肿瘤患者血循环免疫复合物与尿N—乙酰—β—θ—氨基酸葡萄糖苷酶的相关性研

观察恶性肿瘤患者血中循环免疫复合物（ＣＩＣ）及尿中肾小管标志蛋白水平变化，探讨两者间相关关系及其意义。采用ＰＥＧ沉淀比浊法血检测血ＣＩＣ水平；采用化学显色终点法定量检测尿ＮＡＧ活力，共检测治疗前后恶性肿瘤患者４９例，结果：肿瘤患者血ＣＩＣ及尿ＮＡＧ均较正常对照明显增高，且治疗前较治疗后增高显著，血ＣＩＣ与尿ＮＡＧ水平变化是相关。结果表明恶性肿瘤水ＮＡＧ活力显著增高怀肿瘤相关抗原所致ＣＩＣ水平有关     

糖尿病肾病早期诊断检测指标的临床应用

目的检测糖尿病肾病（diabetic nephropathy，DN）早期诊断指标，更好更及时地预防和治疗DN患者.方法采用日立7060全自动生化分析仪，分别检测56例DN患者的尿微量白蛋白（mALB）、尿α1-微球蛋白（u-α1m）和尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）的水平，并与50例健康者进行比较。结果糖尿病肾病患者尿mALB含量明显增高，与健康组比较，有非常显著性差异（P〈0．01）；u-α1m、NAG含量增高，与健康对照组对比，差异有显著性（P〈0．05）。结论检测尿mALB、u-α1m、NAG的含量，对糖尿病肾病患者的早期发现、诊断与治疗肾损害具有重要的临床意义。     

尿NAG、血SCr对早期糖尿病肾病的诊断价值

目的 探讨尿N-乙酰-B-D氨基葡萄糖苷酶（NAG）、血肌酐（SCr）检测对早期糖尿病肾病的诊断价值.方法 对30例2型糖尿病患者及30名健康体检者分别进行NAG、SCr测定.NAG测定采用比色法,SCr由全自动生化分析仪测定.结果 观察组尿NAG水平明显增高,与健康组相比,差异有统计学意义（P〈0.01）;血清SCr水平与对照组相比有所增高,两组相比差异有统计学意义（P〈0.05）.结论 NAG、SCr检测可提高诊断的阳性率,对早期糖尿病肾病的诊断有重要价值.     

血清CA19-9、YkL-40及AkT水平联合诊断子宫内膜肿瘤的临床价值

目的：探讨血清中糖类抗原19-9（CA19-9）、甲壳质酶蛋白-40（YkL-40）及蛋白激酶（AkT）水平在诊断子宫内膜肿瘤中联合检测的临床应用价值。方法选取100例子宫内膜肿瘤患者为观察组，另收集同期进入我院体检的健康者100例为健康组，分别检测2组血清CA19-9、YkL-40及AkT水平，比较各血清指标对诊断子宫内膜肿瘤的敏感度、特异度和准确度。结果观察组血清CA19-9、YkL-40及AkT水平较健康组显著性增高（P＜0.05）；CA19-9、YkL-40及AkT联合检测敏感度、特异度和准确度较各指标单独检测显著增高（ P ＜0.05），敏感度可达94.0％，特异度可达96.0％，准确度可提高至95.0％。结论血清中CA19-9、YkL-40及AkT水平与子宫内膜肿瘤显著相关，联合3项指标进行检测子宫内膜肿瘤具有较高的敏感度、特异度和准确度，能更好的辅助临床对子宫内膜肿瘤的诊断。     

