蓝激光内镜联合化学染色与白光内镜对上消化道早癌检出情况对比研究

摘 要：［目的］探究蓝激光内镜联合化学染色对上消化道早癌及癌前病变的诊断价值。［方法］ 回顾性分析2019年1月至2021年12月行胃镜检查的患者6 332例,根据患者所用内镜及检查过程不同分为蓝激光组与白光组,比较两组患者上消化道早癌及高级别上皮内瘤变、低级别上皮内瘤变及癌前状态的检出情况。［结果］ 蓝激光组上消化道癌及高级别上皮内瘤变检出率为1.63%（42/2 576）,高于白光组的0.85%（32/3 756）,差异有统计学意义（χ2=8.017,P=0.005）。蓝激光组低级别上皮内瘤变及癌前状态检出率为41.15%（1 060/2 576）,高于白光组的37.78%（1 419/3 756）,差异有统计学意义（χ2=7.282,P=0.007）。蓝激光组食管、贲门、胃的活检率均高于白光组,差异有统计学意义（χ2=4.069,P=0.044;χ2=4.010,P=0.045;χ2=28.757,P＜0.001）;蓝激光组对癌性病变及高级别上皮内瘤变早诊率高于白光组,差异有统计学意义（χ2=5.367,P=0.021）。［结论］ 蓝激光内镜联合化学染色可以提高活检率,从而提高上消化道早癌及高级别上皮内瘤变、低级别上皮内瘤变及癌前状态的检出率、早诊率,有利于上消化道癌早诊早治项目的推广。     

不同级别胃黏膜上皮瘤变组织TLR4表达与HP感染的相关性研究

目的：观察低级别和高级别上皮瘤变组织和胃癌组织TLR4的表达和HP感染的关系,探讨两者的相关性。方法：应用免疫组化方法检测30例正常胃黏膜,30例低级别上皮内瘤变组织,30例高级别上皮内瘤变组织及30例胃癌组织中的TLR4的表达。利用^14C幽门螺杆菌呼气试验及改良Giemsa染色法检测HP,两项均阳性者诊断为HP感染。结果：TLR4在低级别上皮内瘤变组的阳性表达率为90．0％,高级别上皮内瘤变组为86．7％,胃癌组63．3％,正常组26．7％,HP阳性率在低级别上皮内瘤变组为93．3％,高级别上皮内瘤变组90％,正常组33．3％;低级别上皮内瘤变组、高级别上皮内瘤变组、胃癌组TLR4阳性率与正常组比较,P〈0．05,低级别上皮内瘤变组、高级别上皮内瘤变组TLR4阳性率与胃癌组比较,P〈0．05。TLR4表达与HP感染检测结果：HP感染的胃黏膜组织TLR4的阳性表达率为83．53％,HP阴性组TLR4阳性表达率为25．71％,TLR4表达和HP感染具有相关性r=0．152,P=0．012。HP感染与不同级别胃黏膜上皮瘤变组织TLR4表达的相关性检测结果：低级别胃黏膜组织11LR4的阳性表达率为88．89％,高级别胃黏膜组织为88．00％。胃黏膜上皮组织瘤变级别与TLR4表达无相关性,P〉0．05。结论：低级别上皮瘤变和高级别上皮瘤变胃黏膜组织TLR4的阳性表达明显高于胃癌组织;HP感染和TLR4阳性表达呈正相关,HP感染的不同级别胃黏膜上皮瘤变组织之间TLR4表达无相关性。     

