重组人白介素-2治疗恶性胸腔积液的疗效分析

目的通过重组人白介素-2治疗恶性胸腔积液的效果分析,为临床工作参考.方法我院36例恶性胸腔积液患者,采用重组人白介素-2（200万单位）配合50ml生理盐水,抽胸水后注入,每周2次,连续2周.判断指标总有效率（CR＋PR）,生活质量状况及毒副反应.结果本组36例患者总有效率为86.1%,生活质量状况提高55.6%,有5例发热（13.9%）, 6例胸痛（16.7%）,经对症处理后缓解,均未见血常规和肝肾功能异常.结论重组白细胞介素-2对恶性胸腔积液治疗有一定的疗效,并无严重毒副反应,要提高疗效还得从联合用药和给药途径上加以探讨.     

B细胞淋巴瘤石蜡包埋组织克隆性重链基因重排检测

目的 探讨克隆性重链基因重排检测在B细胞淋巴瘤(B—NHL)诊断中的价值。方法 用半巢式聚合酶链反应(semi—nested PCR)、聚丙烯酰胺凝胶电泳(PAGE)及银染技术，检测经形态学及免疫组织化学确诊的23例B—NHL石蜡包埋组织标本的克隆性免疫球蛋白第三互补决定区(IgHCDR3)重排基因，对照组为7例T细胞淋巴瘤(T—NHL)及6例反应性增生或肉芽肿性淋巴结炎。结果 B—NHL IgHCDR3检出的阳性率87．0％(20／23)，假阳性率7．7％(1／13)，假阴性率13．0％(3／23)。结论 检测克隆性IgHCDR3重排为B—NHL的诊断及鉴别诊断提供有效的辅助手段。     

46例首诊伴远处转移鼻咽癌的预后分析

Objective To retrospectively analyze the therapeutic results of patients with initially di-agnosed metastatic nasopharyngeal carcinoma (NPC). Methods From January 1995 to December 1998, 46 NPC patients with distant metastases were treated in Fujian provincial cancer hospital. Among these pa-tients, 43 were single site metastasis and 3 were multiple sites metastases;The site of metastasis were 19 pa-tients in the liver, 11 in the bone, 7 in the lung, 1 in the brain, 6 in mediastinal nodes and 6 in axillary lymph nodes. All patients received standard radiotherapy to the primary site and cervical node region with a median dose of 72 Gy. Forty-one patients (89%) received 1-5 cycles chemotherapy (cisplatin and 5-flu-orouracil), and 23 (50%) received palliative irradiation to the metastatic site. Results The median surviv-al time was 20 months. The 1-, 2-, 3-year and 5-year overall survival rates were 66%, 47%, 30% and 19%, respectively. Irradiation to the metastatic sites and KPS were the significant prognostic factors. Pa-tients with palliative irradiation to the metastatic site had longer survival than those without (39 months vs. 13 months, X2=8.63, P=0.012). Patients with good performance status (KPS≥80) had better outcomes thanthose with poor performance status (26 months vs. 12 months, X2= 3.95, P=0.035) . Conclusions Active therapy may prolong the survival of patients with initially diagnosed metastatic NPC, especially for those who have good performance status. Under systematic chemotherapy, radiotherapy to the primary site and supportive care, the palliative irradiation to the metastatic site may also yield a good result.     

46例首诊伴远处转移鼻咽癌的预后分析

Objective To retrospectively analyze the therapeutic results of patients with initially di-agnosed metastatic nasopharyngeal carcinoma (NPC). Methods From January 1995 to December 1998, 46 NPC patients with distant metastases were treated in Fujian provincial cancer hospital. Among these pa-tients, 43 were single site metastasis and 3 were multiple sites metastases;The site of metastasis were 19 pa-tients in the liver, 11 in the bone, 7 in the lung, 1 in the brain, 6 in mediastinal nodes and 6 in axillary lymph nodes. All patients received standard radiotherapy to the primary site and cervical node region with a median dose of 72 Gy. Forty-one patients (89%) received 1-5 cycles chemotherapy (cisplatin and 5-flu-orouracil), and 23 (50%) received palliative irradiation to the metastatic site. Results The median surviv-al time was 20 months. The 1-, 2-, 3-year and 5-year overall survival rates were 66%, 47%, 30% and 19%, respectively. Irradiation to the metastatic sites and KPS were the significant prognostic factors. Pa-tients with palliative irradiation to the metastatic site had longer survival than those without (39 months vs. 13 months, X2=8.63, P=0.012). Patients with good performance status (KPS≥80) had better outcomes thanthose with poor performance status (26 months vs. 12 months, X2= 3.95, P=0.035) . Conclusions Active therapy may prolong the survival of patients with initially diagnosed metastatic NPC, especially for those who have good performance status. Under systematic chemotherapy, radiotherapy to the primary site and supportive care, the palliative irradiation to the metastatic site may also yield a good result.     

