CD44蛋白在人喉癌组织中的表达及临床意义

目的：探讨CD44在人喉癌组织中的表达及其临床意义。方法：采用免疫组织化学Envision法对261例喉不同病变组织标本进行CD44表达检测。结果：人喉癌组织中CD44高表达率为70．9％，明显高于癌前病变（16．7％）及正常喉组织（0％），其差异均有极显著性意义（P＜0．01）；喉癌组织中高分化鳞癌CD44表达明显低于低分化鳞癌（P＜0．01）；Ⅲ-Ⅳ期喉癌病变组织CD44表达明显高于I－Ⅱ期（P＜0．01）；有颈淋巴结转移的喉癌组织CD44表达明显高于无颈淋巴结转移的喉癌组织（P＜0．01）；CD44表达阳性病例3、5年生存率明显低于CD44表达阴性病例（均P＜0．05）。结论：喉癌的发生、发展及患者预后与CD44表达密切相关。     

诱导性动脉内灌注化学治疗在晚期鼻咽癌治疗中的价值

目的：明确诱导性区域动脉灌注化学治疗在局部晚期鼻咽癌（nasopharyngeal carcinoma,NPC)治疗中的价值。方法：采用前瞻性随机对照研究，将病理确诊的121例晚期（Ⅲ-Ⅳ期）初治NPC患者于放射治疗前随机分面两组，61例进行区域性动脉灌注化学治疗（intra-arterial chemotherapy,IACT),60例采用全身化学治疗（systemic chemotherapy,SCT)，对比化学治疗完全缓解率及毒副反应发生情况，放射治疗后比例两组的疗效，统计学处理采用卡方检验。结果：IACT组化学治疗全身性毒副反应发生率较SCT组低，口腔炎的发生率较高（P值分别为＜0．05或＜0．005）。IACT组有6例因血管闭塞不能进行第2疗程的化学治疗。IACT组化学治疗安全缓解率及5年生存率分别为27．9％（17／61）和63．9％（39／61），而SCT组分别为11．7％（7／60）和45．0％（27／60），两组相比较均有统计学差异（P值均＜0．05），两组间无瘤生存率比较，差异无显著性（P＞0．05）。结论：以IACT行诱导化学治疗对Ⅲ-Ⅳ期局部晚期NPC更为合理。     

鼻咽癌调强适形放疗137例远期疗效及预后因素分析

目的：回顾性分析137例鼻咽癌调强适形放射治疗的远期疗效及预后影响因素。方法：对确诊的初治的无远处转移的137例鼻咽癌患者,采用三维适形调强放射治疗技术。在放疗后1个月按WHO实体瘤疗效评价标准进行近期疗效评价。放疗结束后2年内每3个月复查一次,2年后每6～12个月复查一次,常规进行临床查体、鼻咽镜、CT、B超、MRI、胸片、骨扫描检查,了解鼻咽腔、颈部淋巴结及颅神经情况。采用寿命表法计算总生存率,Kaplan-Meier方法计算无复发生存率、无远处转移生存率、无瘤生存率,用Log—rank检验法对14项可能影响预后的临床因素进行单因素分析,采用Cox风险比例模型做多因素分析,P〈0.05为差异有统计学意义。结果：①1、3、5年总生存率分别为98．5％、90．3％、74．6％,无复发生存率分别为97．0％、81．9％、66．7％无远处转移生存率分别为96．3％、80．5％、56．0％,元瘤生存率分别为95．6％、76．9％、43．8％;②单因素分析显示T分期、N分期、92福州临床分期、联合化疗、颅底骨质破坏、颅神经损伤、咽后淋巴结转移、疗终残留、总放疗时间等对预后的影响有统计学意义（均P〈0．05）;性别、族别、年龄、病理类型、贫血与否对预后的影响无统计学意义（均P〉0．05）;③将T分期、颅底骨质破坏、颅神经损伤、咽后淋巴结转移、N分期、联合化疗、疗终残留、总放疗时间、贫血与否引入Cox模型,结果表明N分期、联合化疗、颅神经损伤、疗终残留、总放疗时间是影响鼻咽癌预后的独立因素（均P〈0．05）。结论：鼻咽癌调强适形放射治疗较常规放疗有明显优势,在相关临床因素中N分期、颅神经损伤、联合化疗、疗终残留、总放疗时间是影响预后的最主要因素。     

