卵巢癌患者血清比较蛋白质组学研究

目的探讨应用蛋白质质谱分析鉴定卵巢癌生物标志物的可行性。方法应用美国CipherCen公司金属亲和表面(IMAC3)芯片和蛋白芯片仪检测24例卵巢癌患者、56例正常人血清中的蛋白质相对含量。结果24例卵巢癌患者与56例正常人血清蛋白质在质荷比为4kb-10kb间有6种蛋白质含量有显著差异。用4472Da的血清蛋白质作为生物标志物可将正常人与卵巢癌患者准确地分组。在学习模式下24例卵巢癌患者被正确诊断，56例正常人均被正确识别；在检测模式下24例卵巢癌患者中有23例患者被正确诊断，56例正常人均被正确识别，准确率为98．8％(79／80)，灵敏度和特异性分别为95．8％(23／24)、100％(56／56)。结论该方法可快速、准确检测卵巢癌，灵敏度和特异性高。     

急性心肌梗死病程不同时期患者血清蛋白质组学分析

目的探讨蛋白质质谱分析对急性心肌梗死病程不同时期的鉴别意义。方法应用美国CipherGen公司金属亲和表面(IMAC3)芯片和蛋白芯片仪检测153例心肌梗死患者血清标本(其中刚入院45例,3h标本12例,6h标本22例,9h标本24例,12h标本24例,24h标本16例,48h标本10例)中的蛋白质相对含量。结果不同时期急性心肌梗死患者在质荷比为4kD-12kD问有10种血清蛋白质含量有显著差异。不同时期的患者均被正确判断,准确率为100％(153／153),灵敏度和特异性分别为100％(45／45)和100％(108／108)。结论该方法可快速、准确检测各期急性心肌梗死,灵敏度、特异性高。     

利用血清中蛋白质组构型鉴定Dukes A期结直肠癌

目的通过对血清蛋白质组的质谱分析,寻找用于Dukes A期结直肠癌鉴定的蛋白质组构型。方法随机取10例Dukes A期及68例Dukes B、C、D期结直肠癌患者的血清作为预备组,另取10例Dukes A期及68例Dukes B、C、D期结直肠癌患者的血清作为检测组。预备组血清与金属亲和表面(IMAC3)芯片结合后,用蛋白芯片仪读取数据,分析可得到用于区分Dukes A期和Dukes B、C、D期结直肠癌患者的树状分类规则,并用双盲法测试检测组以证实其准确性。结果预备组中两类血清蛋白质在质荷比为8320、8604、8867、15872Da等4处含量有显著差异,得到树状分类规则,其分类准确率为97．4％(76／78),灵敏度为100％(10／10),特异性为97．1％(66／68);对检测组进行双盲检测,结果显示准确率为94．9％(74／78),灵敏度和特异性分别为100％(10／10)、94．1％(64／68)。结论该方法可快速、准确检测Dukes A期结直肠癌,灵敏度、特异性高。     

血GPDA/尿GPDA比值测定对胃癌诊断的价值

目的 探讨血清甘氨酰脯氨酸二肽氨基肽酶(GPDA)／尿GPDA比值对胃癌的诊断价值。方法采用连续监测法在Olympus AU2700全自动生化分析仪上测定40例胃癌患者、18例胃癌合并淋巴结转移患者、25例贲门癌患者、68例胃肠良性病变患者及90例正常人的血清GPDA和尿液GPDA,计算血GPDA／尿GPDA比值,对其临床应用价值进行评价,并与血清GPDA的诊断价值进行比较。结果 以正常人血GPDA／尿GPDA比值4．31为诊断界值,小于4．31为阳性,对胃癌诊断的灵敏度为87．5％,特异性为97．0％,总符合率为93．5％,均明显高于血清GPDA的测定。结论 血GPDA／尿GPDA比值测定作为一项新的诊断指标,对胃癌的诊断、普查筛选有较好的应用价值。     

胃癌血清蛋白质谱的差异性研究

目的对比胃癌患者手术前后与正常人血清蛋白质谱的差异,筛选出诊断胃癌的特异性蛋白标志物。方法应用表面增强激光解吸离子化飞行时间质谱（SELDI—TOF—MS）技术和CM10蛋白质芯片,对22例胃癌患者和18名正常人的血清蛋白质谱进行检测。结果通过对胃癌术前血清与正常人血清蛋白质谱分析,发现由5个蛋白质峰组成的生物标记物可将胃癌术前患者与正常人准确分组。结论建立胃癌的血清蛋白质谱,为胃癌蛋白质组学研究奠定一定的基础．建立了以8961．2404M／Z、3947．264M／Z、5919．7541M／Z、4103．348M／Z、8711．0363M/Z5个蛋白质峰组成的生物标记物检测胃癌。     