microRNA34a／p53信号通路在大鼠肺鳞癌发生过程中的表达及意义

目的：探讨microRNA34a／p53信号通路在大鼠肺癌发生过程中的表达及意义。方法：用免疫组化检测大鼠模型不同组织中p53蛋白表达情况;qRT－PCR技术检测正常大鼠肺组织、低级别上皮内瘤变、高级别上皮内瘤变（原位癌）、浸润癌中microRNA34a的相对表达量。结果：p53蛋白阳性表达率在正常对照组0（0／40）、低级别上皮内瘤变组45．5％（5／11）、高级别上皮内瘤变组（原位癌）76．5％（13／17）和浸润性癌组80．0％（16／20）中表达逐渐增高,阳性强度增高。p53蛋白在正常对照组与低、高级别上皮内瘤变、浸润癌阳性表达比较,差异有统计学意义（P＜0．05）。microRNA34a在正常对照组、低级别上皮内瘤变组、高级别上皮内瘤变组、浸润癌组中平均表达量逐渐降低,分别为0．9890±0．0942、0．8654±0．0356、0．0446±0．0017、0．0091±0．0041,浸润癌表达水平显著低于对照组、低级别上皮内瘤变组、高级别上皮内瘤变组（P＜0．05）。p53蛋白与microRNA34a在肺癌中的表达呈负相关性（P＜0．01）。结论：microRNA34a／p53通路与肺癌的发生发展具有密切关系,联合检测有利于肺癌的早期诊断。     

胃黏膜瘤变过程中差异蛋白的表达

目的 探讨胃癌发生发展的不同阶段（正常胃黏膜组织、反应性增生、低级别上皮内瘤变、高级别上皮内瘤变及黏膜内腺癌）差异蛋白的表达。方法 以胃窦部肠型胃癌为研究对象,选取正常、反应性增生、低/高级别上皮内瘤变、黏膜内癌5组各30例共150例组织标本,用非标记蛋白质组学（labelfree）联合液性色谱质谱（LC-MC/MC）筛选差异蛋白,并评估差异蛋白潜在的生物学功能。结果 筛选出了8个差异蛋白,和正常黏膜相比,在低级别上皮内瘤变—高级别上皮内瘤变及黏膜内癌的发展过程中,LAMN1、ERGIC1、UQCRFS1、UQCRH和CISD1这5个蛋白质的表达量逐渐降低,表达量逐渐升高的蛋白质有HMGB1、DNA-PKcs和14-3-3。结论 在胃癌发生发展的不同阶段,蛋白质的表达存在明显的差异,这些差异蛋白具有成为胃癌早期诊断及靶向分子治疗标志物的潜能。     

卢戈液染色内镜诊断早期食管癌的作用

卢戈液已被广泛应用于内镜染色诊断食管疾病。作者报告应用该液染色内镜诊断10例早期食管癌,并经手术切除证实。男9例,女1例。年龄46～72岁,平均63.8±8.3岁。10例病人的食管共有17个病变,其中有4个和3个病灶者各1例,有2个病灶者2例,余6例为单个病灶。病变位于食管下段3个,中段10个,上段4个。17个病变均为鳞状细胞癌。病变限于上皮层10个,粘膜层7个。     

DNA定量分析联合高危型HPV检测对高级别CIN的检出价值

目的:研究宫颈细胞DNA定量分析联合高危型HPV检测在诊断高级别宫颈上皮内瘤变（cervical intraepithelial neoplasia,CIN）的应用价值。方法:收集220例有DNA定量分析、宫颈薄层液基细胞学检查（thinprep cytology test,TCT）、二代杂交捕获（hybrid capture II,HC2)检测高危型人乳头瘤病毒（human papillomavirus,HPV）及宫颈活检资料的病例。结果:以宫颈活检组织病理学为诊断标准,220例活检中60例病理组织学为高级别宫颈上皮内瘤变的病例,DNA定量分析对检测高级别CIN的敏感性为96.7%,特异性为25.0%,阳性预测值为32.6%,阴性预测值为95.2%,而TCT及HC2的敏感性、特异性、阳性预测值及阴性预测值分别为96.7%、3.8%、27.4%、75.0%及98.3%、38.8%、37.6%、98.4%。DNA定量分析除敏感性以外,其他指标均高于TCT检测,而低于HC2检测。DNA定量分析及HC2检测均阴性的病例,阴道镜活检无高级别鳞状上皮内瘤变病例。结论:DNA定量分析在诊断高级别宫颈上皮内瘤变中优于TCT,与HC2检测联用可提高诊断高级别宫颈上皮内瘤变的敏感性和特异性。     