uNGAL联合尿NAG对危重症患者急性肾损伤病情及预后的评估价值#br#

摘要：目的　探讨尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）联合尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）对危重症患者急性肾损伤（AKI）病情及预后的评估价值。方法　选取危重症合并AKI的患者101例（AKI组）和同期收治的非AKI患者27例（对照组）。比较2组患者入院后24 h内血肌酐、血钾、血白蛋白和阴离子间隙（AG）、uNGAL、尿NAG、尿蛋白、尿微量白蛋白的差异。AKI组患者根据肾功能损伤严重程度分为Stage 1组（40例）,Stage 2组（36例）和Stage 3组（25例）,另根据患者出院时存活情况,分为存活组（63例）和死亡组（38例）。比较不同严重程度及不同生存状态间上述指标的差异。应用Logistic回归分析危重症患者AKI预后的独立影响因素,受试者工作特征（ROC）曲线评价uNGAL联合尿NAG对危重症患者AKI预后的评估价值。结果　（1）与非AKI组相比,AKI组uNGAL、尿NAG、尿蛋白、尿微量白蛋白、血肌酐水平升高,血清白蛋白水平降低（P＜0.01）。亚组分析结果显示,随着病情的加重,AKI组uNGAL、尿NAG和血肌酐水平均出现明显升高（P＜0.05）;同时死亡组uNGAL、尿NAG、尿微量白蛋白、尿蛋白及血肌酐高于存活组,血清白蛋白低于存活组（P＜0.05）。Logistic回归分析显示,uNGAL和尿NAG升高是影响患者预后的独立危险因素,ROC曲线显示uNGAL联合尿NAG预测预后的曲线下面积（0.886）优于uNGAL（0.850）、尿NAG（0.784）。结论　uNGAL联合尿NAG检测有助于对危重症患者急性肾损伤的危险分层和预后评估。     

缬沙坦-氢氯噻嗪合用治疗高血压早期肾损害的疗效

目的：评价缬沙坦．氢氯噻嗪合用治疗原发性高血压早期肾损害的有效性和安全性。方法：选择64例原发性高血压合并血、尿132微球蛋白增高的患者,采用单盲法随机分成2组：缬沙坦-氢氯噻嗪组32例,服用缬沙坦80mg、氢氯噻嗪12．5mg每日一次;缬沙坦组32例,服用缬沙坦80mg,每日一次,疗程为2个月。治疗前后分别检测患者静态血压和动态血压、血尿素氮、血肌酐、尿α1,微球蛋白、血和尿β2微球蛋白、尿微量白蛋白,比较治疗前后的变化。结果：单用缬沙坦或缬沙坦．氢氯噻嗪合用后,患者SBP、DBP均显著下降,缬沙坦-氢氯噻嗪组降压幅度比缬沙坦组显著（P〈0．01）;两组治疗后血和尿β2-微球蛋白、尿微量白蛋白含量均显著下降（P〈0．01）,缬沙坦-氢氯噻嗪组较缬沙坦组下降更显著（P〈0．01）;两组血肌酐、血尿素氮、尿α1微球蛋白较治疗前也均有下降（P〈0．05）。结论：缬沙坦-氢氯噻嗪合用与缬沙坦单用均能有效降低血压、血和尿β2-微球蛋白、尿微量白蛋白含量,对高血压患者早期肾功能损害有一定保护作用,合用效果优于单用。     

血清 HE4水平在恶性肿瘤患者中的表达及临床意义

目的：观察恶性肿瘤患者血清人附睾上皮分泌蛋白（ HE4）水平的相关性。方法用ELISA方法检测297例恶性肿瘤患者和55例良性肿瘤患者及55例健康对照组。结果恶性肿瘤患者血清HE4水平明显高于良性肿瘤及对照组（ P ＜0．05），血清HE4水平与肿瘤转移呈显著正相关（ P ＜0．05）。结论血清HE4水平与恶性肿瘤及肿瘤转移相关，HE4可能在疾病的发展过程及预后中有重要的作用。     

