血清CA15-3、CEA及全身骨显像联合检查对乳腺癌骨转移的诊断价值

目的 探讨血清糖类抗原15-3(carbonhydrate antigen 15-3,CA15-3)、癌胚抗原(carcinoembryonic antigen,CEA)测定联合全身骨显像(WBS)对提高乳腺癌骨转移诊断的临床价值.方法 对92例乳腺癌患者分别进行血清CA15-3、CEA检测和WBS,并进行对比分析.结果 乳腺癌骨转移组,血清CA15-3和CEA水平显著增高,与无骨转移的乳腺癌组比较有统计学差异(CA15.3:t=91.8342;CEA:t=77.6323,P<0.01).CA15-3、CEA及全身骨显像联合检测对诊断乳腺癌骨转移其灵敏度、特异度分别为95.74%、88.89%,较单独检测某项指标诊断效率均有提高.结论 血清CA15-3、CEA及全身骨显像联合检测可提高乳腺癌骨转移的诊断效率,特别是全身骨显像结果模棱两可时意义更大.     

血清CA15-3、CEA及全身骨显像联合检查对乳腺癌骨转移的诊断价值

目的 探讨血清糖类抗原15-3(carbonhydrate antigen 15-3,CA15-3)、癌胚抗原(carcinoembryonic antigen,CEA)测定联合全身骨显像(WBS)对提高乳腺癌骨转移诊断的临床价值。方法 对92例乳腺癌患者分别进行血清CA15-3、CEA检测和WBS,并进行对比分析。结果 乳腺癌骨转移组,血清CA15-3和CEA水平显着增高,与无骨转移的乳腺癌组比较有统计学差异(CA15.3:t=91.8342;CEA:t=77.6323,P<0.01)。CA15-3、CEA及全身骨显像联合检测对诊断乳腺癌骨转移其灵敏度、特异度分别为95.74%、88.89%,较单独检测某项指标诊断效率均有提高。结论 血清CA15-3、CEA及全身骨显像联合检测可提高乳腺癌骨转移的诊断效率,特别是全身骨显像结果模棱两可时意义更大。     

血清CA15-3、CEA检测联合全身骨显像在乳腺癌骨转移中的诊断价值

目的 评价血清肿瘤标志物糖类抗原15-3(CA15-3)、癌胚抗原(CEA)检测联合全身骨显像在乳腺癌骨转移诊断中的价值.方法 对97例乳腺癌患者(其中,骨转移组46例、无骨转移组51例)及45例良性乳腺疾病患者(良性病变组)行SPECT全身骨显像,对骨显像阴性但骨痛明显患者,再行CT或MRI检查以确诊.同时,用电化学...     

肺癌骨转移患者化疗前后血清骨源性碱性磷酸酶、Ⅰ型前胶原N端前肽、β胶原特殊序列和肿瘤标志物水平变化及其临床意义

目的 探讨肺癌骨转移患者化疗前后血清骨源性碱性磷酸酶（bone alkaline phosphatase,BALP）、Ⅰ型前胶原N端前肽（procollagen typeⅠN-terminal propeptid,PINP）、β胶原特殊序列（β-crosslaps,β-CTX）及肿瘤标志物水平变化及其临床意义。方法 选取2015年1月—2017年12月自贡市第四人民医院收治的肺癌骨转移患者92例作为肺癌骨转移组,均接受唑来膦酸联合含铂双药化疗方案治疗,选取同期医院收治的单纯肺癌无骨转移患者110例作为肺癌组,检测肺癌骨转移组患者化疗前后和肺癌组血清BALP、PINP、β-CTX及肿瘤标志物水平。结果 肺癌骨转移组化疗前BALP、PⅠNP、β-CTX、细胞角蛋白19片段21（cytokeratin 19 fragment antigen21-1,CYFRA21-1）、癌胚抗原（carcinoembryonic antigen,CEA）水平显著高于肺癌组,差异有统计学意义（P＜0.05）;肺癌骨转移组骨转移数目≤3个的患者BALP、PINP、β-CTX、CYFRA21-1、CEA水平显著低于＞3个患者,差异有统计学意义（P＜0.05）;肺癌骨转移组化疗后BALP、PINP、β-CTX、CYFRA21-1、CAE水平低于化疗前,且化疗有效组低于化疗无效组,差异有统计学意义（P＜0.05）。结论 BALP、PINP、β-CTX及肿瘤标志物与肺癌骨转移、骨转移数目有关,且可用于化疗效果评估中。     

