来曲唑与克罗米芬治疗多囊卵巢综合征不孕症临床疗效比较

目的比较来曲唑与克罗米芬治疗多囊卵巢综合征不孕症的疗效。方法选取120例不孕症患者并随机分为来曲唑组(LE组)和克罗米芬组(CC组),每组各60例患者。两组患者均服用炔雌醇环丙孕酮片1次/d、1片/次,盐酸二甲双胍片2次/d、1片/次,治疗3~6周调整患者的内分泌相关指标至正常后停药。LE组从月经或黄体酮撤退性出血的第5天开始,口服来曲唑片1片/d、5 d,CC组服用克罗米芬1次/d、1粒/次。B超监测子宫内膜和卵泡发育情况,肌肉注射人绒毛膜促性腺激素(HCG)5 000~10 000 U诱发排卵。比较两组患者HCG注射日卵泡发育、子宫内膜等相关指标及性激素水平、排卵效果、妊娠结局。结果 LE组成熟卵泡个数及平均直径、螺旋动脉血流阻力指数低于CC组,而子宫内膜厚度、宫颈黏液Insler评分和宫腔容积均高于CC组,两组间比较,差异均有统计学意义(P<0.05)。LE组的雌二醇水平低于CC组,而黄体生成素峰时间大于CC组,两组间比较,差异均有统计学意义(P<0.05)。LE组患者排卵率、多胎妊娠率、未破裂卵泡黄素化综合征发生率及卵巢过度刺激综合征发生率均明显低于CC组,而生化妊娠率及临床妊娠率均明显高于CC组,两组间比较,差异均有统计学意义(P<0.05)。结论对于多囊卵巢综合征不孕症患者,应用LE妊娠率较高,且未破裂卵泡黄素化综合征及卵巢过度刺激综合征发生率均明显低于应用CC者。     

来曲唑与他莫昔芬治疗特发性少精子症的疗效对比

 目的 探讨来曲唑(letrozole)治疗特发性少精子症患者的临床效果。方法 选取150例特发性少精子症患者,按照随机数字法分为A、B、C 3组各50例,A组采用来曲唑片治疗,B组采用枸橼酸他莫昔芬治疗,C组给予安慰剂治疗,疗程均为3个月,比较各组治疗前后性激素水平(E₂、T、FSH、LSH、PRL、T/E₂、INHB)、精液常规参数、睾丸体积和BMI。结果 治疗后A组临床总有效率为96.0%,显著高于B组的84.0%、C组的28.0%,差异有统计学意义(P<0.05);治疗后A组血清FSH、LH、T、INH-B水平、T/E₂比值明显高于B组、C组,血清E₂水平低于B组、C组,差异均有统计学意义(P<0.05);治疗后A组精子浓度、精子总数、精子正常形态比例明显提高(P<0.05);A组有效精子数显著高于B组、C组,差异有统计学意义(P<0.05)。结论 采用来曲唑治疗特发性少精子症能显著提高T、FSH水平、T/E₂比值及精液质量。     

89SrCL2与唑来膦酸联合治疗乳腺癌转移性骨肿瘤的疗效分析

目的：探讨放射性核素二氯化锶（89SrCl2）联合唑来膦酸治疗激素依赖型乳腺癌转移性骨肿瘤的临床疗效。方法回顾性分析64例激素依赖型乳腺癌转移性骨肿瘤患者的临床资料,将所有患者分为3组：89SrCl2治疗组22例;唑来膦酸治疗组21例;89SrCl2联合唑来膦酸治疗组21例;观察治疗后转移病灶疗效、骨痛缓解情况、生活质量状况、骨髓抑制反应情况。结果89SrCl2治疗骨转移病灶有效率为36.4%（8/22）,视觉模拟评分下降率为77.3%（17/22）,全身状况KPS评分提高率为63.6%（14/22）,27.2%（6/22）的患者出现骨髓抑制反应;唑来膦酸治疗后骨转移病灶有效率为33.3%（7/21）,视觉模拟评分下降率为71.4%（15/21）,全身状况KPS评分提高率为52.4%（11/21）,19.0%（4/21）的患者出现骨髓抑制反应;89SrCl2联合唑来膦酸治疗骨转移病灶有效率为42.9%（9/21）,视觉评分下降率为90.5%（19/21）,全身状况KPS评分提高率为90.5%（19/21）,33.3%（7/21）的患者出现骨髓抑制反应。结论89SrCl2联合唑来膦酸对激素依赖型乳腺癌转移性骨肿瘤的疗效明显,不良反应小,联合治疗效果优于89SrCl2和唑来膦酸单独治疗。     

