青少年原发性肝癌与乙型和丙型肝炎病毒感染的相关性分析

目的探讨青少年原发性肝癌(PHC)患者中乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)及HBV和HCV混合感染率及其相互关系。方法将50例青少年PHC患者纳入观察组,将同期住院的50例其他肝病患者纳入对照组,检测两组患者血清中HBV、HCV、HBV/HCV标志物阳性率等情况。结果观察组患者血清中HBsAg、抗Hbe和HBV-DNA阳性率均显著高于对照组患者,差异有统计学意义(P<0.05)。两组患者血清中HBeAg阳性率比较,差异无统计学意义(P>0.05)。观察组和对照组患者血清中抗HCV和HCV-RNA阳性率比较,差异无统计学意义(P>0.05);HBV(+)HCV(+)和HBV(+)HCV(-)与青少年PHC发病呈正相关性(P<0.05),HBV(-)HCV(+)与青少年PHC发病无相关性(P>0.05),HBV(-)HCV(-)与青少年PHC发病呈负相关性(P<0.05)。结论 HBV感染与青少年PHC发病有着较强的相关性,属高度危险因素。     

乙型肝炎病毒感染与弥漫大B细胞淋巴瘤预后的相关性分析

目的探讨乙型肝炎病毒(HBV)感染与弥漫大B细胞淋巴瘤(DLBCL)预后的相关性。方法选取乙型肝炎表面抗原(HBsAg)阳性和HBsAg阴性的初治DLBCL患者各60例,均给予化疗,比较分析两组患者化疗期间的肝功能以及随访2年后的无进展生存时间(PFS)和总生存时间(OS)。结果 HBsAg阳性组和HBsAg阴性组患者化疗期间的肝功能损害发生率分别为66.0%和40.0%,差异有统计学意义(P<0.05)。HBsAg阳性组患者的PFS为(16.1±3.2)个月,PFS率为70.0%,OS率为85.0%;HBsAg阴性组患者的PFS为(17.3±4.1)个月,PFS率为73.0%,OS率为88.0%,两组差异无统计学意义(P>0.05)。结论 HBV感染与DLBCL患者的预后无关,但合并HBV感染会增加DLBCL患者在化疗期间肝功能损害的发生率。     

非霍奇金淋巴瘤与乙型肝炎病毒感染关系的临床研究

目的:探讨四川地区非霍奇金淋巴瘤(NHL)与乙型肝炎病毒(HBV)感染的关系。方法:对160例NHL患者临床资料进行回顾性分析,应用ELISA方法测定确诊NHL时患者的乙型肝炎病毒两对半情况,并随机抽取同期住院的160例其他恶性肿瘤患者(排除原发肝细胞肝癌),160例健康体检者作为对照进行比较。结果:160例NHL患者伴HBV感染者39例(占45%),其他恶性肿瘤患者HBV感染者19例(占11.9%),健康体检者HBV感染者17例(占10.6%),与肿瘤对照组和健康对照组相比,NHL组HBV感染率高于该两组,差异有统计学意义(P<0.05)。而两对照组间比较,差异无统计学意义(P>0.05)。Ⅲ期和Ⅳ期NHL患者HBV感染率明显高于Ⅰ期和Ⅱ期患者,差异有统计学意义(P<0.05)。结论:四川地区NHL患者中HBV感染率高于一般人群和非原发性肝细胞肝癌肿瘤患者,HBV感染与NHL发病有一定相关性。     

多发性骨髓瘤与乙型肝炎病毒感染的临床观察

目的 探讨多发性骨髓瘤（MM）患者乙型肝炎病毒（HBV）的感染状况及乙肝表面抗原（HBsAg）阳性MM患者的临床特点。方法 应用ELISA法测定196例MM患者以及48 697例健康体检者（对照组）的HBV标记物,PCR法测定HBV-DNA拷贝数。结果 196例MM 患者中HBsAg阳性者有5例（2.6％）,与对照组的3.4%比较差异无统计学意义（P>0.05）。5例HBsAg阳性MM患者的HBV血清学标记均为HBsAg、HBeAb、HBcAb三者阳性,其中2例HBV-DNA拷贝数＞1000,给予拉米夫定治疗。5例患者均给予抗MM治疗,未见HBV激活和肝功能异常。结论 HBV感染可能与MM发病无关,抗MM治疗对HBV的病毒激活及肝功能的影响可能不明显,仍有待于进一步研究。     