N-MID、β-CTx在肿瘤骨转移中的临床价值

目的 探讨骨代谢标志物N端骨钙素(N-MID)、β-Ⅰ型胶原羧基端肽(β-CTx)在肿瘤骨转移中的诊断价值.方法 84例恶性肿瘤患者根据骨显像结果分为无骨转移组26例(0级)、骨转移组58例(1,2,3和4级分别17,12,16和13例),测定血清N-MID、β-CTx、25-羟基.维生素D(25-OH-D)、降钙素(CT)、Ca水平.结果 骨转移组β-CTx水平的中位数为0.42 μg/L,较无骨转移组(0.27 μg/L)明显升高,差异有统计学意义(Z=-0.784,P＜0.05);2组N-MID、25-OH-D、CT和Ca水平差异无统计学意义(P均＞0.05);随骨显像所示转移灶级别增加,β-CTx水平逐渐升高,分别为(0.24 4-0.17),(0.31 4-0.11),(0.56 4-0.19),(0.81 4-0.13)和(1.10 4-0.22)μg/L,除0和1级、1和2级外,其他各级两两比较差异均有统计学意义(F0,1=1.602,F1,2=3.890,P均＞0.05;F0,2=5.429,F0,3=9.625,F0,4=16.413,F1,3=8.796,F1,4=13.687,F2,3=4.167,F2,4=9.124,F3,4=5.128,P均＜0.05);N-MID水平有逐渐上升趋势,但各级间差异无统计学意义(P均＞0.05);25.OH-D、CT和Ca水平在各级间差异也无统计学意义(P均＞0.05).结论 血清B-CTx水平对骨转移的诊断和监测可能有一定价值,但尚需作进一步研究证实.     

原发性骨质疏松性椎体及股骨颈骨折病人血清基质金属蛋白酶-1与骨转换生化指标的关系

目的探讨原发性骨质疏松性椎体及股骨颈骨折病人血清基质金属蛋白酶-1(MMP-1)与骨转换生化指标血清碱性磷酸酶(ALP)及Ⅰ型胶原氨基末端肽(NTX)的关系。方法用酶联免疫吸附试验(ELISA)测定34名骨质疏松椎体及股骨颈骨折病人的血清MMP-1、血清ALP和血清Ⅰ型胶原氨基末端肽(sNTX)水平。结果原发性骨质疏松性椎体及股骨颈骨折患者血清MMP-1与ALP及NTX无相关性;患者血清NTX水平较年龄匹配的骨质疏松组增高(P<0.0 5),血清MMP-1水平高于年龄匹配的正常对照组及骨质疏松组(P<0.05)。结论血清NTX水平增高可能为骨折的危险因素。原发性骨质疏松性椎体及股骨颈骨折患者血清MMP-1水平升高,可能为高骨代谢转换过程中的一种生化表现。     

