雷米普利对老年心力衰竭患者血清细胞因子的影响

目的研究老年心力衰竭患者血清细胞因子水平与心功能的关系以及雷米普利对血清细胞因子的影响.方法将76例老年心力衰竭患者随机分为雷米普利治疗组(36例)和常规治疗组(40例),另设年龄、性别与之匹配的健康老年人作为对照组(30例).应用双抗夹心ELISA法检测各组受试者血清肿瘤坏死因子α(TNF-α)、可溶性肿瘤坏死因子受体(STNFRI)、白细胞介素6(IL-6)、白细胞介素10(IL-10)和转化生长因子β1(TGF-β1)水平.常规治疗组和雷米普利组在治疗2周后复查上述指标.结果(1)血清TNF-α、STNFRI、IL-6、IL-10和TGF-βI水平与老年心力衰竭患者的基础心脏病无关(P＜0.05);上述血清细胞因子水平随心功能的恶化而升高(P＜0.05或P＜0.01).(2)与治疗前比较,雷米普利治疗组治疗前后血清TNF-α[(20.9±8.2)μg/L比(13.2±8.4)μg/L]、sTNFRI[(2.7±0.9)μg/L比(1.9±0.4)μg/L]、IL-6[(29.2±6.8)ng/L比(20.5±6.0)ng/L]、IL-10[(22.1±6.4)ng/L比(13.8±5.7)ng/L]及TGF-β1[(2144.1±597.9)ng/L比(1348.8±342.4)ng/L]水平均下降(分别为P＜0.05或P＜0.01),雷米普利治疗组比常规治疗组下降明显(P＜0.01).结论老年心力衰竭患者血清细胞因子与心功能密切相关,能够反映心力衰竭的程度;雷米普利能明显改善老年心力衰竭患者细胞因子的异常.     

肺癌患者血清和胸腔积液膜联蛋白A2水平改变及其临床意义研究

目的探讨肺癌患者血清和胸腔积液膜联蛋白A2(ANXA2)水平改变及其临床意义。方法连续性收录60例肺癌患者,以及40例肺部良性病变患者。检测血清和胸腔积液中ANXA2水平改变,分析其与肿瘤分期、淋巴结以及远处组织转移情况等相关性。结果肺癌组中血清及胸腔积液内ANXA2(血清:32.3±14.0 ng/m Lvs.16.8±6.5 ng/m L,P0.05;胸腔积液:66.8±14.7 ng/m L vs.25.2±12.6 ng/m L,P0.05)水平明显高于良性肺病组。肺癌患者胸腔积液中ANXA2浓度高于血清浓度(32.3±14.0 ng/m L vs.76.8±14.7 ng/m L,P0.05)。TNM分期Ⅰ-Ⅱ期患者血清及胸腔积液ANXA2明显低于Ⅲ-Ⅳ期患者(血清:29.1±12.1 ng/m L vs.34.7±16.2 ng/m L,P0.05;胸腔积液:61.6±18.8 ng/m L vs.78.5±11.7 ng/m L,P0.05);有淋巴结转移患者血清及胸腔积液ANXA2明显高于无淋巴结转移患者(血清:35.2±16.1ng/m L vs.30.5±11.3 ng/m L,P0.05;胸腔积液:88.6±20.7 ng/m L vs.59.3±11.5 ng/m L,P0.05);有远处转移患者血清及胸腔积液ANXA2明显高于无远处转移患者(血清:37.4±9.6ng/m L vs.29.1±6.8 ng/m L,P0.05;胸腔积液:82.2±12.3ng/m L vs.65.9±18.7 ng/m L,P0.05)。血清ANXA2诊断肺癌的AUC为0.712,cut-off值为40.2 ng/m L;而胸腔积液ANXA2水平诊断肺癌的AUC为0.822,cut-off值为78.2 ng/m L。血清和胸腔积液ANXA2水平与肺癌呈正相关(血清:r=0.706,P0.05;胸腔积液:r=0.812,P0.05)。结论肺癌患者血清和胸腔积液中ANXA2水平明显上升,对于肺疾病合并胸腔积液者,血清及胸水ANXA2测定,有助于肺癌鉴别诊断和分期。     