五种基因的蛋白分子表达与鼻咽癌放疗疗效的关系

目的探讨上皮钙黏附蛋白（E-cadherin）、黏附分子CD44H、基质金属蛋白酶-3（matrix metalloproteinase-3，MMP-3）、肿瘤转移抑制基因nm23H1和血管内皮生长因子（vascular endothelial growth factor，VEGF）的表达与鼻咽癌放疗疗效的关系，并分析其预测鼻咽癌疗效的价值。方法应用免疫组织化学SP法检测62例鼻咽癌组织中E-cadherin、CD44H、MMP-3、nm23H1和VEGF的蛋白分子表达水平。结果CD44H（χ^2=18．739，P=0．028）和VEGF（χ^2=18．523，P=0．030）的表达与鼻咽癌放疗后近期疗效密切相关，表达增强则近期疗效下降。CD44H和nm23H1低表达组的3年生存率分别为65．5％、45．5％，5年生存率分别为47．3％、22．7％；高表达组的3年生存率分别为54．6％、75．9％，5年生存率分别为27．8％、53．2％；CD44H（χ^2=7．31，P=0．0069）和nm23H1（χ^2=15．64，P=0．0001）两表达组的生存率差异有统计学意义。结论检测CD44H和VEGF的表达可能作为预测鼻咽癌放疗后近期疗效的指标，检测CD44H和nm23H1的表达可能作为预测鼻咽癌放疗后远期疗效的指标。     

鼻咽癌治疗前后EB病毒DNA载量的动态观察及其临床意义

目的：通过研究鼻咽癌患者血浆EBVDNA载量预测复发及远处转移的发生,为个体化治疗提供分子学指标。方法：对54例初治鼻咽癌患者分别在治疗前和治疗结束时采用荧光定量PCR方法检测血浆EBVDNA载量,并对所有患者进行随访复查,评价其远期疗效,计算无进展生存率及总生存率。结果：所有患者治疗前血浆EBVDNA载量能较好地反映患者的临床特征;远处转移者治疗前血浆EBVDNA载量及治疗后EBVDNA检出率均高于持续缓解者（均P〈0．05）;以治疗前20000copies／ml为界限,EBVDNA低载量患者的无进展生存率、总生存率均高于高载量患者（P〈0．01和P〈0．05）。结论：鼻咽癌患者治疗前血浆EBVDNA载量能一定程度地预测远处转移的发生。     

中药冲洗联合窦内充氧治疗慢性上颌窦炎

作者用中药（大黄、黄连、黄柏煎剂）窦内冲洗并联合充氧治疗慢性上颌窦炎。结果：治疗组59例，近期总有效率为98．3％。对照组用生理盐水冲洗后注入庆大霉素8万~u，55例近期总有效率为74．5％，统计学处理两组有显著性差异（P＜0．01）。治疗组远期治愈41例占70．7％，近期治愈44例占74．6％，无显著差异（P＞0．05），而对照组近期治愈26例占47．3％，远期治愈18例占32．7％，有显著差异（P＜0．05）。表明中药窦内冲洗联合充氧治疗慢性上颌窦炎确实有效。     

中药放疗增敏散对鼻咽癌放疗增敏作用的临床观察

目的：探讨中西医结合治疗鼻咽癌的合理途径。方法：60例Ⅱ，Ⅲ期低分化鳞状细胞癌且有颈淋巴转移灶的鼻咽癌随机分为实验组30例，对照组30例，实验组使用常规放疗加中药放疗增敏散治疗，对照组单用常规放疗，观察两组近期疗效，颈淋巴转移灶缩小及放疗副反应情况。结果：实验组与对照组CR（完全缓解），PR（部分缓解）分别为83．3％、16．7％胶73．3％、26．7％；颈淋巴转移灶缩小50％及完全消退时，实验组与对照组的中位放疗时间分别为14．7天、23．5天和18．7天、28．9天。实验组优于对照组（P＜0．01）。结论：中药放疗增敏散配合鼻咽癌放射治疗能缩短肿瘤的消退时间，提高治疗效果，优于单纯放射治疗疗法。     

诱导化疗加放射治疗Ⅳ期鼻咽癌的疗效观察

目的评价诱导化疗加放射治疗和单纯放疗治疗Ⅳ(N3M0)期鼻咽癌的临床疗效.方法将经病理证实的34例Ⅳ(N3M0)期鼻咽癌34例随机分为诱导化疗加放疗组(Ⅰ)和单纯放疗组(Ⅱ).Ⅰ组放疗前应用PF方案(DDP+5-FU)化疗2周期,2组放疗方法相同.结果Ⅰ组和Ⅱ组鼻咽部肿瘤完全消退率分别为88.2%和82.4%,颈部转移淋巴结完全消退率分别为94.1%和88.2%,差异无显著性(P＞0.05);Ⅰ组和Ⅱ组3年生存率分别为70.6%和47.1%,差异有显著性(P＜0.05);Ⅰ组和Ⅱ组远处转移率分别为23.5%和41.2%,差异有显著性(P＜0.05).Ⅰ组治疗毒副反应比Ⅱ组重.结论诱导化疗加放射治疗Ⅳ(N3M0)期鼻咽癌,可以提高3年生存率,减少远处转移率,毒副反应比单纯放疗大,但不影响治疗进程.     