食管癌、胃癌均高发地区应用内镜对上消化道癌筛查的探讨

[目的]探讨在食管癌、胃癌均高发地区采用内镜对上消化道癌(食管癌、胃癌)联合筛查的价值.[方法]采用流行病学调查、血清胃蛋白酶原(PG)检测、内镜活检和病理检查同时进行的方法,对武威市凉州区40～69岁无症状,有上消化道病史、食管癌和胃癌家族史志愿者进行上消化道癌筛查.[结果]共筛查2 005人,上消化道癌检出率0.65％(13/2005),其中食管癌0.15％(3/2005),胃癌0.50％(10/2005);早期食管癌检出率100.00％(3/3),早期胃癌检出率30.00％(3/10),进展期胃癌为70.00％ (7/10);食管重度异型增生/原位癌、中度异型增生检出率分别为0.15％ (3/2005)、0.20％ (4/2005);胃高级别上皮内瘤变、低级别上皮内瘤变、肠上皮化生及萎缩性胃炎检出率分别为0.20％(4/2005)、12.62％ (253/2005)、10.92％(219/2005)和19.50％(391/2005).以PG Ⅰ≤70ng/ml,PG Ⅰ/Ⅱ≤7.0作为PG单筛胃癌临界值,PG阴性1 280人(63.84％),阳性725人(36.16％);PG阳性者中胃癌检出率0.69％ (5/725),高级别上皮内瘤变、低级别上皮内瘤变、肠上皮化生及萎缩性胃炎检出率分别为0.28％ (2/725)、16.69％(121/725)、16.00％(116/725)、22.34％(162/725);PG阴性者胃癌检出率0.39％(5/1280),高级别上皮内瘤变、低级别上皮内瘤变、肠上皮化生及萎缩性胃炎检出率分别为0.16％(2/1280)、10.31％(132/1280)、8.05％(103/1280)、17.89％(229/1280).PG阳性与PG阴性的胃癌及其癌前病变检出率有显著性差异(P＜0.01).PG阴性1 280人中,检出食管癌2例,重度异型增生/原位癌1例;PG阳性725人中,检出食管癌1例,重度异型增生/原位癌2例.[结论]在食管癌、胃癌高发区直接应用内镜对上消化道癌进行筛查,能最大限度降低上消化道癌的漏诊,使设备、技术、经费及卫生资源得到充分利用.     

结直肠上皮内瘤变中LGR5的表达及其意义

目的检测干细胞标记物LGR5(富含亮氨酸重复单位的G蛋白偶联受体5)蛋白在人结直肠上皮内瘤变中的表达,探讨与其临床病理特征的关系。方法采用免疫组织化学染色法,分别检测60例结直肠上皮内瘤变(腺瘤并高级别上皮内瘤变32例,腺瘤并低级别上皮内瘤变28例)、10例腺瘤,20例高分化腺癌标本中LGR5表达水平。结果LGR5在高分化腺癌中表达率为100.00%(20/20),明显高于结直肠上皮内瘤变[83.33%(50/60)]和腺瘤[40.00%(4/10)],P<0.01。高级别上皮内瘤变组和低级别上皮内瘤变组中其阳性表达率分别为84.37%(27/32)、82.14%(23/28),LGR5表达水平与结直肠上皮内瘤变病理分级无相关性(P>0.05)。结论 LGR5可作为选择结直肠上皮内瘤变手术方式的重要参考指标。     

CDC2在食管鳞状细胞癌及癌前病变中的表达与临床意义

目的 探讨细胞周期调控蛋白CDC2在食管鳞状细胞癌及癌前病变中的表达及临床意义.方法 利用组织芯片技术和免疫组织化学方法,检测了241例食管鳞状细胞癌及癌前病变组织中CDC2表达水平,分析蛋白表达模式与临床病理参数的相关性.结果 在正常食管黏膜鳞状上皮-低级别上皮内瘤变-高级别上皮内瘤变-浸润性癌序列病变中,CDC2阳...     