扩张型心肌病患者血清sICAM-1水平及其临床意义研究

目的 探讨扩张型心肌病患者血清可溶性胞间黏附因子-1(sICAM-1)水平与扩张型心肌病的发生发展的关系及临床意义.方法 应用酶联免疫双抗体夹心法(ELISA)测定25例扩张型心肌病患者和15例健康对照组的血清sICAM-1水平.所有扩张型心肌病患者均经过超声心动图、X线胸片、心电图等多项检查证实,确属不明原因的心脏扩大伴有不同程度的心肌收缩功能减退,左室射血分数(LVEF)＜35%者.结果 扩张型心肌病组血清sICAM-1明显高于对照组[(162.46±78.56)ng/ml,69.48 ng/ml,P＜0.01];心功能Ⅱ级组血清sICAM-1高于对照组[(99.80±13.49)ng/ml,(69.48±16.86)ng/ml,P＜0.05];心功能Ⅲ级组血清sICAM-1水平明显均高于心功能Ⅱ级组[(188.40±27.15)ng/ml,(99.80±13.49)ng/ml,P＜0.01],心功能Ⅳ级组血清sICAM-1水平明显高于心功能Ⅲ级组[(370.85±49.97)ng/ml,(188.40±27.15)ng/ml,P＜0.01].结论 扩张型心肌病患者血清中sICAM-1高表达,并且随着心衰加重,外周血清中sICAM-1的水平逐渐升高.在DCM中,sICAM-1可以作为一种无创性炎症活动的标记物     

妊娠对乙型肝炎肝郁脾虚型患者血清细胞因子浓度的影响及临床意义

目的 :探讨妊娠对慢性乙型肝炎 (乙肝 )肝郁脾虚型患者血清白细胞介素 - 10、12 (IL - 10、IL - 12 )、γ-干扰素 (IFN-γ)浓度的影响及临床意义。方法 :用酶联免疫法 (EL ISA)检测孕期和非孕期患者 IL - 10、IL - 12及 IFN -γ血清浓度 ,并作同期肝功能指标检查。患者分为早孕期 (2 6例 )、晚孕期 (32例 )、非孕期 (31例 ) 3组。 2 0例非孕期健康者为对照组。结果 :早孕期组 IL - 10水平 [(2 6 .0± 9.8) ng/ L ]较非孕期组 [(18.0± 1.3) ng/ L ]升高 (P <0 .0 5 ) ,而与对照组 [(2 9.4± 5 .1) ng/ L ]相近 (P >0 .0 5 )。IL - 12、IFN -γ分别为 (5 4 .1± 2 6 .0 ) ng/ L和 (45 .5± 17.3) ng/ L ,较对照组 [(8.2± 2 .1) ng/ L、(2 4 .5± 6 .1) ng/ L ]和非孕期组 [(8.0± 2 .7) ng/ L、(16 .7± 3.7) ng/ L ]均明显升高 (均P <0 .0 1)。晚孕期组与其他各组比较 ,IL - 10 [(9.4± 1.9) ng/ L ]明显下降 (P <0 .0 1) ,但 IL - 12 [(16 6 8.0± 318.2 )ng/ L ]、IFN -γ[(46 1.0± 10 3.3) ng/ L ]显著升高。结论 :妊娠可使慢性乙肝肝郁脾虚型患者血清 IL - 12、IFN-γ浓度升高 ,在晚孕期表现更为明显。     

