非小细胞肺癌患者呼出气冷凝液中p53蛋白检测的临床意义

Objective To study the clinical significance of the detection of p53 protein in exhaled breath condensate (EBC) of patients with non-small cell lung cancer (NSCLC). Methods EBC and plasma of 98 patients with NSCLC were collected,p53 protein expression in EBC and plasma was detected by enzyme-linked immunosorbent assay,and the data were compared with those of 98 healthy controls. p53 protein expression in cancer tissue of 98 patients with NSCLC was detected by immunohistochemistry. p53 protein expression in EBC and plasma and positive expression rate of p53 protein in cancer tissue were compared among patients with different lung cancer type,stage,histologic type,tumor size,and lymph node metastasis,smoking history. The specificity and sensitivity of diagnosis of p53 protein in patients with NSCLC were analyzed by ROC curve. Results ① The level of p53 protein in EBC of patients with NSCLC was significantly higher than that in healthy control group [(233.99±7.91) ng/L vs ( 130. 26 ± 4. 73) ng/L,P ＜0. 01]. The level of p53 protein in serum of patients with NSCI.C was significantly higher than that in healthy control group [(292. 58 ± 8. 79) ng/L vs (141. 66±3. 33) ng/L,P ＜0. 01]. ② The level of p53 protein in EBC of patients with central lung cancer was higher than that in patients with peripheral lung cancer [(248. 22 ± 8. 58) ng/L vs (215. 78 ± 6.61) ng/L,P＜0. 01]. ③The level of p53 protein in EBC of patients with positive immunostaining group was higher than that in negative group [(249.77 ± 8.07) ng/L vs (216.86 ± 7.44) ng/L,P ＜ 0. 05]. ④The level of p53 protein in serum of smokers was significantly higher than that in non-smokers [(310.18 ± 9.04) ng/L vs (254. 55 ± 6. 91) ng/L,P ＜0. 01]. ⑤The positive expression rate of p53 protein in cancer tissue was 47. 96% (47/98). ⑥The sensitivity and specificity of diagnosis of p53 protein were 95. 90% and 90. 04% in plasma,and those were 92. 90% and 79. 59% in EBC. The cut off values of p53 protein were respectively 175. 68 ng/L and 166. 26 ng/L in EBC and serum. Conclusions The detection of p53 protein in EBC of patients with NSCLC is helpful for the diagnosis of lung cancer.     

非小细胞肺癌患者呼出气冷凝液中p53基因突变检测的研究

Objective To investigate the clinical significance of p53 gene mutation in exhaled breath condensate (EBC) of patients with non-small cell lung cancer (NSCLC). Methods The mutations of exons 5,6,7 and 8 of p53 gene in EBC of 53 patients with NSCLC and 32 healthy persons were detected hy polymerase chain reaction and DNA sequencing method. Results In NSCLC group,p53 gene of 26 cases was amplified,p53 gene mutation was found in ten cases of them,the mutation rate was 38. 5%. In control group,p53 gene of 15 cases was amplified,p53 gene mutation was not found. The mutation rate of p53 gene in NSCLC group was higher than that in control group ( P ＜ 0. 01). Conclusions This research had successfully amplificated and analyzed p53 gene mutation in EBC,which will be helpful for pathogenesis research and clinical diagnosis of lung cancer.     

老年原发性非小细胞肺癌患者外周血T细胞膜型和可溶性CD28的表达

Objective To explore the expression of membrane form of CD28 (mCD28) on T lymphoeytes and the serum level of soluble CD28 (sCD28) in elderly patients with primary non-small cell lung cancer (NSCLC) in order to investigate the relationship between age-related changes of CD28 and the development of NSCLC in elderly patients. Methods 63 elderly patients with NSCLC, 35 elderly patients with lung benign lesion, 30 elderly healthy donors, 30 young healthy donors, 20 young patients with lung benign lesion and 20 young patients with NSCLC were enrolled in this study. The mCD28 on T cells and the serum level of sCD28 were measured by four-color flow eytometric assay and enzyme linked immunosorbent respectively, and the relationship between CD28 and clinical characteristics of NSCLC was analysed Results The expression of mCD28 was decreased and the serum level of sCD28 was increased in elderly patients with NSCLC compared with the other groups (F= 184.25, P<0. 01 ; F= 365.40, P<0.01). The expression of mCD28 was significantly lower and the level of sCD28 was significantly higher in elderly healthy donors than those in young healthy donors and young patients with lung benign lesion (P<0. 05). There were no significantly statistical differences in expression of mCD28 and level of sCD28 between elderly healthy donors and elderly patients with lung benign lesion [(42.84±5.82)% vs. (46.09±-7.34)%, (39.38±6.02)μg/L vs. (35.84±5.02)μg/L, P>0. 05]. Logistic regression analysis showed that aging (OR=2. 432), down-regulation of mCD28 expression (OR=0. 876) and up-regulation of sCD28 level (OR= 1. 113) were the risk factors for lung cancer. In the elderly patients with NSCLC, there were significant differences in mCD28 expression and sCD28 level between stages Ⅲ-Ⅳ and stages Ⅰ-Ⅱ [(16. 51± 5.64)% vs. (24.41±8.24)%, (75.03±5.98) μg/L vs. (66.73±7.52)μg/L; t=4.497,4.794, both P <0. 01]. However, there were no significantly statistical differences among different pathological types (F=0. 609, 0. 302, both P > 0. 05). Conclusions The down-regulation of mCD28 expression and up-regulation of sCD28 level with advancing age play an important role in the oncogenesis and development of primary non-small cell lung cancer in the elderly patients.     