联合检测CA19-9、CEA、AFP和Fer对消化道恶性肿瘤的诊断价值

目的探讨联合检测血清糖类抗原19-9（CA19-9）、癌胚抗原（CEA）、甲胎蛋白（AFP）和铁蛋白（Fer）对消化道恶性肿瘤的临床诊断价值。方法用电化学发光法检测恶性消化道肿瘤183例和良性消化道疾病患者及健康体检者各40例血清肿瘤标志物的含量。结果在消化道恶性肿瘤患者和消化道良性疾病患者血清各肿瘤标志物水平均有上升,而四项联合检测的检出率较单一肿瘤标志物在消化道恶性肿瘤中有显著升高。结论联合检测血清CAl9-9、CEA、AFP和Fer水平,能显著提高对消化道肿瘤诊断的灵敏度。     

糖尿病患者血尿酸、肌酐及尿N-乙酰-β-D氨基葡糖苷酶的相关性研究

目的探讨糖尿病(DM)患者血尿酸、血肌酐、尿N-乙酰-β-D氨基葡糖苷酶(NAG)测定的相关性。方法检测62例糖尿病患者[尿微量白蛋白正常(尿微量白蛋白<30mg/24h)41例(DM-1组)、升高(30mg/24h<尿微量白蛋白<300mg/24h)21例(DM-2组)]血生化(尿酸、肌酐)指标及尿NAG水平,并对尿NAG与血生化指标(尿酸、肌酐)的相关性进行分析。结果 DM-2组尿NAG均显著高于DM-1组(P<0.01),其升高与血尿酸呈正相关,与血肌酐无明显相关性。结论尿NAG在早期预测与筛选糖尿病肾病(DN)方面灵敏度高,是DN的早期诊断有价值的指标。     

一氧化氮在肺感染中损伤作用机制探讨

观察４０例肺感染患者血中一气体氮（ＮＯ）及肿瘤坏死因子（ＴＮＦ）、超氧化物歧化酶（ＳＯＤ）、丙二醛（ＭＤＡ）水平变化，并与３０例正常人进行对比，同时对治疗后的１８例患者各指标的变化进行了观察。结果显示：患者血清ＮＯ及ＴＮＦ、ＭＤＡ水平较对照组显著增高（Ｐ〈０．０１），ＳＯＤ则显著降低（Ｐ〈０．０１），治疗后较治疗前血清ＮＯ、ＴＮＦ及ＭＤＡ水平显著降低（Ｐ〈０．０５），而ＳＯＤ活性则显著回升（Ｐ〈０     

The apoptotic effect of Zoledronic acid on the nasopharyngeal carcinoma cells via ROS mediated chloride channel activation

Zoledronic acid (ZA), a third‐generation bisphosphonate, has been applied for treatment of bone metastases caused by malignant tumors. Recent studies have found its anti‐cancer effects on various tumor cells. One of the mechanisms of anti‐cancer effects of ZA is induction of apoptosis. However, the mechanisms of ZA‐induced apoptosis in tumor cells have not been clarified clearly. In this study, we investigated the roles of chloride channels in ZA‐induced apoptosis in nasopharyngeal carcinoma CNE‐2Z cells. Apoptosis and chloride current were induced by ZA and suppressed by chloride channel blockers. After the knockdown of ClC‐3 expression by ClC‐3 siRNA, ZA‐induced chloride current and apoptosis were significantly suppressed, indicating that the chloride channel participated in ZA‐induced apoptosis may be ClC‐3. When reactive oxygen species (ROS) generation was inhibited by the antioxidant N‐acetyl‐L‐cysteine (L‐NAC), ZA‐induced apoptosis and chloride current were blocked accordingly, suggesting that ZA induces apoptosis through promoting ROS production and subsequently activating chloride channel.     

N-乙酰半胱氨酸对重型病毒性肝炎患者血清一氧化氮水平的影响

目的探讨一氧化氮(NO)在慢性重型病毒性肝炎(慢重肝)早期中的作用以及N-乙酰半胱氨酸(NAC)治疗重肝对NO水平的影响,为重肝提供新的治疗方法.方法采用夹心酶联免疫吸附法(ELISA法)分析65例重肝患者血清NO的水平表达,以及动态变化;通过NAC治疗组(29例)与综合治疗组(36例)的自身治疗前、后及治疗后两组中疗效的对比,观察NAC治疗30d后对NO水平表达的变化.结果重肝患者血清NO水平较正常对照组有非常显著性增高.NAC治疗组血清NO自身治疗前、后比较有非常显著性意义.对NAC治疗组NO与SB、PTA相关性分析发现,治疗前、后NO与SB改变均呈显著正相关,与PTA改变均呈显著负相关.结论 NO水平变化与重肝损伤程度密切相关,可作为判定重肝早期指标之一;NAC可降低NO水平,NAC治疗重肝有效.     