冠心病患者介入治疗前后血清胎盘生长因子水平变化及临床意义

目的:探讨经皮冠状动脉介入治疗(PCI)前后冠心病患者血清胎盘生长因子水平变化及临床意义。方法:选择110例行择期PCI的冠心病患者,分别在术前,术后第1天、3天和5天测定血清胎盘生长因子(PlGF)水平;30例冠状动脉造影正常者作为对照。随访6个月,观察术后心血管事件(MACE)发生与PlGF水平变化之间的关系。结果:冠心病患者术后第1天血清胎盘生长因子水平均较术前增高[(14.49±3.42)∶(13.06±4.05)ng/L,P<0.01],术后第3天明显升高达到峰值[(16.44±3.25)∶(13.06±4.05)ng/L,P<0.01],术后第5天下降接近正常。发生MACE患者术前和术后血清PlGF峰值水平明显高于未发生MACE患者[(15.3±4.07)∶(10.7±2.65)ng/L,P<0.05)和(18.5±4.25)∶(12.3±3.28)ng/L,P<0.01)]。结论:冠心病患者PCI前后血清PlGF水平峰值与MACE相关,PlGF水平升高可能是冠心病患者PCI后发生MACE的危险因素之一。     

非小细胞肺癌患者呼出气冷凝液中p53蛋白检测的临床意义

Objective To study the clinical significance of the detection of p53 protein in exhaled breath condensate (EBC) of patients with non-small cell lung cancer (NSCLC). Methods EBC and plasma of 98 patients with NSCLC were collected,p53 protein expression in EBC and plasma was detected by enzyme-linked immunosorbent assay,and the data were compared with those of 98 healthy controls. p53 protein expression in cancer tissue of 98 patients with NSCLC was detected by immunohistochemistry. p53 protein expression in EBC and plasma and positive expression rate of p53 protein in cancer tissue were compared among patients with different lung cancer type,stage,histologic type,tumor size,and lymph node metastasis,smoking history. The specificity and sensitivity of diagnosis of p53 protein in patients with NSCLC were analyzed by ROC curve. Results ① The level of p53 protein in EBC of patients with NSCLC was significantly higher than that in healthy control group [(233.99±7.91) ng/L vs ( 130. 26 ± 4. 73) ng/L,P ＜0. 01]. The level of p53 protein in serum of patients with NSCI.C was significantly higher than that in healthy control group [(292. 58 ± 8. 79) ng/L vs (141. 66±3. 33) ng/L,P ＜0. 01]. ② The level of p53 protein in EBC of patients with central lung cancer was higher than that in patients with peripheral lung cancer [(248. 22 ± 8. 58) ng/L vs (215. 78 ± 6.61) ng/L,P＜0. 01]. ③The level of p53 protein in EBC of patients with positive immunostaining group was higher than that in negative group [(249.77 ± 8.07) ng/L vs (216.86 ± 7.44) ng/L,P ＜ 0. 05]. ④The level of p53 protein in serum of smokers was significantly higher than that in non-smokers [(310.18 ± 9.04) ng/L vs (254. 55 ± 6. 91) ng/L,P ＜0. 01]. ⑤The positive expression rate of p53 protein in cancer tissue was 47. 96% (47/98). ⑥The sensitivity and specificity of diagnosis of p53 protein were 95. 90% and 90. 04% in plasma,and those were 92. 90% and 79. 59% in EBC. The cut off values of p53 protein were respectively 175. 68 ng/L and 166. 26 ng/L in EBC and serum. Conclusions The detection of p53 protein in EBC of patients with NSCLC is helpful for the diagnosis of lung cancer.     