自杀基因联合放射对食管癌细胞株的实验研究

目的自杀基因具有能将无细胞毒性的前体药物转化为有细胞毒性作用的药物而使细胞死亡,通过观察大肠杆菌胞嘧啶脱氨酶/氟胞嘧啶(CD/5-FC)自杀基因系统对食管癌EC109细胞杀伤效应及与放射联合应用对食管癌肿瘤细胞协同杀伤效应。方法采用PCR方法从大肠杆菌基因组DNA中扩增出CD基因;构建重组真核载体pcDNA3.1-CD;用脂质体转染法转染EC109细胞;观察CD/5-FC体系对EC109细胞的杀伤效应和旁观者效应及对放射的增敏效应。结果RT-PCR分析结果表明CD基因已转入EC109细胞并表达。离体实验证实5-FC对转CD基因后的食管癌细胞株有明显的细胞毒作用,含5%的转基因食管癌细胞加入5-FC后的细胞存活比率为41.8%±14.2%,低于对照组的94.6%±4.3%结果(t=3.14,P<0.05);加入10%的转基因细胞的存活比率为37.8%±4.4%,低于对照组的95.6%±5.4%结果(t=9.75,P<0.01)。CD/5-FC体系对肿瘤细胞放射增敏效果明显,加前药5-FC及放射组细胞存活曲线低于单纯加前药5-FC对照组或单纯放射对照组,重复测量数据方差分析结果显示F=11.50,P<0.01;治疗组分别与5-FC对照组及单纯放射对照组相比F值分别为4.11、10.53,P值分别<0.05、0.01。结论CD/5-FC体系的旁观者效应和放射增敏效果明显。     

人胃印戒细胞癌组织差异表达基因克隆的研究

目的:分离胃印戒细胞癌组织差异表达基因,探讨人胃印戒细胞癌发生的分子机制。方法:采用抑制性消减杂交技术(SSH),构建人胃印戒细胞癌组织cDNA 消减文库;随机挑选部分阳性克隆测序,与GenBank中的已知序列进行基因同源性分析,并进一步探讨基因功能。结果:成功构建高消减效率的人胃印戒细胞癌组织cDNA消减文库,并分离出多个差异表达基因片段:其中1 条与染色体序列相似,可能代表未知的新基因序列,已被GenBank 接收(注册号:CN446913);其他多为已知的肿瘤相关基因的部分片段。结论: 1 )SSH技术是分离差异表达基因的有效方法;2)胃印戒细胞癌的发生发展与多种基因表达异常有关;     

原发性食管小细胞癌64例疗效分析

目的 探讨影响食管小细胞癌治疗预后的因素。方法 将可能影响预后因素的治疗手段进行单因素、多因素分析。结果 从单因素分析看，影响食管小细胞癌预后的主要因素分别为分期、部位、长度、病理、治疗方式（P均〈0．05）。从多因素结果分析看，影响食管小细胞癌患者预后的主要因素为病理、部位、分期（P均〈0．05）。结论 影响食管小细胞癌预后的因素与病理、部位及分期有关，对于原发性食管小细胞癌应强调综合治疗。     

472例胸段食管癌行颈、胸、腹三野淋巴结清扫术的临床研究

目的探讨胸上、中、下段食管癌在食管壁及淋巴系统内转移的规律。方法对472例胸段食管癌行全胸段食管切除加颈、胸、腹三野淋巴结清扫术。结果全组472例共清扫淋巴结10227枚，平均21．7枚／例，其中1028枚见淋巴结转移，全组27：3例有淋巴结转移，转移率57．8％。胸上段食管癌淋巴结转移方向主要向上纵隔和下颈部；中段食管癌颈、胸、腹均可发生淋巴结转移；胸下段食管癌主要向腹部转移；472例全胸段食管切除，两切端均未发现癌残留。结论胸中段食管癌应行全胸段食管切除加颈、胸、腹三野淋巴结清扫术；胸上段食管癌应行纵隔和下颈淋巴结清扫术；胸下段食管癌淋巴结清扫重点在胸腹部，下颈部清扫可酌情施行。     

GM-CSF基因重组腺病毒载体的构建及鉴定

目的：构建人粒细胞-巨噬细胞集落刺激因子（GM-CSF）基因的重组腺病毒载体，为进一步研究GM-CSF基因在肿瘤基因治疗中的应用提供实验基础。方法：采用PCR方法，从重组质粒pcDNA3．1-GM-CSF扩增出GM-CSF基因片段，通过穿梭质粒pShuttle，将带有CMV启动子的目的片段克隆入Adeno-X腺病毒DNA中，获得重组腺病毒DNA，通过脂质体转染HEK293细胞，经包装扩增后，获得重组腺病毒Adeno-X-GM-CSF，PCR鉴定，ELISA法检测表达产物。结果：含GM-CSF基因的重组腺病毒Adeno-X-GM-CSF构建成功，经PCR鉴定和DNA测序等证实了其正确性，重组腺病毒上清液中GM-CSF表达量达26ng／mL。结论：含GM-CSF基因的重组腺病毒构建成功。     

白蛋白结合型紫杉醇单药作为三线及以上方案治疗晚期非小细胞肺癌的临床研究

目的观察白蛋白结合型紫杉醇单药三线及以上治疗晚期非小细胞肺癌的近期疗效及不良反应。方法选取2013年10月至2015年3月在福建省肿瘤医院已接受过二线治疗的晚期非小细胞肺癌患者46例,予以白蛋白结合型紫杉醇260 mg/m2D1,每21天为一周期,每个周期复查CT评价疗效,观察其疗效及不良反应。结果完全缓解(CR)0例,部分缓解(PR)6例,疾病稳定(SD)26例,疾病进展(PD)14例,客观缓解率(ORR)13%,疾病控制率(DCR)70%,中位无进展生存期(PFS)4.7月,主要不良反应为血液学毒性、肝功能损害,外周神经毒性,无毒性相关死亡病例。结论白蛋白结合型紫杉醇用于三线及以上治疗晚期非小细胞肺癌,ORR及DCR高,不良反应可以耐受。