肥胖大鼠袖状胃切除术后骨折风险增加的初步探讨

目的 初步探讨袖状胃切除术(SG)后大鼠骨折风险增加的解剖学和骨代谢学证据.方法 6周龄清洁级雄性SD大鼠40只(海军军医大学实验动物中心提供),平均体质量(173.59±14.27)g,随机分成高脂饲料组(高脂高糖饲料,30只)和普通饲料组(10只),喂养8周,高脂饲料组共26只大鼠成功诱导为肥胖大鼠.随后将26只肥胖大鼠随机分为肥胖组(10只)和SG组(16只),SG组行SG术,围手术期死亡6只大鼠.故最终分组:空白对照组(原普通饲料组)、肥胖组(肥胖大鼠)和SG组(肥胖大鼠+SG术),各10只.所有大鼠喂养时间相同,肥胖组和SG组术前术后均为高脂高糖饲料,SG组术后继续喂养8周,通过观察各组体质量和摄食量的变化,分析SG干预效果及营养摄入的差异;通过观察骨密度(BMD)和骨组织学指标判断SG对骨结构的干预;术后8周通过检测血钙、甲状旁腺素(PTH)和25-羟基维生素D3[25(OH)D3]分析SG对钙吸收和骨代谢的影响;检测Ⅰ型胶原蛋白C端末端肽(CTX)、Ⅰ型前胶原氨基端前肽(PINP)、抗酒石酸酸性磷酸酶-5a(TRACP-5a)、抗酒石酸酸性磷酸酶-5b(TRACP-5b)等骨代谢指标和观察胫骨中段骨髓脂肪细胞的变化,探讨SG后骨代谢变化的证据.结果 (1)SG组术后第1周体质量以及摄食量显著下降,但随着不限量饮食的开放,SG组术后的体质量以及摄食量再次缓慢上升,至术后第8周,三组的摄食量无明显差异但SG组的体质量仍然低于肥胖组,提示SG干预成功并消除营养摄入差异.(2)肥胖组股骨和脊柱BMD降低,SG组BMD进一步降低.(3)SG组较其他两组比较骨小梁显著变细,部分出现断裂和穿孔,同时部分大鼠股骨出现骨皮质变薄,炎细胞浸润增加.(4)三组的血钙、PTH和25(OH)D3比较差异无统计学意义,说明SG对营养物质特别是Ca吸收未造成显著影响.(5)肥胖组CTX和PINP显著升高,SG组CTX和PINP仍有一定的升高,但与肥胖组比较差异无统计学意义.肥胖组TRACP-5a较另外两组显著升高,SG组与空白对照组比较差异无统计学意义.空白对照组和肥胖组的TRACP-5b比较差异无统计学意义,但SG组显著高于空白对照组,与肥胖组比较差异无统计学意义.(6)肥胖组和SG组术后胫骨中段骨髓脂肪细胞个数分别为(11.2±2.8)个和(13.7±3.9)个(P=0.11).结论 SG术后可能导致骨折风险增加,主要表现为骨代谢指标、BMD和形态学变化,其原因可能与能量摄入和钙磷代谢关系不大,而可能与骨髓脂肪细胞增加相关.     

~(131)I治疗中青年Graves病前后骨密度及骨代谢指标的变化

目的探讨131I治疗Graves病甲状腺功能亢进症过程中骨密度及骨代谢指标的变化,并探索患者骨代谢指标和甲状腺功能指标的相关性。方法选择在我院接受治疗的58例Graves病患者作为治疗组,另选同期65例体检者作为正常对照组。测定患者治疗前后的FT3、FT4、TSH、甲状腺素受体抗体(TRAb)等甲状腺功能指标、血清钙(Ca)、磷(P)、碱性磷酸酶(AKP)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、骨钙素(BGP)、血清I型胶原氨基端肽原(PINP)、腰椎L1~4和股骨颈的骨密度等骨代谢指标以及体重指数、瘦素、甲状旁腺素(PTH)等指标的变化情况。结果治疗前,Graves病甲亢组和健康组相比,FT3、FT4、TSH、甲状腺素受体抗体等甲状腺指标以及血清钙、磷、AKP、β-CTX、骨钙素、PINP、PTH、体重指数等指标有显著差异。131I治疗过程中,大部分甲状腺指标及骨代谢指标有显著改善,股骨颈和腰椎骨密度有改善趋势,但不显著。结论131I治疗甲状腺疾病的同时能改善甲状腺功能亢进导致的骨代谢指标异常,可有效防治Graves病引起的骨质疏松。     