不同性别心绞痛患者肌钙蛋白I和脑利钠肽检测的临床意义

目的探讨不同性别心绞痛患者血浆心肌肌钙蛋白I(cTnI)和脑利钠肽(BNP)水平检测的临床意义。方法入选心绞痛患者283例,对照组64例。入院时测定血浆cTnI、BNP,并根据性别、冠状动脉造影结果、心绞痛类型及不稳定型心绞痛(UAP)Braunwald危险分级进行分组分析。结果男性UAP组、BraunwaldⅡ级组、BraunwaldⅢ级组cTnI[分别为(0.113±0.102)ng/L、(0.131±0.111)ng/L、(0.133±0.118)ng/L]明显高于女性对应各组[分别为(0.065±0.047)ng/L、(0.063±0.037)ng/L(、0.076±0.070)ng/L],而且在男性中,UAP组cTnI明显高于稳定型心绞痛(SAP)[(0.056±0.014)ng/L]组和对照组[(0.050±0.002)ng/L],BraunwaldⅢ级组和BraunwaldⅡ级组cTnI明显高于BraunwaldⅠ级组[(0.072±0.055)ng/L];女性各组BNP均明显高于男性对应各组,而且在女性中,UAP组BNP[(92.00±32.72)ng/L]明显高于SAP组[(43.21±14.20)ng/L]和对照组[(37.86±9.27)ng/L],BraunwaldⅢ级组和BraunwaldⅡ级组BNP[(115.20±44.73)ng/L、(89.04±13.92)ng/L]明显高于BraunwaldⅠ级组[(73.98±17.65)ng/L],BraunwaldⅢ级组BNP明显高于BraunwaldⅡ级组。结论心绞痛患者BNP和cTnI的表达存在性别差异;男性患者cTnI水平与心绞痛的类型及其危险层次明显相关;女性患者BNP水平与心绞痛的类型及其危险层次明显相关。     

Th细胞免疫与结核性胸膜炎胸膜粘连关系的研究

目的 探讨胸腔积液辅助性T细胞(Th细胞)免疫与结核性胸膜炎胸膜粘连的关系.方法 用双抗体夹心酶联免疫吸附试验(ELISA)法测定汕头大学医学院第一附属医院、潮南民生医院2005年9月至2006年11月住院的结核性胸膜炎患者44例(结核组)和恶性胸腔积液患者22例(恶性组)胸腔积液干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)质量浓度.依据影像学检查是否存在包裹性胸腔积液,将结核组进一步分为包裹组(23例)和游离组(21例).结果 结核组IFN-γ质量浓度显著高于恶性组[(1238.7±807.2)ng/L对(87.8±64.8)ng/L,P＜0.01],而IL-4质量浓度在两组间差异无显著性意义.结核性胸膜炎病程＜1个月的包裹组胸腔积液IFN-γ质量浓度显著高于相应游离组[(1961.9±1008.1)ng/L对(1140.8±327.4)ng/L,P＜0.01],病程1个月后这种差异不明显,而IL-4质量浓度在结核性胸膜炎各亚组间均未发现显著差异.病程≥1个月患者胸膜粘连发生率高于病程＜1个月者(58.82%对48.15%),但差异无显著性意义(P＞0.05).结论 结核性胸膜炎局部Th1免疫增强,在病程早期尤其明显,但过强的Th1免疫易导致胸膜粘连;Th2免疫在结核性胸膜炎局部无明显变化.     

肺癌组织中内皮抑素表达水平与血清内皮抑素水平的相关性研究

目的探讨非小细胞肺癌(NSCLC)组织中内皮抑素(endostatin)表达水平与血清中endostatin水平的相关性,以及两者水平与肺癌临床病理特征的关系.方法用酶联免疫吸附(ELISA)法检测46例NSCLC患者血清中endostatin的水平;用免疫组织化学(LSAB)法检测其肺癌组织中endostatin表达水平.结果①肺癌患者血清中endostatin水平为(20.85±4.56)ng/ml;肺癌组织中为(84.91±7.65)%.②肺癌患者血清中endostatin水平及肺癌组织中endostatin 的表达水平均与肺癌原发肿瘤大小、有无远处转移、细胞分化程度和TNM分期有关(P＜0.05),与肺癌原发部位、淋巴结转移状态、组织学类型以及患者性别、年龄和吸烟与否等无关(P＞0.05).③肺癌组织中endostatin的表达水平与血清中endostatin水平呈显著正相关(r=0.669,P＜0.01).结论肺癌患者肺癌组织的endostatin的表达水平与血清endostatin水平有显著正相关关系,且均与肺癌的发生、发展、远处转移和细胞分化不良密切相关,NSCLC患者血清endostatin水平和肺癌组织中endostatin 的表达水平可能是预测肺癌恶性行为的有用指标.     