慢性乙肝病毒感染者进展为肝癌病程中血清循环免疫复合物的含量变化和意义

目的 探讨人外周血清循环免疫复合物(CIC)的含量变化与肝癌发生的关系.方法 采用酶联免疫吸附(ELISA)法检测20例临床病理确诊的肝癌和13例肝血管瘤患者术前血清中CIC的含量.采用ELISA法检测45例慢性乙肝病毒(HBV)感染最终进展为肝癌者以及与之匹配的45例慢性HBV感染未进展为肝癌者入组时、随访过程中和随访结束时血清中CIC和抗肝肾微粒体抗体(抗LKM-1)的含量,采用荧光定量PCR法检测这些患者入组时、随访过程中和随访结束时血清HBV-DNA的含量.结果 20例临床手术后病理确诊的肝癌患者术前血清中CIC的含量为(5738±1485)mU/L,显著高于13例肝血管瘤患者[(2410±1080) mU/L;P＜0.001].45例经过长期随访最终进展为肝癌的慢性HBV感染者血清CIC的含量随病程进展而逐渐升高,在肝癌临床诊断时达到最高,与其入组时相比,差异有统计学意义(P＜0.001);而对照组患者血清CIC的含量未见明显变化(P=0.118).随访方过程中,血清CIC的升高与肝癌累积发病率密切相关(HR =2.77,95％ CI为1.47～5.22).最终进展为肝癌的慢性HBV感染者在入组时、随访进程中和临床确诊为肝癌时的血清抗LKM-1和HBV-DNA含量均显著高于与之相匹配的对照组,并维持在较高水平.最终进展为肝癌的慢性HBV感染者血清CIC的含量与HBV-DNA的含量之间仅在肝癌临床诊断时存在相关性(r=0.344,P=0.026).结论 在慢性HBV感染进程中,血清CIC含量的逐渐升高可能是由慢性HBV感染进展为肝癌的重要转归指标之一.     

乙型肝炎病毒感染与原发性肝癌的关联性及危险因素分析

目的 研究乙型肝炎病毒感染与原发性肝癌间关联性,并对危险因素探讨.方法 慢性乙型肝炎病毒感染患者220例,其中慢性乙肝小三阳64例(小三阳组),慢性乙型肝炎大三阳62例(大三阳组),慢性乙型肝炎肝硬化50例(肝硬化组),乙型肝炎相关原发性肝癌44例(原发性肝癌组).观察4组乙肝病毒DNA不同含量(采用乙型肝炎病毒检测试剂盒检测)患者分布情况及表达水平;采用PCR扩增方法 检测4组患者乙肝病毒DNA含量,采用双抗体夹心酶联免疫吸附试验测定乙肝表面抗原.结果 4组患者乙肝病毒DNA不同含量患者分布比较差异有统计学意义(P<0.05),小三阳组DNA不同含量患者分布与大三阳组、肝硬化组、原发性肝癌组比较,差异有统计学意义(P<0.05).小三阳组乙肝病毒DNA表达水平高于大三阳组、肝硬化组和原发性肝癌组,差异有统计学意义(P<0.05),大三阳组乙肝病毒DNA表达水平高于肝硬化组,差异有统计学意义(q=3.884,P<0.05).4组患者乙肝表面抗原水平差异有统计学意义(P<0.05),小三阳组与大三阳、肝硬化组和原发性肝癌组比较,差异有统计学意义(P<0.05),大三阳组与肝硬化组和原发性肝癌组比较,差异有统计学意义(P<0.05).原发性肝癌组5～15年、>15年吸烟率,>15年饮酒率高于肝硬化组,不良饮食、e抗原阳性发生率高于肝硬化组,差异有统计学意义(P<0.05).结论 慢性乙肝小三阳、大三阳、肝硬化、原发性肝癌中,乙型肝炎病毒DNA水平和乙肝表面抗原呈下降趋势,长期吸烟、饮酒,不良饮食习惯和e抗原阳性是原发性肝癌发病的危险因素.     

非霍奇金淋巴瘤与乙型肝炎病毒感染的相关性

目的探讨非霍奇金淋巴瘤(NHL)与乙型肝炎病毒(HBV)感染的相关性。方法选取2008年1月至2013年12月间的108例NHL患者作为观察组,同期216例其他恶性肿瘤患者(原发性肝癌除外)作为对照组。比较两组患者的HBV感染率和乙肝表面抗原(HBs Ag)阳性率,分析不同NHL患者的临床资料与HBV感染的相关性。结果观察组患者的HBV感染率为38.9%(42/108),Hbs Ag阳性率为26.9%(29/108);对照组分别为21.3%(46/216)和15.3%(33/216),组间差异均有统计学意义(P<0.05)。HBV的感染率与患者的肿瘤类型和临床分期有明显相关性(P<0.05),与患者年龄和性别无明显相关性(P>0.05)。结论 NHL与HBV感染具有一定的相关性,临床上应给予一定的重视。     