重组人促甲状腺激素在131I治疗分化型甲状腺癌中的价值

目的 评价重组人TSH (rhTSH)介导DTC 131I清除甲状腺残余组织(简称清甲)治疗的安全性及有效性.方法 回顾性分析144例甲状腺全切或次全切术后接受131I清甲治疗的DTC患者.rhTSH替代组(Ⅰ组)72例使用rhTSH 0.9mg,1次/d,连续2d肌内注射;甲状腺激素撤退组(Ⅱ组)72例停用甲状腺素药物4～6周,2组均给予3.7 GBq 131I进行清甲.观察2组FT3、FT4、TSH和Tg的变化,同时观察患者怕冷、体质量增加、腹胀、便秘、动作迟缓、皮肤干燥、眶周水肿、骨痛等反应;根据131I全身显像结果,评价2组患者的131I清甲治疗效果,显像示甲状腺床区无放射性摄取或摄取率＜1％为一次清甲完全.数据比较行x2检验或t检验.结果 2组131I治疗前血清TSH水平均升高,Ⅰ组TSH明显高于Ⅱ组[(141.26±27.30)与(70.57±51.13) mU/L,t=2.435,P＜0.05],且Ⅰ组患者血清FT3、FT4水平无明显变化;2组131I治疗前血清Tg均升高.Ⅱ组患者发生不良反应统计:怕冷80.56％(58/72),体质量增加86.11％(62/72),便秘15.28％ (11/72),动作迟缓22.22％(16/72),皮肤干燥56.94％(41/72),骨痛2.78％ (2/72),无眼眶周围水肿者.Ⅰ组治疗安全性高,主要不良反应为:头晕恶心(2.78％,2/72),骨骼疼痛(2.78％,2/72),短暂性心动过速(1.39％,1/72).131I全身显像评价患者一次清甲完全率,Ⅰ组达70.83％ (51/72),Ⅱ组达66.67％(48/72),二者差异无统计学意义(x2 =0.58,P ＞0.05).结论 使用rhTSH能有效完成DTC131I治疗前准备,提高患者的生活质量,有利于残余甲状腺组织的清除.     

18F-FDG PET与99Tcm- MDP显像诊断肿瘤骨转移的比较

目的　研究1 8F 脱氧葡萄糖 (FDG)PET显像对肿瘤骨转移的诊断价值 ,并与99Tcm 亚甲基二膦酸盐 (MDP)骨显像比较。方法　 4 3例确诊的肿瘤患者在 1个月内先后行1 8F FDGPET及99Tcm MDP骨显像 ,其中 2 4例经其他检查及随访证实为骨转移。对比分析 2种显像结果。结果　 2 4例骨转移患者FDGPET显像均为阳性 ,骨显像阳性 2 2例 ,灵敏度分别为 10 0 %和 91.7% ,差异无显著性 (P >0 0 5 )。19例无骨转移患者中FDGPET显像阴性 18例 ,骨显像阴性 11例 ,特异性分别为 94 .7%和5 7 9% ,差异有显著性 (P <0 0 5 )。 2种方法检测骨转移的准确性分别为 97.7%和 76 .7% ,差异有显著性 (P <0 0 5 )。结论　1 8F FDGPET显像诊断肿瘤骨转移的灵敏度与99Tcm MDP骨显像无明显差别 ,但有更高的特异性和准确性。     

Aneurysmal bone cyst of the temporal bone

Aneurysmal bone cyst (ABC) of the temporal bone is rare. The nature of the underlying disorder that converted into the ABC might, however, be difficult to ascertain on imaging as well as on histopathology. The unusual CT and MRI findings in a case of ABC of the temporal bone are presented. This had transdural intracerebral spread with a large component of solid enhancing matrix but no peripheral calcific rim. The patient was an adult of 45 years with a history of headache for more than 1 year.     

Aneurysmal bone cyst of the temporal bone

Summary Aneurysmal bone cysts occurring within the calvarium are uncommon. The following case report describes the radiological and pathological findings of a temporal bone aneurysmal bone cyst with intra- and extracranial manifestations. The pertinent literature is reviewed.     

