spinal accessory nucleus. A few labeled neurons were found in the inferior salivatory nucleus, the rostral division of the dorsal motor nucleus of the vagus (DMX), the accessory facial nucleus and the lateral column of lamina IX at the C2 and C3 levels. All these labeled neurons showed ChAT immunoreactivity. When CTb was injected into the cut end of the unilateral recurrent laryngeal nerve, many labeled neurons were found in the ipsilateral AmC, the AmL, and the bilateral medial column at the C1 and C2 levels. Following injection of CTb into the subdiaphragmatic esophagus resulted in heavy labeling of the neurons only in the AmC and the DMX. When CTb was injected into the sternomastoid muscle, many labeled neurons were found in the medullary reticular formation, the facial nucleus, the medial column at the C1-C3, C5 and C6 levels, and the lateral column at the C2, C3, C5 and C6 levels. Injections of a Fluoro-Gold into the cervical esophagus and a CTb into the sternomastoid muscle or the subdiaphragmatic esophagus in the same animal showed many double labeled neurons in the medial column of the accessory nucleus at the C1 and C2 levels, but no double labeled neurons in the AmC. These results indicated that the upper cervical esophagus is innervated by the visceral medullary vagal motoneurons as well as the somatic spinal accessory motoneurons. The lower esophagus is innervated only by the visceral medullary vagal motoneurons.