Renal protection by radical scavenging in cardiac surgery patients

OBJECTIVE: Renal function impairment is a common complication in cardiac surgery patients. Because cardiopulmonary bypass and cardioplegic arrest are associated with formation of free radicals, which have been shown to impair various organs including the kidneys, radical scavenging may protect renal function. Therefore, the purpose of our study was to evaluate the impact of the radical scavenger N-acetylcysteine (NAC) versus placebo on peri-operative renal function in cardiac surgery patients. RESEARCH DESIGN AND METHODS: We reanalyzed the data of our previous study in which 40 coronary artery surgery patients (66 +/- 9 [SD] years, 9 women and 31 men) with normal pre-operative renal function had been randomized in a double-blind fashion to receive either NAC (100 mg/kg into the cardiopulmonary bypass prime followed by infusion at 20 mg/kg/h; n = 20) or placebo (n = 20). We determined serum creatinine levels as an indicator for renal function pre- and at 1 day post-surgery as well as peri-operative urinary output and diuretic medication. Creatinine clearance was calculated according to Cockcroft and Gault. RESULTS: Biometric and intra-operative patient data were similar between both groups. In the placebo group, serum creatinine increased from 93.1 +/- 35.4 micromol/L pre-operatively to 115.9 +/- 47.2 micromol/L on post-op day 1 (p < 0.001). In contrast, serum creatinine in the NAC group remained unchanged (92.3 +/- 31.3 micromol/L pre-op; 99.3 +/- 25.4 micromol/L on post-op day 1; p = 0.084). Accordingly, creatinine clearance decreased by 16.9 +/- 14.3 mL/min in the placebo group as compared to 7.5 +/- 17.7 mL/min in the NAC group (p = 0.039). Urinary output and diuretic medication were similar between NAC and placebo. CONCLUSIONS: Our data suggest that free radical-scavenging using NAC protects renal function in patients subjected to cardiac surgery on cardiopulmonary bypass.     

Neoadjuvant systemic therapy for breast cancer: an overview and review of recent clinical trials

Neoadjuvant chemotherapy (NAC) is long established as part of the multi-modality management of locally advanced breast cancer or inflammatory breast cancer, leading to significantly improved outcome. Numerous recent studies have compared the use of anthracycline-based NAC with adjuvant chemotherapy in earlier-stage disease, and have shown equivalent disease-free and overall survival rates with increased breast conservation rates. These studies have also shown that a pathological complete response after NAC is associated with improved long-term outcome. More recently, the taxanes have been introduced into clinical trials of NAC with increased overall and pCR rates. However, there is no evidence that the addition of taxanes to neoadjuvant anthracycline-based chemotherapy significantly improves long-term disease free survival or overall survival. This paper reviews these trials, as well as trials of dose-dense and trastuzumab-containing NAC regimens. The review discusses the potential for NAC to replace prolonged adjuvant trials in the assessment of new therapeutic agents (using pathological complete response as a surrogate for long-term outcome), to be used as an in vivo chemosensitivity assay to guide further treatment, and to identify molecular markers that correlate with tumour sensitivity or resistance to chemotherapeutic agents so that the treatment of patients can be individualised.     