来曲唑对体外培养子宫内膜异位细胞增殖的影响

目的探讨来曲唑对体外培养的子宫内膜异位症患者在位内膜细胞的增殖影响。方法MTT比色法检测来曲唑对位内膜细胞（Eutopic Endometrium,EE）/正常内膜（normal endometriumNE）抑制情况,并采用蛋白印迹法与RT-PCR方法检测芳香化酶及其转录调节因子SF-1的蛋白与mRNA表达情况。结果NE细胞用药组与对照组比较无显著性差异（P〉0.05）;EE细胞在来曲唑作用下呈现较强的抑制增殖效应,抑制作用随浓度增加而加强,细胞增殖活力明显降低,有显著性差异（P〈0.01）,不同浓度的来曲唑均可明显抑制细胞内芳香化酶及其转录调节因子SF-1的蛋白与mRNA表达,且呈剂量依赖性,有显著性差异（P〈0.01）。结论芳香化酶抑制剂-来曲唑对内异症在位内膜细胞具有抑制其增殖作用,明显抑制EE细胞内芳香化酶及其转录调节因子SF-1的蛋白与mRNA表达。     

大剂量甲孕酮治疗晚期耐药乳腺癌的效果评价

1 临床资料 25例晚期乳腺癌患者,年龄48(35～70)岁.转移部位:骨转移17例,肺转移8例,胸壁软组织7例,胸腔积液5例,肝转移5例,骨髓转移3例,脑转移2例.     

唑来膦酸与阿仑膦酸钠治疗绝经后妇女OP的疗效比较

目的比较唑来膦酸和阿仑膦酸钠治疗绝经后妇女骨质疏松症(OP)的疗效。方法 110例绝经后妇女OP患者,随机分入唑来膦酸组(5 mg/年)和阿仑膦酸钠组(70 mg/w),疗程为24个月。在治疗前后,检测患者腰椎L1~4、全胯和股骨颈部位的骨密度(BMD)值,并以视觉模拟评分法(VAS)评估患者疼痛程度。结果治疗24个月后,两组患者在上述3个部位的BMD值均较治疗前显著增加(P<0.05),且唑来膦酸组在腰椎L1~4、全胯等2个部位的BMD值增加幅度显著大于阿伦磷酸组(P<0.05)。阿仑膦酸钠组在治疗12个月后,VAS评分较其治疗前开始有显著下降(P<0.05);唑来膦酸组在治疗6个月后较其治疗前开始有显著下降(P<0.05),且VAS评分的降幅均较同期阿仑膦酸钠组更为显著(P<0.05)。结论唑来膦酸治疗绝经后妇女OP,疗效优于阿仑膦酸钠,安全性相近,值得临床推广应用。     

唑来膦酸治疗绝经后骨质疏松患者2年结果分析

目的 分析唑来膦酸（商品名：密固达）治疗绝经后骨质疏松患者2年后的疗效和不良反应.方法 统计我院2009~2012年中连续使用密固达治疗2年的绝经后骨质疏松患者47例的临床资料,分析治疗前后患者骨密度变化情况及不良反应发生率.结果 首次使用密固达患者中,出现发热3例（6.4%）,肌痛3例（6.4%）,发热合并肌痛9例（19.1%）.其中1例出现高热（最高体温40.5 ℃）;1例出现双侧大腿内侧出血点,1 w后消退;其余不良反应少见.第二次输注后出现发热5例（10.6%）,但无高热发生.左侧股骨颈骨密度、左侧全髋骨密度、L2~4椎体骨密度,治疗后与治疗前以及治疗第2年与第1年比较均明显升高（P＜0.05）.结论 密固达治疗绝经后骨质疏松对骨密度提升效果明显,且总体安全性好,主要不良反应为发热和肌痛.     