重组人p53腺病毒注射液联合治疗对鼻咽癌组织中KAI1和CD44 v6表达的影响

目的探讨重组人p53腺病毒注射液（今又生）联合放化疗对鼻咽癌组织中KAI1和CD44v6表达的影响，并分析KAI1和CD44v6表达与鼻咽癌患者预后之间的关系。方法58例鼻咽癌患者经直线加速器常规放疗和两个阶段铂类＋5-Fu的同步化疗后再分为今又生治疗组（29例）和对照组（29例），应用免疫组织化学S—P法检测治疗前后癌组织中KAI1及CD44v6蛋白的表达情况，比较两组患者的肿瘤消退率及远期生存情况。结果治疗组患者治疗后KAI1表达上调、CD44v6表达下调，而对照组患者治疗前后比较无明显差异；治疗组局部消退率明显高于对照组；治疗组在3年生存率及远期生存情况同对照组比较无明显差异。结论重组人p53腺病毒注射液治疗可以明显影响鼻咽癌组织中KAI1和CD44v6的表达，提高肿瘤的局部消退率，但无法有效延长远期生存率。     

血卟啉衍生物配合放射治疗鼻咽癌患者三项免疫功能的检测

观察在放射治疗鼻咽癌时血卟啉衍生物（hematoporphyrinderivative，HPD）对患者免疫功能的影响，选择病理确诊的初诊鼻咽癌78例，分成单纯放疗组和血卟啉衍生物（HPD）＋放疗组，各39例，采用自身配对方法，分别测定各组放疗前、后免疫功能。结果为：①HPD＋放疗组放疗前后免疫功能无明显变化；②单纯放疗组放疗后较放疗前免疫功能明显下降，包括OKT3、OKT4、OKT4／OKT8和淋巴细胞转化率均具有统计学意义（P＜0．01和P＜0．05）。上述结果提示HPD配合放射治疗鼻咽癌对免疫功能具有一定的保护作用。     

康莱特联合放射治疗老年鼻咽癌的临床观察

目的探讨康莱特注射液(KLT)联合放疗治疗老年鼻咽癌患者的疗效及其对放疗毒副反应、免疫反应和生活质量的影响.方法收治老年鼻咽癌患者75例,分为治疗组(KLT 放疗)39例和对照组(单纯放疗)36例.对两组的疗效、放疗反应和生活质量予以观察对比.结果两组总有效率和1年生存率分别为94.9%、97.4%和91.7%、94.4%,P>0.05;两组3年生存率分别为79.5%和69.4%,P<0.05;放射性口腔炎对照组明显重于治疗组,P<0.05;生活质量(Karnofsky评分)治疗组好于对照组,P<0.05;T淋巴细胞免疫活性(Ag-NORs)治疗组高于对照组.结论康莱特注射液联合放射治疗老年鼻咽癌,不但能提高患者的生活质量,增强机体的免疫功能,减轻患者的放疗反应,而且能提高生存率,延长生存期,确为配合放疗的一种理想药物,值得在临床上积极应用.     

鼻咽癌放疗后分泌性中耳炎的治疗

目的探讨治疗鼻咽癌放疗后分泌性中耳炎的治疗方法。方法将60例鼻咽癌放疗后并发分泌性中耳炎患者随机分为A、B两组,每组30例。A组鼓室置管;B组在鼻内镜下行鼻腔鼻咽部清理加鼓膜穿刺抽液加鼓室给药沐舒坦。比较分析两组治疗效果及并发症。结果随访10个月,60例中存活49例。存活患者中,分泌性中耳炎治疗有效率A组为52.6%,B组为81.6%,差异有统计学意义（P〈0.05）;并发症发生率A组为23.7%,B组为7.9%,差异有统计学意义（P〈0.05）。结论对鼻咽癌放疗后伴发的分泌性中耳炎治疗,鼻腔鼻咽部清理加鼓膜穿刺抽液加鼓室给药沐舒坦优于单纯鼓室置管引流。     

中药治疗鼻咽癌急性放射性口咽炎的疗效观察

目的观察中药治疗鼻咽癌急性放射性口、咽炎的临床效果.方法对2001年3月～2004年3月鼻,咽癌行常规放射治疗,出现急性放射性口咽炎的患者86例,随机分为中药治疗组43例和对照组(朵贝氏液含漱 溶菌酶含服 复合维生素B口服)43例,进行疗效对照观察.结果中药治疗组有效率为93.0%,对照组为44.2%,中药治疗组疗效明显优于对照组(P＜0.01);且中药治疗组起效时间较对照组快(P＜0.01).结论中药治疗鼻咽癌急性放射性口、咽炎有很好的临床效果,值得临床推广应用.     