血清Tg测定和131I显像用于分化型甲状腺癌术后随访

目的 建立血清甲状腺球蛋白（Tg)测定的正常分界值,以预测分化甲状腺癌（DTC）术后有无复发与转移。方法 采用界值特征曲线,分析测定34例DTC未复发者与50例复发者血清Tg值,同时对治疗剂量131I全身显像与血清Tg测定值进行比较,结果 未复发组Tg值明显低于对照组（P＜0．05）,若以血清Tg 8ug/L作为判断界值,则81％（39／48例）的复发与转移患者可被正确预测,其诊断DTC复发与转移的灵敏度与特异性分别为80．4％和100％,结论 采用Tg正常分界值,可明显提高DTC复发与转移的检出率。     

PET/CT与增强CT检测乳腺癌及其腋淋巴结转移的对照研究

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT显像与螺旋CT增强扫描检测乳腺癌及其腋淋巴结转移的临床价值。方法27例乳腺肿块患者于同日行^18F—FDG PET／CT显像与CT增强扫描。患者俯卧于乳腺专用泡沫垫上接受检查，前者图像由3位核医学科医师采用目测法结合半定量法进行诊断，后者图像由3位影像科医师分析诊断；最后与病理检查结果对照。结果27例患者PET／CT与增强CT均发现31个乳腺肿块，病理检查证实其中21个为乳腺癌，10个为良性病变；发现腋淋巴结91个，共有66个转移（1例有双侧腋淋巴结转移）；PET／CT显像检测乳腺癌原发灶的灵敏度为80．95％，特异性为90％，阳性预测值为94．44％；检测淋巴结转移的灵敏度为89．39％，特异性为88％，阳性预测值为95．16％。增强CT检测乳腺癌原发灶的灵敏度为90．48％，特异性为60％，阳性预测值为82．61％；检测淋巴结转移的灵敏度为86．36％，特异性为52％，阳性预测值为82．61％。^18F—FDG PET／CT和增强CT对腋淋巴结状态的诊断与病理检查结果的列联系数分别为0．64和0．37；两者对乳腺癌及其腋淋巴结转移的诊断特异性差异有显著性（P〈0．05）；对直径〈2cm的病灶，^18F—FDG PET／CT诊断准确性明显高于增强CT（P〈0．05）。结论^18F—FDG PET／CT对诊断乳腺癌及其腋淋巴结转移的特异性均高于增强CT。     

运动试验心肌灌注显像诊断冠心病伴心房颤动的价值

目的评价运动试验心肌灌注显像诊断冠心病伴心房颤动（房颤）的能力。方法回顾性分析58例接受运动试验^99Tc^m-甲氧基异丁基异腈（MIBI）心肌灌注显像，且运动试验心电图示房颤心律的患者检查结果，并与冠状动脉造影结果比较。结果58例患者中，瓣膜性心脏病20例，非瓣膜性心脏病38例。运动试验心肌灌注显像诊断冠心病伴房颤患者的灵敏度、特异性和准确性分别为60％（9／15）、88％（38／43）和81％（47／58）。在非瓣膜性心脏病患者中，运动试验心肌灌注显像诊断冠心病的灵敏度和特异性分别为60％（9／15）和96％（22／23）；在瓣膜性心脏病患者中，运动试验心肌灌注显像的诊断准确性为80％（16／20）。结论运动试验心肌灌注显像诊断非瓣膜病房颤患者冠心病有中等程度的灵敏度和较高的特异性；诊断瓣膜病房颤患者冠心病有较高的准确性，但存在一定的假阳性。     

用颈淋巴显像检测N0期口腔癌患者颈前哨淋巴结

目的评价颈淋巴显像检测口腔癌患者前哨淋巴结(SLN)的价值。方法21例临床N0期口腔癌患者术前行颈淋巴显像与术中蓝染法检测SLN，结果与组织学检查比较。结果①淋巴显像检测SLN的灵敏度为100％(21／21例)，蓝染法为85％(17／20例)。②SLN活组织检查和颈淋巴结清扫术均证实33．3％(7／21例)患者有颈淋巴结转移，准确性100％；活组织检查阴性者14例，颈淋巴结清扫术亦为阴性，特异性100％。结论淋巴显像能有效检测口腔癌患者的SLN，准确预测颈淋巴结转移情况。     