老年原发性非小细胞肺癌患者外周血T细胞膜型和可溶性CD28的表达

Objective To explore the expression of membrane form of CD28 (mCD28) on T lymphoeytes and the serum level of soluble CD28 (sCD28) in elderly patients with primary non-small cell lung cancer (NSCLC) in order to investigate the relationship between age-related changes of CD28 and the development of NSCLC in elderly patients. Methods 63 elderly patients with NSCLC, 35 elderly patients with lung benign lesion, 30 elderly healthy donors, 30 young healthy donors, 20 young patients with lung benign lesion and 20 young patients with NSCLC were enrolled in this study. The mCD28 on T cells and the serum level of sCD28 were measured by four-color flow eytometric assay and enzyme linked immunosorbent respectively, and the relationship between CD28 and clinical characteristics of NSCLC was analysed Results The expression of mCD28 was decreased and the serum level of sCD28 was increased in elderly patients with NSCLC compared with the other groups (F= 184.25, P<0. 01 ; F= 365.40, P<0.01). The expression of mCD28 was significantly lower and the level of sCD28 was significantly higher in elderly healthy donors than those in young healthy donors and young patients with lung benign lesion (P<0. 05). There were no significantly statistical differences in expression of mCD28 and level of sCD28 between elderly healthy donors and elderly patients with lung benign lesion [(42.84±5.82)% vs. (46.09±-7.34)%, (39.38±6.02)μg/L vs. (35.84±5.02)μg/L, P>0. 05]. Logistic regression analysis showed that aging (OR=2. 432), down-regulation of mCD28 expression (OR=0. 876) and up-regulation of sCD28 level (OR= 1. 113) were the risk factors for lung cancer. In the elderly patients with NSCLC, there were significant differences in mCD28 expression and sCD28 level between stages Ⅲ-Ⅳ and stages Ⅰ-Ⅱ [(16. 51± 5.64)% vs. (24.41±8.24)%, (75.03±5.98) μg/L vs. (66.73±7.52)μg/L; t=4.497,4.794, both P <0. 01]. However, there were no significantly statistical differences among different pathological types (F=0. 609, 0. 302, both P > 0. 05). Conclusions The down-regulation of mCD28 expression and up-regulation of sCD28 level with advancing age play an important role in the oncogenesis and development of primary non-small cell lung cancer in the elderly patients.     

Clinicopathological significance of p53 and mdm2 protein expression in human pancreatic cancer

AIM: To study the clinicopathological significance of p53 and mdm2 protein expression in human pancreatic cancer. METHODS: To investigate the expression of p53 and mdm2 in pancreatic cancer by immunohistochemistry, and the relationships between the p53 and mdm2 protein expression and clinicopathological parameters in pancreatic cancer. RESULTS: The positive expression of p53 protein was found in 40 of 59 patients (67.8%) and that of mdm2 protein in 17 of 59 patients (28.8%). No obvious relationships were found between p53 as well as mdm2 expression and sex, tumor site,TNM staging and histological differentiation. p53 expression was increased in patients younger than 65 years old, while mdm2 had no relationship with age. The survival time of the patients with the positive expression of p53 and mdm2 proteins was obviously shorter than the other groups. CONCLUSION: Both p53 and mdm2 presented relatively high expression in human pancreatic cancer.The overexpression of p53 and mdm2 might reflect the malignant proliferation of pancreatic cancer and their co-expression might be helpful to evaluate the prognosis of the patients with pancreatic cancer.     

非小细胞肺癌DNA甲基转移酶及基因p53表达与预后的关系

Objective To investigate the expression and role of O~6-methylguanine DNA methyltransferas(MGMT) and p53 in non-small cell lung cancer(NSCLc)and the association with prognosis. Methods Immunohistochemical method was used to investigate the expression of MGMT and p53 in NSCLC specimens from 110 cases and in 20 cages of benign lung diseases as the control.The association of their expression with the prognosis of the 110 patients was evaluated. Results The positive expression of MGMT in NSCLC and benign lung diseases was 41.8%(46/110)and 80%(16/20)(x2=9.89,P<0.05),respectively.The positive expression of p53 in NSCLC and benign lung diseases were 56.4%(62/110)and 0%(0/20)(x2=21.551,P<0.05),respectively.There was a significant association between expression of MGMT with smoking,and lymph node metastasis (x2=12.107,P<0.05;x2=6.512P<0.05).There was also a significant association between expression of p53 with smoking and lymph node metastasis(x2=6.330,P<0.05;x2=7.909,P<0.05).A negative correlation was observed between the expression of MGMT and that of p53 protein in NSCLC(R_S=-0.592,P<0.05).The 5-year survival rate and median survival time of 110 cages was 10.9%(12/110),and(30.4±0.6)months.In 46 cases with positive expression of MGMT the 5-year survival rate was 0%(0/110)and median survival was(25.9±0.4)months,which were lower than those in the 64 patients with negative expression of MGMT [18.8%(12/64),(32.4 ±0.7)months],Log rank test x2=23.569,P<0.05.in the 62 patients with positive expression of p53.the 5-year survival rate and modian survival were 4.8%(3/62)and(30.4±1.2)months,which were lower than those in the 48 cases with negative expression of p53[18.8%(9/48),(30. 5± 1.1 ) months], Log rank test X2 =5. 521, P <0. 05. Conclusion The loss of expression of MGMT may lead to activation of the wild-type p53. They may participate in lung carcinomatosis, and may predict prognosis in patients with NSCLC.     