Treatment of chronic cadmium nephrotoxicity by N-acetyl cysteine

Chronic cadmium (Cd)-induced nephrotoxicity is believed to be irreversible at advanced stages and no treatment is currently available. This study examined the beneficial effect of N-acetyl cysteine (NAC) on Cd-induced nephrotoxicity. Female Sprague-Dawley rats were injected s.c. with 5 micromol CdCl2/kg per day, five times/week for up to 26 weeks. Nephrotoxicity was detected after 10 weeks by elevation in urinary lactate dehydrogenase activity and protein. NAC co-administration from week 13 prevented the progression of nephrotoxicity. In these animals, with low-level nephrotoxicity, discontinuation of Cd exposure at the end of week 22 resulted in gradual recovery over the next several weeks, without the need for treatment with NAC. On the other hand, discontinuation of NAC co-treatment at the end of week 22 resulted in quick progression of nephrotoxicity, indicating that NAC protection was short-lived. Resumption of NAC treatment and cessation of Cd exposure after 26 weeks resulted in rapid recovery from advanced nephrotoxicity. It is concluded that protection from Cd-induced nephrotoxicity is possible by continued co-administration of NAC and that recovery from advanced nephrotoxicity can also be achieved with NAC, provided that Cd exposure is stopped.     

Neoadjuvant systemic therapy for breast cancer: an overview and review of recent clinical trials

Neoadjuvant chemotherapy (NAC) is long established as part of the multi-modality management of locally advanced breast cancer or inflammatory breast cancer, leading to significantly improved outcome. Numerous recent studies have compared the use of anthracycline-based NAC with adjuvant chemotherapy in earlier-stage disease, and have shown equivalent disease-free and overall survival rates with increased breast conservation rates. These studies have also shown that a pathological complete response after NAC is associated with improved long-term outcome. More recently, the taxanes have been introduced into clinical trials of NAC with increased overall and pCR rates. However, there is no evidence that the addition of taxanes to neoadjuvant anthracycline-based chemotherapy significantly improves long-term disease free survival or overall survival. This paper reviews these trials, as well as trials of dose-dense and trastuzumab-containing NAC regimens. The review discusses the potential for NAC to replace prolonged adjuvant trials in the assessment of new therapeutic agents (using pathological complete response as a surrogate for long-term outcome), to be used as an in vivo chemosensitivity assay to guide further treatment, and to identify molecular markers that correlate with tumour sensitivity or resistance to chemotherapeutic agents so that the treatment of patients can be individualised.     

N-Acetylcysteine prevents ifosfamide-induced nephrotoxicity in rats

BACKGROUND AND PURPOSE: Ifosfamide nephrotoxicity is a serious adverse effect for children undergoing cancer chemotherapy. Our recent in vitro studies have shown that the antioxidant N-acetylcysteine (NAC), which is used extensively as an antidote for paracetamol (acetaminophen) poisoning in children, protects renal tubular cells from ifosfamide-induced toxicity at a clinically relevant concentration. To further validate this observation, an animal model of ifosfamide-induced nephrotoxicity was used to determine the protective effect of NAC. EXPERIMENTAL APPROACH: Male Wistar albino rats were injected intraperitoneally with saline, ifosfamide (50 or 80 mg kg(-1) daily for 5 days), NAC (1.2 g kg(-1) daily for 6 days) or ifosfamide+NAC (for 6 days). Twenty-four hours after the last injection, rats were killed and serum and urine were collected for biochemical analysis. Kidney tissues were obtained for analysis of glutathione, glutathione S-transferase and lipid peroxide levels as well as histology analysis. KEY RESULTS: NAC markedly reduces the severity of renal dysfunction induced by ifosfamide with a significant decrease in elevations of serum creatinine (57.8+/-2.3 vs 45.25+/-2.1 micromol l(-1)) as well as a reduced elevation of beta2-microglobulin excretion (25.44+/-3.3 vs 8.83+/-1.3 nmol l(-1)) and magnesium excretion (19.5+/-1.5 vs 11.16+/-1.5 mmol l(-1)). Moreover, NAC significantly improved the ifosfamide-induced glutathione depletion and the decrease of glutathione S-transferase activity, lowered the elevation of lipid peroxides and prevented typical morphological damages in renal tubules and glomeruli. CONCLUSIONS AND IMPLICATIONS: Our results suggest a potential therapeutic role for NAC in paediatric patients in preventing ifosfamide nephrotoxicity.     