胸水及血清中癌胚抗原水平测的临床意义

本文利用放免方法分析了31例胸腔积液患者胸水、血清的癌胚抗原(CEA)水平及其比值(其中11例为癌性胸水,20例为结核性胸水),肿瘤患者胸水及血清中的CEA(ug/L)水平明显高于结核患者(胸水30.216±2.313,10.547±3.127,P＜0.001;血清16.726±2.24,7.635±2.365,P＜0.001),肿瘤患者胸水/血清CEA值超过1.5,而结核患者低于此值.连续检测肿瘤患者胸水及血清CEA水平及其比值有升高的趋势,有助于临床胸水性质的诊断.     

血清和胸液肿瘤坏死因子及受体检测对鉴别结核性和癌性 …

通过检测结核性及癌性胸液患者血清及胸液中肿瘤坏死因子α（ＴＮＦ－α）及可溶性受体（ｓＴＮＦＲ－Ⅰ、ｓＴＮＦＲ－Ⅱ）水平,探讨其对临别良恶性疾病的意义。方法采用双抗体夹心免疫酶标（ＥＬＩＳＡ）法检测２５例结核性胸液,２８例癌性胸液患者血清及胸液及３２例正常人血清中ＴＮＦ－α及ｓＴＮＦＲ－Ⅰ、ｓＴＮＦＲ－水平。     

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     

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.     

A novel biomarker in the diagnosis of parapneumonic effusion: neutrophil gelatinase-associated lipocalin

Background

The protein neutrophil gelatinase-associated lipocalin (NGAL) is a mediator synthesized and released by neutrophils. Its physiological function is as yet unclear. Levels in blood increase in several inflammatory diseases. High serum values indicate poor prognosis for several diseases. Pleural effusion may appear as the result of various pathologies. The most common cause is heart failure (HF). Other common causes include parapneumonic (PPE) and malignant (MPE) pleural effusions, and pulmonary embolism. Tubercular effusion (TE) is commonly encountered in Turkey and similar developing countries. The purpose of this study was to investigate the effectiveness of NGAL, a current inflammation marker, in discriminating between different etiological diseases that cause pleural effusion.

Methods

The study was performed at the Recep Tayyip Erdo?an University Faculty of Medicine Chest Diseases Clinic. One hundred patients were included in the study, 25 with parapneumonic effusion, 25 with heart failure-related effusion, 25 with tubercular effusion and 25 with cancer-related effusion. NGAL was measured in patients’ serum and pleural fluids.

Results

Serum NGAL levels in PPE (171?±?56 ng/ml) were significantly higher (p?<?0.001) than those in HF (86?±?31 ng/ml), CA (103?±?42 ng/ml) and TE (63?±?19 ng/ml). Pleural NGAL levels were also significantly higher in PPE compared to HF, MPE and TE (p?<?0.001). Serum NGAL levels exhibited a positive correlation with white blood cell (WBC), neutrophil, C-reactive protein (CRP), sedimentation, serum LDH, creatinine, pleural leukocyte and pleural neutrophil numbers. The most significant correlation was between NGAL level and WBC (p?<?0.001, r?=?0.579). Both serum and pleural NGAL levels are highly effective in differentiating patients with PPE from those without PPE (AUC: 0.910 and 0.790, respectively).