雾化吸入防治鼻咽癌放射性口咽损伤的时机

目的　观察吸入用布地奈德混悬液加沐舒坦（盐酸氨溴索）氧气驱动雾化吸入治疗防治鼻咽癌放疗所致咽部损伤的时机。方法　108例鼻咽癌患者分为4组,每组27例。3个治疗组分别在放疗初始、放疗5次后、放疗10次后以布地奈德混悬液+沐舒坦氧气驱动雾化吸入治疗;对照组未予雾化吸入治疗。比较各组在不同放疗剂量时咽部黏 膜III度损伤情况。结果　照射剂量在30 Gy以下时,3个治疗组均无III度咽部黏膜损伤发生,对照组1例。在30～40 Gy时,3个治疗组及对照组均有III度黏膜损伤,组间无统计学意义。照射计量达40 Gy以上,治疗1组、治疗2组III度黏膜损伤低于对照组,差异有显著性。治疗3组与对照组比较差异无显著性。结论 鼻咽癌放疗5～10次,以布地奈德混悬液+沐舒坦氧气驱动雾化吸入治疗可减轻放疗所致咽部损伤,且为较好时机。     

金龙胶囊对鼻咽癌患者放疗期间免疫功能的影响

目的观察金龙胶囊对鼻咽癌患者放疗期间免疫功能的影响。方法将40例初治鼻咽癌患者随机分为治疗组20例,接受常规放疗加口服金龙胶囊;对照组20例,仅接受单纯常规放疗。于放疗前及放疗结束时以流式细胞术检测患者外周血淋巴细胞和自然杀伤细胞,比较两组结果差异。结果放疗结束时,治疗组和对照组CD4／CD8、CDl9均值均比放疗前降低（P〈0．05）,但治疗组较对照组下降幅度小（P〈0．05）,CD56变化组间差异不大（P〉0．05）。结论金龙胶囊可以减缓鼻咽癌患者放疗期间的免疫功能下降水平,尤以CD4／CD8和CDl9明显。     

Epidemiological research into nasopharyngeal carcinoma in the Chubu region of Japan.

Although patient death due to nasopharyngeal carcinoma (NPC) is increasing, few epidemiological analyses of NPC in Japan have been conducted since Sawaki's report in 1979. To determine the current incidence of NPC in Japan we examined NPC case in the Chubu area from 1986 to 1995. The leaders and reporting representatives of all otorhinolaryngological groups in the area were asked for their support of this epidemiological research. A total of 607 cases (445 male and 162 female NPC patients) were analyzed epidemiologically, histologically, serologically and clinically in this study. The incidence of NPC gradually increased with age. The mean age of the patients was 54.1 years. The age-standardized annual incidence in the Chubu region was 0.28 per 10(5) persons per year. The incidence in prefectures bordering Japan Sea (0.36) was significantly higher than that of prefectures facing the Pacific Ocean (0.21, P<0.05). On the basis of World Health Organization (WHO) histological criteria, 12%) of the cases were classified as WHO I, 54% as WHO II and 34% as WHO III. As for tumor origin, in 58% of the cases it originated posterosuperiorly, in 32% laterally and in 1% inferiorly. Tumor staging showed 4% to belong to stage I, 9% to stage II, 15% to stage III and 72% to stage IV. The positive rates of serum titers of the antibodies to Epstein Barr virus     

Expression and clinical significance of epidermal growth factor receptor and type 1 insulin-like growth factor receptor in nasopharyngeal carcinoma