老年原发性非小细胞肺癌患者外周血T细胞膜型和可溶性CD28的表达

Objective To explore the expression of membrane form of CD28 (mCD28) on T lymphoeytes and the serum level of soluble CD28 (sCD28) in elderly patients with primary non-small cell lung cancer (NSCLC) in order to investigate the relationship between age-related changes of CD28 and the development of NSCLC in elderly patients. Methods 63 elderly patients with NSCLC, 35 elderly patients with lung benign lesion, 30 elderly healthy donors, 30 young healthy donors, 20 young patients with lung benign lesion and 20 young patients with NSCLC were enrolled in this study. The mCD28 on T cells and the serum level of sCD28 were measured by four-color flow eytometric assay and enzyme linked immunosorbent respectively, and the relationship between CD28 and clinical characteristics of NSCLC was analysed Results The expression of mCD28 was decreased and the serum level of sCD28 was increased in elderly patients with NSCLC compared with the other groups (F= 184.25, P<0. 01 ; F= 365.40, P<0.01). The expression of mCD28 was significantly lower and the level of sCD28 was significantly higher in elderly healthy donors than those in young healthy donors and young patients with lung benign lesion (P<0. 05). There were no significantly statistical differences in expression of mCD28 and level of sCD28 between elderly healthy donors and elderly patients with lung benign lesion [(42.84±5.82)% vs. (46.09±-7.34)%, (39.38±6.02)μg/L vs. (35.84±5.02)μg/L, P>0. 05]. Logistic regression analysis showed that aging (OR=2. 432), down-regulation of mCD28 expression (OR=0. 876) and up-regulation of sCD28 level (OR= 1. 113) were the risk factors for lung cancer. In the elderly patients with NSCLC, there were significant differences in mCD28 expression and sCD28 level between stages Ⅲ-Ⅳ and stages Ⅰ-Ⅱ [(16. 51± 5.64)% vs. (24.41±8.24)%, (75.03±5.98) μg/L vs. (66.73±7.52)μg/L; t=4.497,4.794, both P <0. 01]. However, there were no significantly statistical differences among different pathological types (F=0. 609, 0. 302, both P > 0. 05). Conclusions The down-regulation of mCD28 expression and up-regulation of sCD28 level with advancing age play an important role in the oncogenesis and development of primary non-small cell lung cancer in the elderly patients.     

老年原发性非小细胞肺癌患者外周血T细胞膜型和可溶性CD28的表达

Objective To explore the expression of membrane form of CD28 (mCD28) on T lymphoeytes and the serum level of soluble CD28 (sCD28) in elderly patients with primary non-small cell lung cancer (NSCLC) in order to investigate the relationship between age-related changes of CD28 and the development of NSCLC in elderly patients. Methods 63 elderly patients with NSCLC, 35 elderly patients with lung benign lesion, 30 elderly healthy donors, 30 young healthy donors, 20 young patients with lung benign lesion and 20 young patients with NSCLC were enrolled in this study. The mCD28 on T cells and the serum level of sCD28 were measured by four-color flow eytometric assay and enzyme linked immunosorbent respectively, and the relationship between CD28 and clinical characteristics of NSCLC was analysed Results The expression of mCD28 was decreased and the serum level of sCD28 was increased in elderly patients with NSCLC compared with the other groups (F= 184.25, P<0. 01 ; F= 365.40, P<0.01). The expression of mCD28 was significantly lower and the level of sCD28 was significantly higher in elderly healthy donors than those in young healthy donors and young patients with lung benign lesion (P<0. 05). There were no significantly statistical differences in expression of mCD28 and level of sCD28 between elderly healthy donors and elderly patients with lung benign lesion [(42.84±5.82)% vs. (46.09±-7.34)%, (39.38±6.02)μg/L vs. (35.84±5.02)μg/L, P>0. 05]. Logistic regression analysis showed that aging (OR=2. 432), down-regulation of mCD28 expression (OR=0. 876) and up-regulation of sCD28 level (OR= 1. 113) were the risk factors for lung cancer. In the elderly patients with NSCLC, there were significant differences in mCD28 expression and sCD28 level between stages Ⅲ-Ⅳ and stages Ⅰ-Ⅱ [(16. 51± 5.64)% vs. (24.41±8.24)%, (75.03±5.98) μg/L vs. (66.73±7.52)μg/L; t=4.497,4.794, both P <0. 01]. However, there were no significantly statistical differences among different pathological types (F=0. 609, 0. 302, both P > 0. 05). Conclusions The down-regulation of mCD28 expression and up-regulation of sCD28 level with advancing age play an important role in the oncogenesis and development of primary non-small cell lung cancer in the elderly patients.     