不同分割剂量放疗联合唑来膦酸治疗肺癌骨转移效果观察

目的：观察两种分割剂量放疗联合唑来膦酸治疗肺癌骨转移的临床疗效。方法：选择肺癌骨转移70例,随机分为观察组36例和对照组34例。观察组采用高分割放疗,即6MV-X线照射,3Gy／次,5次／周,共30Gy／10次／2周;对照组采用常规分割放疗,照射方式同观察组,剂量为2Gy／次,5次／周,共30Gy／15次／3周。两组均同时给予唑来瞵酸4mg静脉滴注,每4周重复,共4个周期。观察比较两组疼痛缓解率和生存率及不良反应等。结果：治疗结束时,观察组和对照组疼痛缓解率分别为86．1％、79．4％,治疗结束后3个月疼痛缓解率分别为80．6％、73．5％,两组疼痛缓解率比较,差异不显著（P〉0．05）;观察组和对照组1年生存率分别为44．4％、41．2％,2年生存率分别为11．1％、9．5％,两组生存率比较,差异不显著（P〉0．05）。结论：两种不同分割剂量放疗联合唑来瞵酸治疗肺癌骨转移镇痛效果及生存率相似。     

影像学检查在乳腺癌的诊断及疗效评估中的应用价值

乳腺癌是严重影响女性身心健康甚至危及生命的常见病,影像学检查对于乳腺癌的诊断及治疗效果的评估有着重要的意义.该文旨在介绍并比较超声、乳腺钼靶、乳腺CT、乳腺MRI、乳腺99Tcm-MIBI显像及PET、PET-CT等在乳腺癌诊断及治疗疗效评估中的应用价值.     

CE-Magnetic Resonance Mammography for the evaluation of the contralateral breast in patients with diagnosed breast cancer

PURPOSE: To evaluate the role of contrast-enhanced Magnetic Resonance Mammography (MRM) in the evaluation of the contralateral breast in patients with recently diagnosed breast cancer. MATERIALS AND METHODS: Fifty patients with proved unilateral breast cancer, with a negative contralateral breast at physical examination, ultrasound and mammography, were studied with a 1.5 T magnet (Siemens, Vision Plus, Germany). A bilateral breast surface coil was used. Dynamic 3D Flash T1-weighted sequences were acquired in the axial plane before and 0, 2, 4, 6 and 8 minutes after the administration of 0.1 mmol/kg of Gd-BOPTA at a flow rate of 2 ml/s followed by 10 ml of saline. The level of suspicion was reported on a scale from 0 to 5 following the BI-RADS classification, based on lesion morphology and kinetic features. The results were compared with the histological findings after biopsy or surgery. RESULTS: Fourteen out of 50 patients (28%) had contralateral lesions identified on MRM. Biopsy was performed in four of them for suspicious lesions (BI-RADS 4) while 10 patients underwent surgery because of highly suggestive malignant lesions (BI-RADS 5). Histology diagnosed three fibroadenomas, 5 ductal carcinomas in situ, 2 lobular carcinomas in situ, 3 invasive ductal carcinomas and 1 invasive lobular carcinoma. Contrast-enhanced MRM yielded no false negative and three false positives. CONCLUSIONS: Our results demonstrate a very good accuracy of Magnetic Resonance Mammography in the detection of synchronous contralateral cancer in patients with newly diagnosed breast cancer. Therefore, contrast-enhanced MRM could be introduced to screen patients with proven breast cancer before they undergo surgery.     

Pericardial irritation in breast cancer patients treated by curative postoperative radiotherapy--early results

Authors prospectively examined 54 breast cancer patients treated by postoperative telecobalt, or electron therapy. They studied the cardiological side effects caused by ionizing radiation. ECG, echocardiography and measurement of systolic time intervals were performed before, immediately, six weeks, six months, one and 1.5 to two years after the completion of radiotherapy. 23 symptom-free patients were found to have signs of transitory pericardial irritation, more after telecobalt, than electron therapy (17/6). T-wave inversions were seen on the ECG of 20 patients. In six and three patients small amounts of pericardial effusion could be detected by echocardiography with, or without ECG alterations, respectively. Other side effects mentioned by the literature could not be found yet, further follow-up is recommended, however. In the authors' opinion the effect of ionizing radiation, mainly of telecobalt therapy is possibly a risk factor for cardiovascular disease, it is suggested to be considered at the planning of radiation therapy accordingly.     