18F-FDG PET/CT双时相显像对孤立性肺结节的诊断价值

目的探讨^18F-脱氧葡萄糖（FDG）PET／CT双时相显像对孤立性肺结节（SPN）的诊断价值。方法31例SPN待查患者行^18F—FDGPET／CT双时相显像，计算标准摄取值（SUV），随访时间5～17个月。结果19例患者（61．3％）有病理学诊断结果，其余为临床诊断。肺癌患者结节的延迟相平均SUV明显高于早期相，早期相和延迟相最大SUV间无差异；单纯以平均SUV变化幅度[ASUV平均=（SUV延迟-SUV早期）／SUV早期×100％]≥15％为诊断肺癌的标准，灵敏度为81．8％，特异性为77．8％，准确性为80．6％；PET／CT综合的诊断灵敏度为95．5％，特异性为85．7％，准确性为87．1％。单纯以ASUV平均≥15％为标准，诊断肺癌的阳性预测值和阴性预测值分别为90．0％和63．6％；以ASUV平均≥15％伴结节放射性高于纵隔血池为标准，阳性预测值和阴性预测值分别为93．3％和85．7％。结论^18F—FDGPET／CT双时相显像鉴别诊断SPN的良恶性有一定的临床价值，其与临床表现结合诊断准确性较高。     

Lymph node staging of gastric cancer using (18)F-FDG PET: a comparison study with CT.

This study was performed to compare (18)F-FDG PET with CT for the evaluation of primary tumors and lymph node metastases in gastric cancer. METHODS: Eighty-one patients (28 women and 53 men; mean age, 56.6 y; age range; 32-82 y) who had undergone radical (n = 74) or palliative (n = 7) gastrectomy and lymph node dissection for the management of gastric cancer were included. Preoperative (18)F-FDG PET and CT were reviewed retrospectively for primary tumors of the stomach and lymph node metastases. Any increased (18)F-FDG uptake exceeding that of the adjacent normal gastric wall was considered positive for the primary tumor. Lymph nodes were classified into 3 groups based on their anatomic sites. Because perigastric lymph nodes (N1) were often not clearly differentiated from primary tumors, N1 lymph node metastases were determined when possible. Lymph nodes were considered positive or negative on the basis of the group as a whole. Final conclusions for primary tumors and lymph node metastases were based on histopathologic specimens in all patients. RESULTS: There were 17 patients with early gastric cancer (EGC) and 64 patients with advanced gastric cancer (AGC). For primary tumors, both PET and CT showed a sensitivity of 47% (8/17) for EGC and 98% (63/64) for AGC. The sensitivity of CT for N1 disease was significantly higher than that of PET. (18)F-FDG PET had a sensitivity, specificity, and accuracy of 34% (11/32), 96% (47/49), and 72% (58/81), respectively, for N2 metastases, whereas the corresponding CT values were 44% (14/32), 86% (42/49), and 69% (56/81). For N3 metastases, PET and CT had the same sensitivity, specificity, and accuracy: 50% (3/6), 99% (74/75), and 95% (77/81), respectively. Overall, the sensitivity, specificity, and accuracy of (18)F-FDG PET were not significantly different from those of CT for primary tumors or for N2 and N3 metastases. CONCLUSION: (18)F-FDG PET is as accurate as CT for the detection of primary tumors of either EGC or AGC. The low sensitivities of PET and CT were insufficient to allow decision making on the extent of lymphadenectomy. In contrast, the high specificity of PET for N disease appeared valuable, and the presence of N disease on PET may have a clinically significant impact on the choice of initial therapy.     

Radioimmunodetection of occult carcinoembryonic antigen-producing cancer.

This study evaluates the ability of 111In-labeled anti-carcinoembryonic antigen (CEA) monoclonal antibody (Mab) ZCE-025 to detect sites of occult cancer in patients with elevated serum CEA who have negative or equivocal CT scans. One hundred forty patients suspected of having occult cancer were evaluated. Except for elevated CEA levels, all had negative work-ups, including negative or inconclusive CT scans. Eighty-two patients (59%) had positive scans and 58 (41%) had negative scans. Seventy-five of the 82 patients with positive scans had confirmation of at least one Mab-positive lesion (91% positive predictive value). Thirty-eight of the 58 patients with negative scans had negative follow-up (66% negative predictive value). The Mab scan correctly identified at least one site of tumor in 75 of the 95 patients with recurrent or metastatic disease (79% sensitivity) and correctly predicted the absence of disease in 38 of 45 patients (84% specificity).     