p16INK4a和Ki67在胃癌及癌前病变中的表达和意义

目的:探讨p16INK4a、Ki67在慢性胃炎、胃上皮内瘤变、胃癌及癌旁非肿瘤性胃黏膜中的表达和临床意义。方法:采用免疫组织化学SP法检测23例慢性胃炎、16例胃低级别上皮内瘤变、16例胃高级别上皮内瘤变、45例胃癌及癌旁非肿瘤性胃黏膜组织样本中p16INK4a、Ki67的表达。结果:p16INK4a在慢性胃炎、低级别上皮内瘤变、高级别上皮内瘤变和胃癌细胞中均呈核浆型表达,阳性表达率分别为4.34%、25.00%、62.50%、66.67%,在癌旁非肿瘤性胃黏膜腺体上皮细胞中呈阴性表达;Ki67在慢性胃炎、低级别上皮内瘤变、高级别上皮内瘤变和胃癌组织细胞中呈核型表达,Ki67指数分别为17.39%、37.50%、56.25%和77.78%。结论:p16INK4a代偿性高表达是胃癌和胃癌前病变的重要免疫表型特征,联合检测p16INK4a和Ki67表达可作为胃癌诊断的分子靶标和可靠方法。     

Lugol's iodine dye-enhanced endoscopy in patients with cancer of the oesophagus and head and neck.

Lugol's iodine dye indicates the presence of unsuspected early oesophageal cancers during endoscopy at which such cancers fail to show the characteristic black colour change. We evaluated Lugol's iodine dye-enhanced endoscopy in 17 patients with oesophageal cancer. In a further 37 patients with head and neck cancer we examined the use of Lugol's iodine since these patients have a 29% risk of synchronous oesophageal cancer. The oesophagus was sprayed with Lugol's iodine (1.5%) during endoscopy. Any areas not turning black were biopsied. In 13 patients with oesophageal cancer discrete areas beyond the macroscopically obvious primary tumour showed no change in colour. Biopsy revealed cancer in all cases. Six synchronous cancers were found in the head and neck group, one of which was identified only by the use of Lugol's iodine. Lugol's iodine augmented the information gained about the oesophageal mucosa during endoscopy. It revealed unsuspected cancer which altered the management of patients with primary oesophageal cancer as well as those with head and neck cancer. We recommend the routine use of Lugol's iodine-enhanced endoscopy for surveillance of all 'at risk' oesophageal cases.     

醋酸染色法联合碘染色法在宫颈癌筛查中的应用

[目的]评价醋酸染色法（VIA）联合碘染色法（VILI）对农村地区宫颈癌筛查的可行性和价值。[方法]采用VIA/VILI在杭州市萧山区农村28-55岁的妇女人群中开展宫颈癌筛查。VIA或VILI阳性者行阴道镜检查,阴道镜检查阳性者转送上级医院进一步检查。[结果]2007-2009年期间,总筛查1697人次,其中低级别CIN17例、高级别CIN10例、浸润癌2例。[结论]在资源、设备有限的农村地区,VIA/VILI方法对妇女开展宫颈癌及癌前病变的筛查是可行的,有利于宫颈癌的早发现及早诊早治。     

Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol's iodine (VILI) in cervical cancer screening in Kerala,India