Conclusions

NGAL can be used in the diagnosis of diseases with an acute inflammatory course. Serum and pleural NGAL levels can differentiate PPE from other diseases causing pleural fluid with high sensitivity and specificity.

     

白细胞介素27在结核性胸腔积液和恶性胸腔积液鉴别诊断中的价值

目的研究胸腔积液中白细胞介素27(IL-27)浓度对于结核性胸腔积液(TPE)和恶性胸腔积液(MPE)的鉴别诊断价值.方法纳入2015~2018年收住北京朝阳医院诊断为TPE或MPE的患者,通过酶联免疫吸附法测定胸腔积液及血浆中IL-27浓度.通过受试者工作特征曲线获取胸腔积液中IL-27的浓度、胸腔积液与血浆IL-27浓度的差值和比值的诊断价值.结果143例患者中TPE组78例,MPE组65例.TPE患者中胸腔积液IL-27浓度显著高于MPE患者,胸腔积液IL-27诊断TPE的诊断界值为499.71 ng/L,敏感度为93.6%,特异度为95.4%,曲线下面积为0.952(95%CI:0.913~0.991),Z统计分析显示,胸腔积液与血浆IL-27浓度差值和比值的诊断价值不高于胸腔积液IL-27浓度.结论胸腔积液IL-27浓度是鉴别TPE和MPE的理想生物标志物.     

联合检测对结核性和恶性胸腔积液的鉴别诊断价值

目的探讨联合检测胸腔积液中腺苷脱氨酶(ADA)、C反应蛋白(CRP)、癌胚抗原(CEA)、乳酸脱氢酶(LDH)对结核性和恶性胸腔积液的诊断价值。方法以我院2012年1月至2012年12月112例住院的胸腔积液患者为研究对象,其中62例结核性胸腔积液患者,50例恶性胸腔积液患者,以酶比色法,免疫比浊法,速率法和电化学发光法检测上述患者胸腔积液中ADA、CRP、CEA和LDH浓度。结果结核性胸腔积液患者ADA和CRP的诊断敏感性显著高于恶性胸腔积液患者(P0.01),恶性胸腔积液患者CEA的诊断敏感性较结核性胸腔积液患者明显增高(P0.01)。以胸腔积液CEA7 ng/ml及LDH245 U/L为诊断标准,诊断恶性胸腔积液的敏感性,特异性分别为78.0%,80.6%;而以CEA7 ng/ml,LDH245 U/L及ADA40 U/L,CRP5 mg/L为诊断标准,诊断恶性胸腔积液的敏感性,特异性分别为94.0%,95.2%。以胸腔积液ADA40 U/L,CRP5 mg/L为诊断标准,诊断结核性胸腔积液的敏感性,特异性分别为82.3%,86.0%;而以CEA7 ng/ml,LDH245 U/L及ADA4 0U/L,CRP5 mg/L为诊断标准,诊断结核性胸腔积液的敏感性,特异性分别为96.8%,92.0%。结论联合检测胸腔积液中ADA、CRP、CEA、LDH的浓度可提高结核性和恶性胸腔积液鉴别诊断的敏感性和特异性。     