老年原发性非小细胞肺癌患者外周血T细胞膜型和可溶性CD28的表达

Objective To explore the expression of membrane form of CD28 (mCD28) on T lymphoeytes and the serum level of soluble CD28 (sCD28) in elderly patients with primary non-small cell lung cancer (NSCLC) in order to investigate the relationship between age-related changes of CD28 and the development of NSCLC in elderly patients. Methods 63 elderly patients with NSCLC, 35 elderly patients with lung benign lesion, 30 elderly healthy donors, 30 young healthy donors, 20 young patients with lung benign lesion and 20 young patients with NSCLC were enrolled in this study. The mCD28 on T cells and the serum level of sCD28 were measured by four-color flow eytometric assay and enzyme linked immunosorbent respectively, and the relationship between CD28 and clinical characteristics of NSCLC was analysed Results The expression of mCD28 was decreased and the serum level of sCD28 was increased in elderly patients with NSCLC compared with the other groups (F= 184.25, P<0. 01 ; F= 365.40, P<0.01). The expression of mCD28 was significantly lower and the level of sCD28 was significantly higher in elderly healthy donors than those in young healthy donors and young patients with lung benign lesion (P<0. 05). There were no significantly statistical differences in expression of mCD28 and level of sCD28 between elderly healthy donors and elderly patients with lung benign lesion [(42.84±5.82)% vs. (46.09±-7.34)%, (39.38±6.02)μg/L vs. (35.84±5.02)μg/L, P>0. 05]. Logistic regression analysis showed that aging (OR=2. 432), down-regulation of mCD28 expression (OR=0. 876) and up-regulation of sCD28 level (OR= 1. 113) were the risk factors for lung cancer. In the elderly patients with NSCLC, there were significant differences in mCD28 expression and sCD28 level between stages Ⅲ-Ⅳ and stages Ⅰ-Ⅱ [(16. 51± 5.64)% vs. (24.41±8.24)%, (75.03±5.98) μg/L vs. (66.73±7.52)μg/L; t=4.497,4.794, both P <0. 01]. However, there were no significantly statistical differences among different pathological types (F=0. 609, 0. 302, both P > 0. 05). Conclusions The down-regulation of mCD28 expression and up-regulation of sCD28 level with advancing age play an important role in the oncogenesis and development of primary non-small cell lung cancer in the elderly patients.     

老年原发性非小细胞肺癌患者外周血T细胞膜型和可溶性CD28的表达

Objective To explore the expression of membrane form of CD28 (mCD28) on T lymphoeytes and the serum level of soluble CD28 (sCD28) in elderly patients with primary non-small cell lung cancer (NSCLC) in order to investigate the relationship between age-related changes of CD28 and the development of NSCLC in elderly patients. Methods 63 elderly patients with NSCLC, 35 elderly patients with lung benign lesion, 30 elderly healthy donors, 30 young healthy donors, 20 young patients with lung benign lesion and 20 young patients with NSCLC were enrolled in this study. The mCD28 on T cells and the serum level of sCD28 were measured by four-color flow eytometric assay and enzyme linked immunosorbent respectively, and the relationship between CD28 and clinical characteristics of NSCLC was analysed Results The expression of mCD28 was decreased and the serum level of sCD28 was increased in elderly patients with NSCLC compared with the other groups (F= 184.25, P<0. 01 ; F= 365.40, P<0.01). The expression of mCD28 was significantly lower and the level of sCD28 was significantly higher in elderly healthy donors than those in young healthy donors and young patients with lung benign lesion (P<0. 05). There were no significantly statistical differences in expression of mCD28 and level of sCD28 between elderly healthy donors and elderly patients with lung benign lesion [(42.84±5.82)% vs. (46.09±-7.34)%, (39.38±6.02)μg/L vs. (35.84±5.02)μg/L, P>0. 05]. Logistic regression analysis showed that aging (OR=2. 432), down-regulation of mCD28 expression (OR=0. 876) and up-regulation of sCD28 level (OR= 1. 113) were the risk factors for lung cancer. In the elderly patients with NSCLC, there were significant differences in mCD28 expression and sCD28 level between stages Ⅲ-Ⅳ and stages Ⅰ-Ⅱ [(16. 51± 5.64)% vs. (24.41±8.24)%, (75.03±5.98) μg/L vs. (66.73±7.52)μg/L; t=4.497,4.794, both P <0. 01]. However, there were no significantly statistical differences among different pathological types (F=0. 609, 0. 302, both P > 0. 05). Conclusions The down-regulation of mCD28 expression and up-regulation of sCD28 level with advancing age play an important role in the oncogenesis and development of primary non-small cell lung cancer in the elderly patients.     

非小细胞肺癌患者呼出气冷凝液中p53基因突变检测的研究

目的 探讨非小细胞肺癌(NSCLC)患者呼出气冷凝液(EBC)中p53基因突变检测的临床意义.方法 采用PCR结合DNA测序法,检测53例NSCLC患者(治疗前)EBC中p53基因第5、6、7、8外显子的突变情况,32名健康体检者EBC标本作为对照.结果 肺癌组(治疗前)EBC标本中扩增到p53基因26例,其中10例检...     