OBJECTIVES: Epidermal growth factor (EGF) and type 1 insulin-like growth factor (IGF-1) receptors play an important role in the growth and apoptosis of nasopharyngeal carcinoma (NPC). They were separately found to be associated with prognosis in patients with NPC. To date, their expression correlation and clinicopathologic significance have never been specifically addressed in NPC. METHODS: Seventy-five patients with NPC and 21 noncancerous nasopharyngeal epithelial samples were accrued between 1998 and 2006 in a single hospital. The expressions of EGF and IGF-1 receptors were detected by immunohistochemical staining in the 75 NPC samples and the 21 noncancerous samples. Furthermore, the messenger RNA and protein expressions were assessed by real-time quantitative polymerase chain reaction and the Western blot technique, respectively, in NPC cell lines and normal nasopharyngeal epithelial cells. RESULTS: The 5-year survival rates, assessed by the Kaplan-Meier method, were 71.4% and 66.6% in the EGF and IGF-1 receptor protein-negative groups, respectively, whereas they were only 28.6% and 33.3% in the receptor protein-positive groups. The levels of these two proteins significantly correlated with each other, and the overexpression rates of EGF and IGF-1 receptors were 65.3% and 56% in nasopharyngeal samples, respectively. Furthermore, both protein expressions were significantly higher in NPC patients with cervical lymph node or distant metastasis than in NPC patients without lymph node or distant metastasis. Recurrence more often appears in cases positive for both proteins than in cases negative for both proteins. The expression levels of the receptor messenger RNA and proteins were higher in several NPC cell lines than in normal nasopharyngeal epithelial cells. CONCLUSIONS: These findings demonstrate that both receptor proteins may play an important role in the invasion, metastasis, and recurrence of NPC. Both receptors are valuable markers for assessing the prognosis of NPC. Their expression at such high frequencies provides the basis of combined targeted therapy with specific pharmacologic inhibitors to enhance the effects of radiotherapy and chemotherapy.     

原发性鼻腔癌128例的治疗分析

目的 探讨鼻腔癌的最佳治疗手段和影响预后的因素。方法 对本院自１９７７年３月～１９９３年８月收治的１２８例鼻腔癌进行回顾性分析。治疗方式：单纯放射治疗８９例,术前放射治疗＋手术２１例,手术＋术后放射治疗１３例,单纯手术５例。结果 １２８例鼻腔癌患者的总５年生存为４２．２％;单纯放射治疗５年生存率为３３．７％;术前放射治疗＋手术的５年生存率５７．１％（Ｐ〈０．０５）;手术＋术后放射治疗的５年生存率为     

Sequential external beam radiotherapy and high-dose-rate intracavitary brachytherapy in T1 and T2 nasopharyngeal carcinoma: an evaluation of long-term outcome

OBJECTIVES/HYPOTHESIS: The standard treatment for nonmetastatic nasopharyngeal carcinoma (NPC) is external beam radiotherapy (EBRT), with or without chemotherapy. Because local control in NPC is an independent prognostic factor for distant metastases and survival, various dose-escalation strategies have been used to reduce recurrences at the primary site. The objective of this report was to evaluate the outcome of adjuvant high-dose-rate intracavitary brachytherapy (HDRIB) in patients with T1 and T2 NPC. STUDY DESIGN AND METHODS: Thirty-three consecutive patients with T1 and T2 NPC were treated prospectively according to a standardized institutional protocol between March 1999 and July 2001. Seventeen patients with stage I/II disease were treated with EBRT to 66 Gy followed by HDRIB (10 Gy in 2 weekly 5 Gy fractions). The remaining 16 patients with Stage III to IVb disease received chemotherapy in addition to radiation. All patients were assessed for treatment response, local control, survival, and toxicity. RESULTS: Median follow-up for all surviving patients was 67 (range 52-76) months. Local failure occurred in two patients; both subsequently underwent successful salvage treatments. Three patients died of metastatic disease, whereas two died of unrelated causes. Five year local control, overall survival, and disease-free survival rates were 93.8%, 83.9% and 78.4%, respectively. All patients experienced acute or late radiotherapy-related sequelae. However, no grade 4/5 toxicities were reported. Specifically, toxicities that could be attributed to brachytherapy were not seen, except for in one patient who developed severe choanal stenosis. CONCLUSIONS: EBRT supplemented by HDRIB produced superior local control rates for T1 and T2 NPC at 5 years of follow-up, with acceptable rates of acute and late toxicities.     

鼻内镜下微波凝固配合养阴利咽汤治疗舌扁桃体肥大的临床观察

目的观察微波凝固配合养阴利咽汤治疗舌扁桃体肥大的临床疗效.方法门诊舌扁桃体肥大治疗患者216例,随机分成三组,一组采用微波凝固配合养阴利咽汤联合治疗(综合治疗组),二组为单纯微波凝固(微波组),三组为单纯养阴利咽汤服用(养阴利咽汤组),比较分析三组的疗效.结果综合治疗组患者微波引起的咽干、咽痛等咽部不适症状很快得到缓解,总有效率为93.1%,微波治疗组和养阴利咽汤组总有效率分别为73.6%和61.1%,综合治疗组与微波凝固组、养阴利咽汤组之间疗效差异有显著性意义(P＜0.05).结论综合治疗舌扁桃体肥大疗效显著,值得临床推广应用.