Parathyroid adenomas evaluated by Tl-201/Tc-99m pertechnetate subtraction scintigraphy and high-resolution ultrasonography

Thallium-201/technetium-99m pertechnetate subtraction scintigraphy of the parathyroid glands was performed in a prospective study of 33 patients who had undergone bilateral neck exploration for elevated serum calcium and serum parathyroid hormone levels. In 31 cases, the Tl-201/Tc-99m subtraction technique yielded an overall sensitivity of 81%, specificity of 99%, and accuracy of 94% for identifying solitary parathyroid adenomas. Tl-201/Tc-99m subtraction scintigraphy correctly identified 73% of parathyroid adenomas weighing less than 499 mg, 79% of those weighing 500-1,499 mg, and 100% of adenomas weighing more than 1,500 mg. In a subgroup of 24 patients with solitary parathyroid adenomas who underwent both scintigraphy and high-resolution sonography, the sensitivity, specificity, and accuracy of both procedures were similar.     

复发性卵巢癌血清差异表达蛋白分析

目的探讨血清差异表达蛋白对提高复发性卵巢癌的诊断意义。方法采用弱阳离子（WCX）磁珠纯化试剂盒和基质辅助激光解吸电离飞行时间质谱（MALDI-TOF-MS）技术,对21例复发性卵巢癌和18例完全临床缓解期卵巢癌患者（对照组）的血清标本进行检测,筛选出复发性卵巢癌患者与对照组血清中的差异表达质谱峰,并建立诊断模型。结果在Mr1000～12000区段,发现复发性卵巢癌与对照组间差异表达蛋白峰10个（P〈0.05）。其中Mr1944、1980、2080、2661、2993、4450、4659、5359的蛋白峰显著上调,Mr1897、7868则显著下调。结论 MALDI-TOF-MS结合磁珠技术能直接检测出复发性卵巢癌患者血清差异表达蛋白,对提高复发性卵巢癌诊断的敏感性和特异性具有一定的临床意义。     

Vagina: evaluation with MR imaging. Part II. Neoplasms

The potential of magnetic resonance (MR) imaging in the detection of vaginal tumors and the assessment of their extent was evaluated retrospectively in 87 patients in whom primary, metastatic, or recurrent vaginal cancer was clinically suspected. MR findings were compared with the results of surgery and/or biopsy. Results of histopathologic study verified a normal vagina in 51 patients, benign cysts in two, primary tumor in four, metastatic cancer in 22, and recurrent tumor in eight. MR imaging demonstrated the two benign cysts, correctly depicting their size and location, and demonstrated and enabled correct staging of the four primary tumors. MR accuracy for demonstrating metastatic cancer was 92%, sensitivity was 95%, and specificity was 90%. Tumor extension to the vagina was reliably excluded (negative predictive value = 97%), but false-positive interpretations occurred (positive predictive value = 84%) primarily because inflammation (n = 2) and congestion (n = 2) could not be distinguished from tumor invasion. An additional role of MR imaging was the ability to differentiate tumor from fibrotic tissue in patients with suspected recurrent vaginal carcinoma. The overall accuracy of MR imaging for recurrent vaginal cancer was 82% (14 of 17).     

Linear discriminant analysis of regional ejection fractions in the diagnosis of coronary artery disease

We studied the application of linear discriminant analysis to the computer assisted interpretation of rest and exercise gated blood pool studies. Data were obtained in 45 patients in whom the presence or absence of coronary artery disease was determined by coronary angiography. Automated analysis of regional ejection fractions using a linear discriminant function (LDF) was compared to the fully automated calculation of global ejection fraction and to the subjective evaluation of wall motion. A LDF constructed from the data for the first 31 consecutive patients correctly classified 25/31 (81%). The change in global ejection fraction correctly classified 24/31 (77%) and wall motion analysis 25/31 (81%). In a distinct group of 14 patients the same LDF correctly classified 12/14 (86%), global ejection fraction 9/14 (64%) and wall motion analysis 10/14 (71%).