非小细胞肺癌患者呼出气冷凝液中p53蛋白检测的临床意义

目的 研究非小细胞肺癌(NSCLC)患者呼出气冷凝液(EBC)中p53蛋白检测的临床意义.方法 收集98例NSCLC患者的EBC和血浆,应用双抗体夹心ABC-ELISA法检测EBC和血浆中p53蛋白表达水平,并与98名健康对照者测定值比较.用免疫组化法检测98例NSCLC患者手术切除标本癌组织中p53蛋白表达.比较肺癌组中不同分型、分期、病理类型、肿瘤大小以及有无淋巴结转移、吸烟史者EBC和血浆中p53蛋白水平和癌组织p53蛋白阳性表达率.应用 ROC曲线分析肺癌组血浆及EBC的p53蛋白诊断肺癌的特异性及敏感性.结果 ①肺癌组EBC中p53蛋白测定值高于健康对照组[(233.99±7.91)ng/L vs(130.26±4.73)ng/L,P＜0.01];肺癌组血浆p53蛋白测定值高于健康对照组[(292.58±8.79)ng/L vs(141.66±3.33)ng/L,P＜0.01].②肺癌组中央型患者EBC中p53蛋白测定值高于周围型患者[(248.22±8.58)ng/L vs(215.78±6.61)ng/L,P＜0.05].③免疫组化阳性组EBC中p53蛋白测定值高于阴性组「(249.77±8.07)ng/L vs(216.86±7.44)ng/L,P＜0.05].④肺癌组中吸烟者血浆p53蛋白测定值高于无吸烟者[(310.18±9.04)ng/L vs(254.55±6.91)ng/L,P＜0.01].⑤癌组织p53蛋白阳性表达率为47.96%(47/98).⑥血浆p53蛋白对于肺癌的诊断的敏感性为95.90%.特异性为90.04%;EBC p53蛋白埘于肺癌的诊断的敏感性为92.90%,特异性为79.59%;肺癌患者p53蛋白诊断最佳参考临界值血浆为175.68 ng/L,EBC为166.26 ng/L.结论 NSCLC患者中EBC p53蛋白的检测有助于肺癌的诊断.

Abstract：

Objective To study the clinical significance of the detection of p53 protein in exhaled breath condensate (EBC) of patients with non-small cell lung cancer (NSCLC). Methods EBC and plasma of 98 patients with NSCLC were collected,p53 protein expression in EBC and plasma was detected by enzyme-linked immunosorbent assay,and the data were compared with those of 98 healthy controls. p53 protein expression in cancer tissue of 98 patients with NSCLC was detected by immunohistochemistry. p53 protein expression in EBC and plasma and positive expression rate of p53 protein in cancer tissue were compared among patients with different lung cancer type,stage,histologic type,tumor size,and lymph node metastasis,smoking history. The specificity and sensitivity of diagnosis of p53 protein in patients with NSCLC were analyzed by ROC curve. Results ① The level of p53 protein in EBC of patients with NSCLC was significantly higher than that in healthy control group [(233.99±7.91) ng/L vs ( 130. 26 ± 4. 73) ng/L,P ＜0. 01]. The level of p53 protein in serum of patients with NSCI.C was significantly higher than that in healthy control group [(292. 58 ± 8. 79) ng/L vs (141. 66±3. 33) ng/L,P ＜0. 01]. ② The level of p53 protein in EBC of patients with central lung cancer was higher than that in patients with peripheral lung cancer [(248. 22 ± 8. 58) ng/L vs (215. 78 ± 6.61) ng/L,P＜0. 01]. ③The level of p53 protein in EBC of patients with positive immunostaining group was higher than that in negative group [(249.77 ± 8.07) ng/L vs (216.86 ± 7.44) ng/L,P ＜ 0. 05]. ④The level of p53 protein in serum of smokers was significantly higher than that in non-smokers [(310.18 ± 9.04) ng/L vs (254. 55 ± 6. 91) ng/L,P ＜0. 01]. ⑤The positive expression rate of p53 protein in cancer tissue was 47. 96% (47/98). ⑥The sensitivity and specificity of diagnosis of p53 protein were 95. 90% and 90. 04% in plasma,and those were 92. 90% and 79. 59% in EBC. The cut off values of p53 protein were respectively 175. 68 ng/L and 166. 26 ng/L in EBC and serum. Conclusions The detection of p53 protein in EBC of patients with NSCLC is helpful for the diagnosis of lung cancer.     