非霍奇金淋巴瘤患者乙型肝炎病毒感染情况分析

目的 分析非霍奇金淋巴瘤(NHL)患者乙型肝炎病毒(HBV)感染发生情况.方法 采用全自动微粒子化学发光免疫分析法检测2014年1月至2016年12月西南医科大学附属医院确诊的305例NHL患者血清中HBV标志物,并与同期住院的312例大肠癌患者及81775名全国普通人群HBV检出率进行比较.结果 305例NHL患者的乙型肝炎病毒表面抗原(HBsAg)阳性率、乙型肝炎病毒表面抗体(HBsAb)阳性率、乙型肝炎病毒核心抗体(HBcAb)阳性率与全国普通人群比较,差异均有统计学意义[19.0％(58/305)比7.2％(5888/81775),44.3％(135/305)比50.1％(40969/81775),45.9％(140/305)比34.1％(27885/81775),χ2值分别为63.1、4.1、18.8,均P<0.05],且NHL患者的HBsAg阳性率与大肠癌患者及全国普通人群比较,差异有统计学意义(χ2=65.7,P<0.01).B细胞NHL(B-NHL)和T细胞NHL(T-NHL)患者的HBsAg阳性率比较,差异有统计学意义[21.3％(51/239)比10.6％(7/66),χ2=3.869,P<0.05],而两组患者的HBsAb、HBcAb阳性率比较,差异无统计学意义(均P>0.05).133例NHL患者进行HBV DNA检测,其中44例(33.1％)阳性,58例HBsAg阳性患者中43例(74.1％)HBV DNA阳性,HBsAg阴性但HBcAb阳性的24例患者中1例(4.2％)HBV DNA阳性.结论NHL患者的HBV感染率高于大肠癌患者及全国普通人群,其中HBV的隐匿性感染是值得重视的问题.T-NHL患者的HBsAg阳性率低于B-NHL患者.如果NHL患者合并HBV感染,为预防HBV激活应在抗肿瘤治疗前给予抗病毒治疗.     

HBV感染与恶性淋巴瘤的关系

目的:探讨乙型肝炎病毒感染与恶性淋巴瘤发病的关系.方法:采用ELISA法检测156例淋巴瘤患者的乙肝5项和肝功能,随机抽取同期住院的156例其他恶性肿瘤患者(排除原发肝脏的恶性肿瘤)和156名健康体检者为对照进行比较.结果:淋巴瘤患者的HBsAg阳性率为22.4%,明显高于其他恶性肿瘤患者(9.6%)和健康对照者(8.3%),差异有统计学意义,P<0.05.以其他恶性肿瘤作参照组,HBsAg阳性患者患淋巴瘤的优势比为2.719,可信区间为1.417～5.218,HBsAg阳性的淋巴瘤患者化疗诱发的肝功能异常率(57.1%)明显高于HBsAg阴性的淋巴瘤患者(27.3%),差异有统计学意义,P<0.05.结论:淋巴瘤患者的HBsAg阳性率明显高于其他恶性肿瘤和普通对照人群,化疗更易引起HBsAg阳性的淋巴瘤患者的肝功异常.     

乙型肝炎表面抗原阴性的非霍奇金淋巴瘤患者化疗后乙型肝炎病毒再激活的影响因素分析

目的 分析乙型肝炎表面抗原(HBsAg)阴性的非霍奇金淋巴瘤(NHL)患者化疗后乙型肝炎病毒(HBV)再激活的影响因素.方法 选取112例NHL患者,按照随机数字表法分为观察组和对照组,每组56例.所有患者均给予环磷酰胺+多柔比星+长春新碱+醋酸泼尼松(CHOP)或利妥昔单抗+CHOP(R-CHOP)化疗方案,观察组患者于化疗前1周开始口服恩替卡韦.比较两组患者的HBV再激活率和肝功能不全发生率,分析HBV再激活的影响因素.结果 观察组患者HBV再激活率、肝功能不全总发生率分别为10.71％、19.64％,均低于对照组的28.57％、35.71％,差异均有统计学意义(P<0.05).病理分期为Ⅲ～Ⅳ期及R-CHOP化疗方案是HBV再激活的危险因素(P<0.05),恩替卡韦是HBV再激活的保护因素(P<0.05).结论 HBsAg阴性NHL患者HBV再激活与多种因素相关,恩替卡韦可以减少NHL患者的HBV再激活率和肝功能不全总发生率.     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.     

Quality of life and care in leukemia, myeloma and non-malignant disease. Opinions of patients and relatives, and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P less than 0.05). Similarly, relatives of decreased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P less than 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P less than 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P less than 0.001). The opinions of patients were similar to those of their relatives. However, the relatives of leukemia patients were even more satisfied with the contact with the medical staff than the patients themselves (P less than 0.05). As many as 10-30% of the relatives never gave up hope for their relative's survival. Only two out of 27 deaths were considered not dignified. The lung carcinoma patients reported a less good quality of life (P less than 0.001), and less satisfaction with the information given (P less than 0.01), than the hematological patients from the same year. Similarly, their attitude to the medical care improved less (P less than 0.01), and they were less content with the general care than the leukemia group (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)