缬沙坦对慢性肾衰竭高血压患者血浆内皮素的影响及临床意义

目的 :观察缬沙坦对慢性肾衰竭 (CRF)合并高血压患者血浆内皮素 (ET)、降钙素基因相关肽 (CGRP)含量、尿蛋白和Q -T离散度 (Q -Td)的影响。方法 :将慢性肾衰竭患者分为血压升高组 (研究组 )24人 ,口服缬沙坦80mg/d ,共治疗4wk ;血压正常组 (对照组 )20人 ,健康对照组9人 ,分别测定研究组用药前、后与对照组及健康组的血浆ET和CGRP含量、24h尿蛋白定量及Q -Td。结果 :(1)CRF患者血浆ET含量均高于健康组 ,且CRF研究组高于CRF对照组 ,药物治疗后ET含量下降 ;(2)CRF患者血浆CGRP含量高于健康组 ,且CRF研究组高于CRF对照组 ,药物治疗后CGRP含量明显升高 ;(3)CRF患者尿蛋白高于健康组 ,且CRF研究组高于对照组 ,药物治疗后尿蛋白减少 ;(4)CRF患者合并高血压后Q -Td明显比对照组及健康组延长 ,药物治疗后无明显改变。结论 :缬沙坦可治疗CRF合并高血压患者 ,有效降血压、降尿蛋白 ,延缓肾功能恶化 ,但无逆转心血管重塑的作用     

N—乙酰半胱氨酸对缓解期肺心病的抗氧化和免疫调节作用

目的：研究Ｎ－乙酰半胱氨酸（ＮＡＣ）对缓解期肺心病的抗氧化和免疫调节作用。方法：３８例肺心病缓解期患者予ＮＡＣ ６００ ｍｇ．ｐｏ,ｑｄ,共６ｍｏ。比较治疗前和治疗后１,３,６ｍｏ血清ＭＤＡ,ＣＤ３,ＣＤ４,ＣＤ８水平,并与健康志愿者（对照组）比较。结果：与对照组比较肺心病缓解期ＭＤＡ明显升高（Ｐ＜０．０５）,而ＣＤ４显著降低（Ｐ＜０．０１）;经ＮＡＣ治疗后ＭＤＡ、ＣＤ４分别于１,３ｍｏ月恢复正常。结论：ＮＡＣ能降低肺心病缓解期患者的过氧化物水平,捉高免疫力,有可能减少急性加重的发生。     

缬沙坦对慢性肾衰竭合并高血压患者血浆内皮素的影响及临床意义

目的:观察缬沙坦对慢性肾衰竭（CRF）合并高血压患者血浆内皮素（ET）、降钙素基因相关肽（CGRP）含量、尿蛋白和Q-T离散度（Q-Td）的影响。方法:将慢性肾衰竭患者分为血压升高组（研究组）24人,口服缬沙坦80mg/d,共治疗4wk;血压正常组（对照组）20人,健康对照组9人,分别测定研究组用药前、后与对照组及健康组的血浆ET和CGRP含量、24h尿蛋白定量及Q-Td。结果:（1）CRF患者血浆ET含量均高于健康组,且CRF研究组高于CRF对照组,药物治疗后ET含量下降;（2）CRF患者血浆CGRP含量高于健康组,且CRF研究组高于CRF对照组,药物治疗后CGRP含量明显升高;（3）CRF患者尿蛋白高于健康组,且 CRF研究组高于对照组,药物治疗后尿蛋白减少;（4）CRF患者合并高血压后 Q-Td明显比对照组及健康组延长,药物治疗后无明显改变。结论:缬沙坦可治疗CRF合并高血压患者,有效降血压、降尿蛋白,延缓肾功能恶化,但无逆转心血管重塑的作用。