急性脑出血患者血清胶质纤维酸性蛋白含量及临床意义

目的研究急性脑出血患者血清中胶质纤维酸性蛋白(GFAP)含量及临床意义。方法采用ELISA法检测发病后1 d内脑出血患者(56例,脑出血组)及健康体检者(50例,对照组)血清GFAP含量,分析脑出血患者血清GFAP含量与美国国立卫生研究院脑卒中量表(NIHSS)、血肿体积、血肿周围水肿体积及预后之间的关系。结果脑出血组患者发病第1天血清GFAP含量明显高于对照组,差异有统计学意义[(9.41±2.17)ng/L vs (1.17±0.41)ng/L,P0.01];大量出血患者血清GFAP含量明显高于少量出血患者,差异有统计学意义[(16.08±3.61)ng/L vs (5.19±2.06)ng/L,P0.01];血清GFAP含量与NIHSS、血肿体积、血肿周围水肿体积及预后呈正相关(r=0.7912,0.4920,0.4870,0.8032,P0.01);ROC曲线分析,以血清GFAP含量4.5 ng/L为标准评估预后,敏感性为0.82,特异性为0.77。结论脑出血后血清GFAP含量增高,在一定程度上反映了患者的病情程度,有助于早期预后的评估。     

肺癌患者胸水CA125、CEA测定及其临床意义

目的　探讨 CA1 2 5、CEA在良、恶性胸腔积液鉴别诊断中的价值。方法　对 36例恶性胸腔积液、34例良性胸腔积液于治疗前同时抽取血清及第一次胸腔积液标本进行 CA1 2 5、CEA测定。结果　恶性胸腔积液组血清和胸腔积液 CA1 2 5、CEA测定值高于良性胸腔积液组 (P<0 .0 1)。 CA1 2 5敏感度 5 8.3% (2 3/36 ) ,特异度 88.2 % (30 /34) ;CEA敏感度 6 8.3% (2 3/36 ) ,特异度 85 .3% (2 9/34)。CA1 2 5和 CEA联合检测敏感度 72 .2 % ,特异度 94 .1%。结论　胸腔积液 CA1 2 5和 CEA联合检测对恶性胸腔积液的诊断价值更大。     

恩度和顺铂治疗原发性肺癌合并恶性胸腔积液的短期疗效对比分析

目的回顾性分析69例肺癌合并恶性胸腔积液(malignant pleural effusion, MPE)患者的临床资料,探讨恩度与顺铂胸腔内灌注治疗肺癌合并MPE的短期疗效和不良反应。 方法收集陆军军医大学新桥医院2016年至2018年6月收治的69例肺癌合并MPE患者的临床资料,根据治疗方法的不同,分为恩度组23例,顺铂组46例。两组治疗前均已排尽胸水,恩度组胸腔灌注恩度30 mg,每周2次,顺铂组胸腔灌注顺铂30 mg/m²,每周2次,比较两种药物的疗效及不良反应的差异。 结果恩度组的客观有效率(objective response rate, ORR)为56.5%,顺铂组ORR为26.1%。恩度组的治疗效果显著优于顺铂组,差异有统计学意义(P<0.05)。分层分析发现,在血性胸腔积液患者中,恩度组ORR 88.9%,顺铂组ORR 5%,差异有统计学意义(P<0.05)。在非血性胸腔积液患者中,恩度组ORR 35.7%,顺铂组ORR 42.3%。胸腔积液中癌胚抗原(carcinoembryonic antigen, CEA)数值较低(<100 μg/L)的患者中,恩度组ORR 53.8%,顺铂组ORR 8.3%,差异有统计学意义(P<0.05)。胸腔积液中CEA数值较高(≥100 μg/L)的患者中,恩度组ORR 50%,顺铂组ORR 45.4%。 结论恩度胸腔内灌注治疗原发性肺癌合并MPE是一种安全有效的治疗方法,疗效优于顺铂,尤其对于血性胸腔积液患者、胸腔积液中CEA数值较低(<100 μg/L)的患者,效果更为明显。且恩度组较顺铂组不良反应更小,安全性好,能明显改善患者生活质量。