Aneurysmal bone cyst of the frontal bone

BACKGROUND: Aneurysmal bone cyst (ABC) is a benign, expansive, osteolytic lesion that mainly occurs in young people, and involves the skull bones only exceptionally. The origin of ABC is controversial: secondary reactive bone lesion, or primary disease that represents an independent nosological entity. Blunt head trauma was suggested as a possible etiological factor. CASE REPORT: A case of a 19-year-old man with primary ABC of the right frontal bone was reported. The lesion was totally excised through frontal craniotomy, and the skull bone defect primarily reconstructed with an acrilate cranioplasty. Five years after the surgery, the patient was without signs of local recurrence. CONCLUSION: Clinical and neuroradiological presentation of the skull ABC was not specific. Pathohistology confirmed the diagnosis. Total excision was the treatment of choice.     

Aneurysmal bone cyst of the ethmoid bone

Aneurysmal bone cysts is a benign, slow growing expansile lesion usually found in long bones or vertebrae. Only 5 cases of ABC of the ethmoid bone have been reported in the literature. Plain radiographs are not specific. CT and MRI are very useful to depict the extent of the lesion and demonstrate the presence of blood-fluid levels, which is a characteristic finding of ABC. We present one atypical case of ABC of the ethmoid bone in a 15-year-old female characterised by its extensive involvement and its rare location.     

Aneurysmal bone cyst of the temporal bone

Aneurysmal bone cysts are benign fibrosseous lesions of the bone that are rarely detected in the temporal bone. Seventeen cases of aneurysmal bone cysts with histological confirmation involving the temporal bone were reported in the literature. We report a case of left temporal aneurysmal bone cyst in a 52-year-old male with the clinical findings of periauricular painful swelling, decreased hearing, and facial paralysis. A magnetic resonance image of the patient showed a well-circumscribed multi-loculated expansile lesion of the left temporal bone during the first admission to the hospital. The lesion recurred 1 year after the subtotal resection with a more solid appearance. In addition, we review the literature for these rare lesions.     

异种脱蛋白骨修复山羊长骨大段缺损的成骨观察

目的 评估改良法制备异种脱蛋白骨(deproteinzated bone,DPB)作为组织工程支架材料修复大动物大段长骨缺损的能力,为异种DPB的临床应用提供实验依据.方法 山羊24只,在每只山羊右侧胫骨中下段截除胫骨总长度20%形成节段性骨缺损,按分组情况植入不同材料.A组为单纯异种DPB,B组为自体骨,C组为异种DPB+自体骨髓间充质干细胞(BMSCs)+重组人骨形态发生蛋白2(rhBMP2),均采用半环槽式外固定器固定.术后4～24周每隔4周进行X线及术后24周取新生骨进行双能X线(DEXA)、组织学、生物力学检测,评价骨缺损修复效果. 结果 术后4～24周,在同一时相点,X线Lane-Sandhu法评分B组》C组》A组,并且术后24周新骨的骨密度、骨矿含量、组织学和生物力学检测经统计学分析,C组与B组比较,差异无统计学意义(P>0.05). 结论 改良法制备的异种DBP复合自体BMSCs和rhBMP2修复山羊胫骨大段缺损成骨能力与自体骨相当,可以作为组织工程支架材料试用于临床.     

Giant-cell tumor of bone and aneurysmal bone cyst

A correlated histologic and radiographic study of nine giant-cell tumors, six aneurysmal bone cysts, and one combined lesion is presented. Clinical findings and plain radiographic appearances were found to overlap. Angiographically, the giant-cell tumors were richly vascularized, with a marked intratumoral contrast uptake, occasional irregular tumor vessles, a prominent peritumoral arterial net-work, and early draining veins. Microscopic examination revealed fine, capillary-like and somewhat larger, angulated, sinusoid vessels, and occasional small, bloodfilled cysts within the tumor. Conspicuous arteries, veins, and capillaries surrounded the tumor. The aneurysmal bone cysts at angiography were predominantly avascular in the interior, surrounded by a thin hyperemic zone in the peritumoral tissue, with sometimes early filling of veins. Microscopically, the aneurysmal bone cysts showed large, anastomosing, bloodfilled vascular channels, and a moderate number of capillaries within the solid, fibrous areas and the granulation tissue. It is concluded that angiography, particularly with a subtraction technique, may be a valuable diagnostic method in the pre-operative differentiation of giant-cell tumors from aneurysmal bone cysts.