MRI 在三阴性乳腺癌中的诊断与疗效评估

乳腺癌是严重影响女性身心健康的常见恶性肿瘤,它是一类异质性明显的疾病,有各种各样的形态学表现、临床进程和对治疗的反应[1]。在临床中,通常用雌激素受体(estrogen receptor,ER)、孕激素受体(pro-gesterone receptor,PR)和人类表皮生长因子受体2(human epidermal growth factor receptor2,HER2)表达程度的免疫组化谱来识别乳腺癌不同亚组的患者。三阴性乳腺癌(tripple negative breast cancer,TNBC)是指 ER、PR 阴性,HER2无扩增的一种乳腺癌亚型, TNBC 仅占所有乳腺癌发病率的10%~20%,但由于它具有较强的侵袭性且在临床中缺乏有效的靶向治疗,所以在乳腺癌死亡率中占有较大的比例[2]。故早期发现、早期诊断、早期治疗的原则在 TNBC 中显得尤为重要。磁共振成像(MRI)是目前诊断乳腺疾病最敏感的影像学检查,其在乳腺癌中的应用价值也渐渐受到肯定。本文将就 TNBC 在 MRI 中的特征及 MRI在 TNBC 新辅助化疗中的应用与价值做一综述。     

静脉畸形硬化治疗效果影像学评价

【摘要】 静脉畸形（VM）是临床最常见的先天性血管畸形,可发生在身体任何部位。主要引起患者疼痛、功能障碍、肢体和面部不对称,严重时可并发大出血或呼吸道梗阻,进而危及生命。目前VM主要治疗方法为血管内硬化治疗,但对其临床疗效仍缺乏客观的评价标准。该文就目前VM血管内硬化治疗评价方法超声、CT、MRI、全身血池闪烁显像（WBBPS）和静脉造影等研究现状作一综述,旨在为临床准确把握疗效,在精准治疗病灶的同时减少并发症发生提供帮助。     

Endometrial evaluation with transvaginal US and hysterosonography in asymptomatic postmenopausal women with breast cancer receiving tamoxifen

PURPOSE: To determine performance characteristics of transvaginal ultrasonography (US) and hysterosonography for diagnosing endometrial abnormality in asymptomatic postmenopausal women with breast cancer receiving tamoxifen. MATERIALS AND METHODS: The authors prospectively examined 138 women receiving tamoxifen by using transvaginal US, hysterosonography, and office hysteroscopy. The combined hysteroscopic-histopathologic diagnosis was the reference standard. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of transvaginal US and hysterosonography were calculated. RESULTS: All 138 women underwent transvaginal US; 104, successful hysterosonography; and 117, successful hysteroscopy. Uterine abnormality was present in 47 (40.2%) of 117 women: 45 with polyps and two with submucosal fibroids. Receiver operating characteristic curve analysis revealed 6 mm to be the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities. When a thickness greater than 6 mm or a focal endometrial finding was considered abnormal, transvaginal US had a sensitivity of 85.1% and a specificity of 55.7%. In 92 women who completed transvaginal US, hysterosonography, and hysteroscopy, hysterosonography was more specific (79.2%; P =.008) but not significantly more sensitive (89.7%; P =.508) than transvaginal US. When women with abnormal transvaginal US findings were further examined with hysterosonography, the sequential combination of transvaginal US and hysterosonography was more specific (77.1%) than transvaginal US alone (P <.001), without a significant decrease in sensitivity (78.7%; P =.25). CONCLUSION: In asymptomatic postmenopausal women receiving tamoxifen, 6 mm is the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities with transvaginal US. Further examination with hysterosonography can improve specificity by reducing the high false-positive rate of transvaginal US.     

Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral breast cancer or high-risk lesions