老年原发性非小细胞肺癌患者外周血T细胞膜型和可溶性CD28的表达

目的 检测老年原发性非小细胞肺癌(NSCLC)患者外周血T细胞膜型CD28(mCD28)及血清中可溶性CD28(sCD28)的表达,探讨该分子增龄性改变与老年人肺癌发生发展之间的联系.方法 应用四色免疫荧光标记流式细胞术和酶联免疫吸附法对63例老年人NSCLC(老年肺癌组)外周血的mCD28和sCD28进行检测,将其结果 与老年肺良性病变组(老年非癌组35例)、老年健康组30例、青年健康组30例、青年肺良性病变组(青年非癌组20例)及青年肺癌组(20例)进行对比分析,并研究其与老年人肺癌临床病理特征之间的关系. 结果 老年肺癌组外周血mCD28的表达量[(19.27±6.93)%]显著低于其余各组(F=184.25,P<0.01).其血清sCD28含量[(72.00±6.85)μg/L]则显著高于其余各组(F=365.40,P<0.01);老年健康组外周血mCD28的表达量((46.09±7.34)%]明显低于青年健康组和青年非癌组,其血清sCD28的含量[(35.84±5.02)μg/L]则明显高于青年健康组和青年非癌组;老年非癌组[(42.84±5.82)%、(39.38±6.02)μg/L]与老年健康组比较,两者表达差异均无统计学意义;Logistic回归分析显示,增龄、mCD28表达下调、sCD28含量增加均与肺癌的发生有统计学关联(OR值分别为2.432、0.876,1.113);老年肺癌组Ⅲ～Ⅳ期mCD28和sCD28的表达[(16.51±5.64)%、(75.03±5.98)μg/L]与Ⅰ～Ⅱ期表达[(24.41±8.24)%、(66.73±7.52)μg/L]比较,差异均有统计学意义(t值分别为4.497、4.794,均为P<0.01),而不同病理类型之间比较,差异均无统计学意义(F值分别0.609、0.302,均为P0.05). 结论 呈增龄性下调的mCD28和增龄性上调的sCD28,在老年人原发性肺癌的形成和进展过程中可能起重要作用.     

丙氨酸转移酶升高的2型糖尿病患者伴有更多的心血管风险因素

根据血丙氨酸转氨酶(ALT)水平将4 509例2型糖尿病患者分为A组(n=449,ALT增高)和B组(n=4 060,ALT正常),ALT升高的患者为10%.与B组患者相比,A组患者相对年龄更轻[(48.5±11.3对55.7±11.4)岁,P＜0.01]、糖尿病病程更短[(36.8±45.0对56.2±58.8)个月,P＜0.01]、体重指数以及腰臀比更大[(27.7±3.9对25.8±3.4)kg/m2,P＜0.01;0.95±0.06对0.93±0.07,P＜0.01].两组之间的血压存在差别[收缩压(132±19对131±21)mm Hg,1 mm Hg=0.133 kPa,P=0.60;舒张压(78±10对75±10)mm Hg,P＜0.01].A组的空腹血糖[(9.04±2.91对8.63±3.05)mmol/L,P=0.008]、餐后血糖[(13.85±4.67对13.07±4.92)mmol/L,P=0.002]、HbA1C(8.11%±1.82%对7.74%±1.96%,P＜0.01)、空腹胰岛素[(10.59±7.31对7.97±7.18)mU/L,P＜0.01]和餐后胰岛素[(48.96±43.80对35.25±32.37)mU/L,P＜0.01]及稳态模型评估的胰岛素抵抗指数(HOMA-IR,4.11±2.85对3.00±2.92,P＜0.01)、甘油三酯[(2.77±2.50对2.19±2.99)mmoL/L,P＜0.01]明显增高,高密度脂蛋白胆固醇[HDL-C,(1.20±0.30对1.29±0.83)mmol/L,P=0.01]更低.Logistic回归分析说明,HbA1C、餐后胰岛素、HOMA-IR、尿酸和尿白蛋白与ALT水平正相关,HDL-C则为负相关.提示ALT增高的2型糖尿病患者发病年龄更轻,有更严重的胰岛素抵抗和更多的心血管危险因素.     

室间隔缺损患儿封堵术前后血浆N末端B型利钠肽原和左心室Tei指数变化的意义

目的 探讨室间隔缺损(VSD)患儿封堵术前后血浆N末端B型利钠肽原(NT-proBNP)水平和左心室Tei指数变化的临床意义.方法选择膜固型VSD患儿60例作为VSD组,年龄相当的健康儿童30名作为正常对照组.采用电化学发光免疫学方法测定正常对照组与VSD组术前和术后5 min、24 h、1个月、3个月、6个月的血浆NT-proBNP水平.应用超声心动图测定正常对照组与VSD组术前和术后24 h、1个月、3个月、6个月左心室Tei指数.将VSD封堵术前后患儿的左心室Tei指数的变化与血浆NT-proBNP水平作相关性分析.结果 (1)VSD组术前血浆NT-proBNP水平显著高于正常对照组[(229.45±57.75)ng/L比(99.21±46.86)ng/L,P＜0.01];VSD组术后5 min、术后24 h血浆NT-proBNP水平均显著高于术前[(356.27±96.78)ng/L和(356.38±91.95)ng/L比(229.45±57.75)ng/L,均P＜0.01];VSD组术后1、3和6个月血浆NT-proBNP水平均显著低于术前[(131.33±34.79)ng/L、(96.56±31.55)ng/L和(93.39±29.46)ng/L比(229.45±57.75)ng/L,P＜0.05或P＜0.01];VSD组术后3和6个月与正常对照组比较差异无统计学意义(P＞0.05).(2)VSD组术前左心室Tei指数显著高于正常对照组(0.45±0.05比0.33±0.08,P＜0.01);VSD组术后24 h(0.52±0.05)与1个月(0.51±0.03)左心室Tei指数均显著高于术前和正常对照组(均P＜0.01);VSD组术后3和6个月左心室Tei指数均显著低于术前(0.34±0.07和0.34±0.06比0.45±0.05,均P＜0.01),与正常对照组比较差异无统计学意义(P＞0.05).(3)VSD患儿封堵前后左心室Tei指数的变化与血浆NT-proBNP水平呈正相关(r=0.653,P＜0.05).结论血浆NT-proBNP水平与左心室Tei指数可作为评价VSD患儿封堵前后心功能的参考指标.