Simple and inexpensive methods based on visual examination of the cervix are currently being investigated as alternative methods of cervical screening. The test characteristics of visual inspection with 4% acetic acid (VIA), and Lugol's iodine (VILI) and conventional cytology were investigated in a cross-sectional study involving 4,444 women aged 25 to 65 years in Kerala, India. While detection of any acetowhite area constituted a low-threshold positive VIA, detection of well-defined, opaque acetowhite lesions close to or touching the squamocolumnar junction constituted a high-threshold positive VIA test. Detection of definite yellow iodine nonuptake areas in the transformation zone close to or touching the squamocolumnar junction constituted a positive VILI test. Cytology was considered positive if reported as atypia or worse lesions. All screened women were evaluated by colposcopy and biopsies were directed in 1,644 women (37.0%), which allowed the direct estimation of sensitivity, specificity and predictive values. The reference diagnosis was based on a combination of histology and/or colposcopy. True disease status was defined as CIN 2 and worse lesions. A total of 149 (3.4%) women had CIN 2 or worse lesions. The sensitivities of low-threshold VIA, high-threshold VIA, VILI and cytology to detect CIN 2 or worse disease were 88.6%, 82.6%, 87.2% and 81.9%, respectively; the corresponding specificities were 78.0%, 86.5%, 84.7% and 87.8%. Our results indicate that VIA and VILI are suitable alternate screening tests to cytology for detecting cervical neoplasia in low-resource settings.     

农村地区醋酸/碘染色法筛查子宫颈癌的3年结果分析

背景与目的:我国至今还没有一个系统的子宫颈癌防治计划,尤其是广大农村地区更缺乏子宫颈癌的防治技术和经验。本研究报道山西省襄垣县子宫颈癌早诊早治示范基地的人群筛查资料,评价基层医生采用醋酸或碘染色法(VIA/VILI)在农村地区筛查子宫颈癌及其癌前病变的效果。方法:采用醋酸染色法(VIA)和碘染色法(VILI)在山西省襄垣县30～59岁的妇女人群中开展子宫颈癌筛查,VIA或VILI阳性者进行阴道镜检查,阴道镜检异常者在病变处取活检进行病理学诊断。采用同样的程序对人群进行复查,通过比较1年筛查、连续2年筛查和连续3年筛查的结果,评价该方案的筛查效果。结果:在2005～2008年期间,有7145名适龄妇女参加了筛查,平均年龄为42.16岁,筛查人群平均参与率为74.75%。其中2005～2007年期间,对1287人连续筛查了3年,第1轮筛查CIN2、CIN3及子宫颈癌的检出率分别为0.70%(9例)、1.01%(13例)、0.23%(3例);第2轮(976人)筛查检出率分别为0.22%(2例)、0.11%(1例)、0;第3轮筛查仅增加了1例CIN2病例。2006～2007年期间对3490人连续筛查了2年,第1轮(3...     

曲马多混合液治疗癌痛

 应用曲马多混合液治疗癌痛，并观察20例用药镇痛效果。结果：不同部位注射用药和方法显示较好作用，其镇痛时间13.16±9.26h.认为，该药镇痛作用强，安全性高，疗效确切，作用持久，比单纯使用曲马多疗效好，是一种较强的镇痛剂能治疗癌痛，可以替代吗啡应用于临床。     

Antifungal prophylaxis with itraconazole oral solution in neutropenic patients

The role of itraconazole in anti-fungal prophylaxis has been limited by the low bioavailability of the capsule formulation but the bioavailability of the oral solution is much improved. Three multi-centre studies using itraconazole solution (5 mg/kg/day) have recently been completed. The UK trial compared itraconazole solution with fluconazole suspension (100 mg/day). No invasive aspergillosis occurred in the itraconazole arm and there were more fungal deaths due to proven/suspected infection in the fluconazole group than in the itraconazole group (0 versus 7, p = 0.024). An Italian study compared itraconazole solution with placebo. Proven, suspected and superficial fungal infections were fewer in the itraconazole arm compared with placebo, with significant differences in proven and suspected systemic fungal infections (itraconazole 24% versus placebo 33%, p = 0.035). The third study compared itraconazole with amphotericin B capsules (2 g/day). There were more invasive fungal infections, Aspergillus infections and fungal deaths in the amphotericin B arm than with itraconazole but none of these differences were statistically significant. Azole prophylaxis in neutropenic patients may reduce the incidence of Candida infections, empirical amphotericin B usage, and the incidence of proven fungal infections. Itraconazole may be more effective than fluconazole in preventing invasive aspergillosis. All of these effects are more pronounced in high risk patients.