PURPOSE: To prospectively evaluate accuracy of gadobenate dimeglumine-enhanced magnetic resonance (MR) mammography for depiction of synchronous contralateral breast cancer in patients with newly diagnosed unilateral breast cancer or high-risk lesions, with histologic analysis or follow-up as reference. MATERIALS AND METHODS: The study had ethics committee approval; all patients provided written informed consent. One hundred eighteen consecutive women (mean age, 52 years) with unilateral breast cancer or high-risk lesions and negative findings in the contralateral breast at physical examination, ultrasonography, and conventional mammography underwent gadobenate dimeglumine-enhanced 1.5-T MR mammography. Transverse three-dimensional T1-weighted gradient-echo images were acquired before and at 0, 2, 4, 6, and 8 minutes after gadobenate dimeglumine administration (0.1 mmol per kilogram body weight). Breast Imaging Reporting and Data System (BI-RADS) was used to categorize breast density and the level of suspicion for malignant contralateral breast lesions. Results were compared with histologic findings. Sensitivity, specificity, accuracy, and positive and negative predictive values for contrast-enhanced MR mammography were evaluated. RESULTS: Contrast-enhanced MR mammography revealed contralateral lesions in 28 (24%) of 118 patients. Twenty-four lesions were detected in patients with dense breasts (BI-RADS breast density category III or IV). Lesions in eight (29%) of 28 patients were BI-RADS category 4; patients underwent biopsy. Lesions in 20 (71%) patients were BI-RADS category 5; patients underwent surgery. At histologic analysis, 22 lesions were confirmed as malignant; six lesions were fibroadenomas. No false-negative lesions were detected; none of the fibroadenomas were BI-RADS category 5. The sensitivity, specificity, accuracy, and positive and negative predictive values of contrast-enhanced MR mammography for depiction of malignant or high-risk contralateral lesions were 100%, 94%, 95%, 79%, and 100%, respectively. Follow-up findings (12-24 months) confirmed absence of contralateral lesions in 90 of 118 patients with negative contrast-enhanced MR mammographic findings in the contralateral breast. CONCLUSION: Contrast-enhanced MR mammography is accurate for detection of synchronous contralateral cancer or high-risk lesions in patients with newly diagnosed breast cancer or high-risk lesions.     

超声在先天性肌性斜颈诊断及推拿治疗疗效评估中的应用

目的:探讨超声在先天性肌性斜颈诊断及推拿疗效评估中的应用价值。方法:35例先天性肌性斜颈患儿,其中男27例,女8例;年龄10d~14个月,平均(4.70±4.29)个月;根据超声表现分为四型。患儿年龄与分型之间的相关性分析使用Pearson检验;治疗前后,胸锁乳突肌厚度比率比较使用配对t检验。结果:不同分型阶段,超声表现各具特征性;患儿年龄与超声分型之间相关性分析:相关系数0.482,P=0.0030.05;治疗前后患侧胸锁乳突肌与健侧比例分别为2.10±0.55、1.40±0.33,两者之间差异有统计学意义(t=6.689,P=0.000)。结论:先天性肌性斜颈超声表现具有特征性,有助于临床诊断及疗效评估。     

超声对恩度联合新辅助化疗治疗乳腺癌的疗效观察

目的：探讨彩色多普勒超声检查在恩度联合新辅助化疗治疗乳腺癌疗效评估中的价值。方法：分别于治疗前后应用彩色多普勒超声对38例乳腺癌的40个乳腺病灶及腋窝淋巴结进行观察及分析。结果：40个病灶中34个治疗有效,病灶内血流信号分级降低或血流消失;Vm ax值明显降低（P〈0.05）;化疗前发现异常淋巴结共32个,治疗后有28个缩小或消失,30个血流信号明显减少。超声评估原发肿瘤缓解的总有效率为85%（34/40）。结论：超声检查可为恩度联合新辅助化疗治疗乳腺癌提供简便、安全的疗效观察手段。     

Supplementary treatment with Esberitox of female patients undergoing curative adjuvant irradiation following breast cancer

1. The study was supposed to investigate a possible prevention or reduction of the toxicity of radiotherapy by an additional treatment with Esberitox. This question arose when performing an investigation about the effect of Esberitox in a combined chemo-radiotherapy. Whereas the latter induces above all a systemic damage to the hemopoietic system, radiotherapy is a regional noxa. 2. The present prospective, randomized study was conducted with 50 patients submitted to curative adjuvant irradiation following surgery for mammary carcinoma. The radiotherapy was performed in the same way in all patients with irradiations of the thoracic wall and the regional lymph nodes. Two groups were built by randomization. The study group received an additional treatment with Esberitox, the control group did not receive an additional treatment. 3. As a result, no protective influence of Esberitox could be demonstrated. The parameters investigated were the peripheral blood count (leucocytes, granulocytes, lymphocytes, monocytes, thrombocytes, hemoglobin, hematocrit) and the incidence of infections. 4. This result diverging from literature is discussed. It is probably affected by volume and extension of the injury induced by a hematotoxic noxa and furthermore by the ability of regeneration. If this ability is exhausted, the protective effect of Esberitox can act no longer. Therefore the essential factor seems to be the duration of exposure to the noxa. Esberitox was effective in case of a short toxicity, it was ineffective in case of prolonged toxicity, if the treatment continuity (noxa) was not broken up by some regeneration intervals. The radiotherapy studied in this trial had a duration of 50 days, and its effect was that of a longterm injury.