Abstract：

Objective To explore the implication of the dynamic changes of plasma N-terminal proB-type natriuretic peptide (NT-proBNP) level and Tei index of left ventricle (LV) in children with ventricular septal defect(VSD) treated by transcatheter closure. Methods Sixty children with VSD treated by transcatheter closure with VSD occluder (Group VSD) and 30 healthy children (Group C) were included in this study. The plasma concentration of NT-proBNP, Tei index of LV and left ventricle ejection fraction (LVEF) were measured in Group C and at before, 5th minute, 4th hour, 1st month, 3rd month and 6th month after VSD closure in Group VSD. Results ( 1 ) The concentration of plasma NT-proBNP was significantly increased in children with VSD before transcatheter closure compared with Group C [(229.45 ±57.75 ) ng/L vs. (99. 21 ± 46. 86) ng/L,P ＜ 0. 01], significantly increased at 5th minute and 24th hour after transcatheter closure[( 356.27 ± 96. 78 ) ng/L and ( 356. 38 ± 91.95 ) ng/L vs. ( 229. 45 ± 57.75 ) ng/L, all P ＜0. 01], and significantly decreased at 1st month, 3rd months and 6th months after transcatheter closure [( 131.33 ± 34. 79 ) ng/L, (96. 56 ± 31.55 ) ng/L and ( 93. 39 ± 29. 46 ) ng/L vs. ( 229. 45 ± 57.75 ) ng/L,P＜0.05 or P＜0. 01]. (2) The Tei indexes of LV in Group VSD before transcatheter closure were significantly higher than in Group C (0. 45 ± 0. 05 vs. 0. 33 ± 0. 08, P ＜ 0. 01 ) and Tei index was significantly increased at 24th hour, 1 st month after transcatheter closure (P ＜ 0. 01 ) while significantly decreased at 3rd and 6th month compared with those before transcatheter closure (0. 34 ±0. 07 and 0. 34 ±±0. 06 vs. 0. 45 ±0. 05 ,all P ＜0. 01 ). (3) There is a positive correlation between the changes of the plasma concentration of NT-proBNP and the change of Tei index of LV before and after transcatheter closure (r = 0. 653, P ＜ 0. 05).Conclusion Tei index of LV and NT-proBNP can monitor cardiac function changes in children with VSD before and after transcatheter closure.     

慢性阻塞性肺疾病的高分辨率CT分型及其与白细胞介素-6的关系

目的 探讨高分辨率CT评价COPD的方法,并依此判断COPD影像学分型及其与气道炎症的关系.方法 收集2007年11月至2009年3月上海交通大学医学院附属瑞金医院收治的84例COPD稳定期患者,其中男59例,女25例,年龄34～81岁,平均年龄(67±11)岁,进行胸部高分辨率CT扫描和肺功能检查,根据高分辨率CT影像中肺气肿程度和支气管管壁增厚情况进行分型,并测定其中30例的呼出气冷凝液中白细胞介素(IL)-6的水平.结果 根据胸部高分辨率CT表现,将COPD患者分为3种类型:(1)A型(34例):无或轻微肺气肿,合并或不合并支气管管壁增厚;(2)E型(23例):有肺气肿,无支气管管壁增厚;(3)M型(27例):有肺气肿和支气管管壁增厚.A型患者的平均体重指数为(25.1±4.4)kg/m~2,明显高于E型和M型[(22.5±4.1)和(21.3±3.4)kg/m~2],差异有统计学意义(F=6.732,P＜0.01).A型中轻度呼吸困难者(15/34例)明显多于E型(2/23例)和M型(6/27例),差异有统计学意义(χ~2=9.097,P＜0.05).E型的中、重度咳痰者(均为0/23例)明显少于A型(2/34)和M型(4/27),差异有统计学意义(χ~2=8.702,P＜0.05).A型患者的FEV_1/FVC和FEV_1占预计值%分别为(67±11)%和(72±24)%,明显高于E型[(53±14)%和(52±26)%]和M型[(53±14)%和(51±25)%],差异均有统计学意义(F值分别为10.252和6.508,均P＜0.01).A型患者的深吸气量/肺总量为(41±17)%,明显高于E型和M型[(33±13)%和(28±13)%],差异有统计学意义(F=5.964,P＜0.01).A型患者的残气容积/肺总量为(37±9)%,明显低于E型和M型[(44±10)%和(45±8)%],差异有统计学意义(F=6.954,P＜0.01).M型患者的呼出气冷凝液中IL-6水平为(25.6±4.4)ng/L,明显高于A型和E型[(19.9±6.3)和(16.7±2.1)ng/L],差异有统计学意义(F=7.749,P＜0.01).结论 COPD高分辨率CT3种分型的临床特征不同,且与肺功能及气道炎症相关.     

缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性的影响

目的 比较缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性及一氧化氮、内皮素的影响.方法选取61例2、3级老年高血压患者,随机分为两组,分别给予缬沙坦+氨氯地平或缬沙坦+氢氯噻嗪行降压治疗,观察入选时、治疗第8周和第16周各种相关指示的变化.人选时检测血脂、空腹血糖、血尿酸,试验各个阶段监测24 h动态血压,检测血浆一氧化氮、内皮素水平.结果在患者入选时、治疗第8周和第16周三个时间点,缬沙坦+氨氯地平组和缬沙坦+氢氯噻嗪组24 h血压及白昼血压比较差异无统计学意义.治疗第16周,缬沙坦+氨氯地平组晨峰收缩压较缬沙坦+氢氯嚷嗪组明显降低[(22.6±8.8)mm Hg(1 mm Hg=0.133 kPa)比(26.3±13.7)mm Hg,P＜0.05];缬沙坦+氨氯地平组及缬沙坦+氢氯噻嗪组24 h收缩压变异性(SBPV)进行性降低[缬沙坦+氨氯地平组:(12.5±2.8)mm Hg比(10.2 ±2.2)mm Hg比(8.8±1.6)mm Hg,P＜0.01;缬沙坦±氢氯噻嗪组:(12.5±2.5)mmHg比(10.7±2.2)mm Hg比(9.6±2.0)mmHg,P＜0.01],缬沙坦+氨氯地平组及缬沙坦+氢氯噻嗪组白昼SBPV明显降低[缬沙坦+氨氯地平组:(12.2±3.0)mm Hg比(10.1±2.3)mm Hg比(8.4±1.9)mm Hg,P＜0.01;缬沙坦+氢氯噻嗪组:(11.8±2.7)mm Hg比(10.4±1.9)mm Hg比(9.6±2.2)mm Hg,P＜0.01],缬沙坦+氨氯地平组24 h舒张压变异性(DBPV)显著降低[(15.5±3.4)mm Hg比(13.0±3.5)mm Hg比(12.3±2.5)mm Hg,P＜0.01],缬沙坦+氢氯噻嗪组24 h DBPV无显著性变化;缬沙坦+氨氯地平组第16周白昼SBPV低于缬沙坦+氢氯噻嗪组[(8.4±1.9)mm Hg比(9.6 ±2.2)mm Hg,p＜0.05],缬沙坦+氨氯地平第8周、第16周的24 h DBPV、白昼DBPV低于缬沙坦+氢氯噻嗪组(P ＜0.01～0.05);缬沙坦+氨氯地平组一氧化氮进行性升高[(27.3±13.6)μmol/L比(47.2±16.3)μmol/L比(69.5±18.9)μmol/L,P＜0.01]、内皮素进行性降低[(45.3±8.0)ng/L比(37.4±3.9)ng/L比(34.2±4.4)ng/L,P＜0.01];缬沙坦+氢氯噻嗪组一氧化氮进行性升高[(33.5±13.9)μmol/L 比(49.7±21.9)μmol/L比(66.7 ±24.7)μmol/L,P＜0.01]、内皮素显著降低[(46.6±10.4)ng/L比(37.0±5.4)ng/L比(36.1±8.2)ng/L,P＜0.01].治疗第8周,缬沙坦+氨氯地平组收缩压变异性的降幅与一氧化氮的升幅有相关性(r =0.401,P=0.025).结论缬沙坦联合氨氯地平或氢氯噻嗪均能降低老年高血压患者血压变异性、改善血管内皮功能,缬沙坦联合氨氯地平可能更适合于老年高血压患者.     

腺相关病毒介导的血管内皮生长因子基因与骨髓间充质干细胞联合治疗大鼠肢体缺血的研究

目的 探讨腺相关病毒(rAAV)介导的人血管内皮生长因子(VEGF)165基因转染大鼠骨髓间充质干细胞(MSC)移植对血管新生的影响.比较单纯干细胞移植与联合基因治疗的疗效.方法 全骨髓培养法提取培养MSC;rAAV-VEGF165转染MSC中,酶联免疫吸附试验(ELISA)及反转录-聚合酶链反应(RT-PCR)检测VEGF的表达;以近交系大鼠建立骨骼肌缺血模型,40只大鼠随机分为4组,每组10只.对照组注射磷酸盐缓冲液(PBS);干细胞组移植等量MSC,转染术后7 d组和转染术后10 d组分别于结扎7 d和10 d后的缺血区移植转染VEGF基因的MSC,移植6周后做Ⅷ因子染色检测血管新生情况.结果成功培养出MSC,免疫组化CD44阳性表达,CD34阴性表达;流式细胞术CD90阳性表达.在转染rAAV-VEGF165后转染组1、3、5、7、9 d上清液中VEGF165分泌水平分别为(131.98±6.00)、(263.96±4.58)、(540.85±5.97)、(208.98±5.06)、(174.45±5.00)ng/L,明显高于未转染组的(68.72±1.99)、(76.47±4.98)、(89.86±1.99)、(84.93±8.97)、(68.71±5.98)ng/L[t值分别为14.14、51.16、79.28、27.56、26.07,(均P＜0.05)],且5 d时达到高峰,此后表达开始下降.琼脂糖凝胶电泳可见在579 bp处见到高亮度条带,证明rAAV-VEGF165成功转染进MSC细胞中.转染后的生长曲线及细胞形态较未转染组无明显变化.Ⅷ因子染色示转染术后10 d组动物缺血区毛细血管密度[(9.35±2.72)条/视野]明显高于对照组[(1.05±0.50)条/视野]和干细胞组[(3.10±1.43)条/视野](均P＜0.01),较转染术后7 d组[(6.95±1.69)条/视野]亦有一定程度的升高(P＜0.05).结论 MSC有利于VEGF基因的稳定表达,可作为VEGF基因的良好细胞载体,且联合应用效果高于单独移植MSC,移植最佳时间为术后10 d.     

人类乳头瘤病毒与广东地区非小细胞肺癌相关性研究

目的：通过前瞻性观察广东地区非小细胞肺癌(non-small cell lung cancer,NSCLC)患者中人乳头瘤病毒(human papillomavirus,HPV)的阳性率,以及 HPV 阳性与否与血管内皮生长因子(vascular endothelial growth factor,VEGF)和表皮生长因子受体(epidermal growth factor receptor,EGFR)表达水平的关系,探讨 HPV与广东地区 NSCLC 的相关性。方法采用 PCR 方法检测44例 NSCLC患者(分成吸烟组与非吸烟组)和24例肺良性病变患者肺组织中 HPV 的 DNA。采用酶联免疫吸附试验法检测 NSCLC 患者中 HPV DNA 阳性组和 HPV DNA 阴性组血清 VEGF、EGFR的水平。结果 NSCLC 组 HPV DNA 阳性率(18/44,40.91%)明显高于肺良性病变组(3/24,12.50%)(χ2=5.8718,P<0.05)。NSCLC患者中 HPV阳性组 VEGF和 EGFR 的水平均明显高于 HPV阴性组[VEGF：(509.19±216.14)ng/L vs (80.80±61.06)ng/L,T=627.00,P<0.01;EGFR：(2482.41±92.47)ng/L vs (2254.59±74.85)ng/L,T=639.00,P <0.01]。NSCLC 中吸烟者27例,HPV阳性率为40.74%(11/27);非吸烟者17例,HPV 阳性率为41.18%(7/17),2组比较差异无统计学意义(χ2=0.005,P>0.05)。结论 HPV可能是广东地区 NSCLC 发生的潜在因素,预防 HPV感染对降低肺癌的发生有一定的意义。     

血清脂联素和抵抗素与2型糖尿病及其大血管病变相关

测定2型糖尿病患者血清脂联素和抵抗素水平,发现2型糖尿病组血清脂联素浓度(2.51±1.42)mg/L低于正常对照组(5.26±0.78)mg/L,2型糖尿病大血管病变组为(1.38±0.77)mg/L又低于非大血管病变组(3.66±0.91)mg/L,差异均有统计学意义(均P＜0.01).2型糖尿病组血清抵抗素浓度(7.07±1.11)μg/L高于正常对照组(6.09±0.47)μg/L,2型糖尿病大血管病变组为(7.96±0.65)μg/L又高于非大血管病变组(6.10±0.43)μg/L,差异均有统计学意义(均P＜0.01).     

非小细胞肺癌微波消融术后血清Caspase-4变化及意义

目的探讨非小细胞肺癌(NSCLC)患者微波消融术后血清半胱天冬酶(Caspase-4)变化及意义。 方法选择2013年3月至2016年1月我院及省肿瘤医院收治的159例NSCLC患者作为研究对象,所有患者均接受微波消融治疗。采用活性荧光法测定检测NSCLC患者微波消融治疗前后血清Caspase-4水平。比较不同预后NSCLC患者血清Caspase-4水平。采用受试者工作特征(ROC)曲线分析血清Caspase-4评估NSCLC患者预后的价值。比较不同血清Caspase-4水平NSCLC患者平均生存时间,并采用Cox单因素及多因素分析影响NSCLC患者预后的相关因素。 结果NSCLC患者微波消融术后血清Caspase-4水平明显低于术前,差异有统计学意义(3.51±0.82)ng/ml vs. (4.33±0.96)ng/ml,P<0.05。死亡组NSCLC患者血清Caspase-4水平高于生存组,差异有统计学意义(5.01±0.63)ng/ml vs. (3.04±0.47)ng/ml,P<0.05。微波消融术后血清Caspase-4评估NSCLC患者预后的AUC、敏感度、特异性分别为0.851、65.79%、90.91%。Caspase-4≥3.17 ng/ml的NSCLC患者平均生存时间明显低于Caspase-4<3.17 ng/ml的NSCLC患者,差异有统计学意义30.19(95%CI：27.84～32.49)个月vs. 33.19(95%CI：31.77～34.60)个月,P<0.05。Cox单因素分析显示年龄、病理类型、分化程度、TNM分期、淋巴结转移、Caspase-4水平与NSCLC预后可能有关(P<0.05),进一步Cox多因素回归分析显示TNM分期、淋巴结转移、Caspase-4水平与NSCLC患者预后密切相关(P<0.05)。 结论微波消融术后NSCLC患者血清Caspase-4水平明显降低,血清Caspase-4水平与NSCLC患者预后密切相关,检测术后血清Caspase-4水平对于评估NSCLC患者预后具有重要临床意义。