恶性血液病血浆内皮素与多脏功能衰竭的关系

作者采用放射疫免分析法，测定了６３例恶性血液病患者（其中３３例伴多脏器功能衰竭，３０例无多脏器功能衰竭）及３０例正常人的血浆内皮素水平。结果表明：恶性血液病伴在功能衰竭者血浆内皮素水平明显高于无多脏器功能衰竭者和正常人。恶性血液病血浆内皮素水平随受累脏器的增多而增高，死亡率也随之升高。提示：恶性血液病发生多脏器功能衰竭伴有明显的血管收缩和微循环紊乱。动态监测血浆内皮素水平可作为对恶性血液病疗效判断     

老年晚期恶性肿瘤与多脏器功能衰竭27例分析

多脏器功能衰竭系指两个或两个以上系统同时或前后出现功能衰竭。现将我院收治的60岁以上晚期恶性肿瘤并发多脏器功能衰竭住院死亡的27例患者进行以下分析。     

恶性血液病患者血一氧化氮、内皮素及超氧化物歧化酶的变化

目的：探讨恶性血液病患者血一氧化氮（NO）、内皮素（ET）及超氧化物歧化酶（SOD）的变化。方法：采用RIA法、硝酸还原法对26例恶性血液病患者和20例正常对照进行NO、ET、SOD测定。结果：26例初治恶性血液病患者NO、ET水平明显高于正常对照（P＜0．05），SDO低于正常水平（P＜0．05）。26例恶性血液病患者治疗后，10例完全缓解，8例部分缓解，8例未缓解，其中完全缓解组NO、ET、SOD与正常对照组差异无显著性（P＞0．05）；而部分缓解与未缓解组三者水平仍与正常对照差异有显著性（P＜0．05）。结论：NO、ET、SOD可能与恶性血液病发病有关，对三者动态监测有利于判断疗效。     

IL-10与恶性血液病关系的研究

Mosman等根据TH细胞(Helper T cells,辅助T细胞)分泌的细胞因子及这些细胞因子作用的不同,将TH细胞分为TH1、TH2两大类.TH1主要分泌IL-2、IFN-8、LT等,主要作用于T细胞,调节细胞免疫;而TH2主要分泌IL-4、IL-5、IL-6、IL-10等,主要作用于B细胞,调节体液免疫.其中IL-10可以抑制TH1细胞的增殖和分化,并可以抑制TH1细胞分泌的细胞因子,还可以通过下调MHCⅡ类分子(HLA-DR/Dp和DQ)在人类单核巨噬细胞的表达,从而抑制这类细胞的抗原递呈作用,因此,IL-10有较强的细胞免疫抑制作用.由于体内IL-10水平增高、细胞免疫受到了抑制,肿瘤细胞逃脱了免疫监视,从而使肿瘤易于发生.     

恶性血液病与中枢神经系统

急性白血病尤以急性淋巴细胞白血病(ALL),易有中枢神经系统(CNS)浸润,引起白血病性脑膜炎、脑瘤或脑病.防治CNS白血病已成为白血病治疗方案中不可缺少的组成部分.其它恶性血液病亦可累及CNS,但因少见易忽略.此外,恶性血液病还可因并发高粘综合征、高钙血症、高血细胞综合征、单克隆异常蛋白血症、高凝状态、低凝状态、电解质紊乱及酸碱失衡而损及CNS.鞘内注射化疗药、系统性应用大剂量化疗以及继发感染累及CNS,更增加鉴别的难度.因此,及早识别恶性血液病本身累及CNS有重要意义.     

恶性血液病与血管新生

实体瘤的进展伴有血管新生已早为人所知,造血系统的恶性病是否也伴有血管新生引起人们的重视.     

恶性血液病患者白细胞数变化与感染关系分析

恶性血液病在治疗过程中出血与感染是两大主要死亡原因,随着成分输血的广泛开展,血小板输液的应用,明显降低了出血的死亡率,而感染仍严重影响患者的生存.     

血管生成与恶性血液病

血管生成在实体瘤的发生、发展和转移中有重要作用,表现在促血管生长因子如血管内皮生长因子(vascular endothelial growth factor,VEGF)、碱性成纤维细胞生长因子(basic fibroblast growthfactor,bFGF,FGF-2)表达升高;基质金属蛋白酶(matrix metalloprotienase,MMP)过度表达和肿瘤内微血管密度增高等[1,2].     

恶性肿瘤患者死亡的原因及脏器衰竭：附208例分析

回顾分析恶性肿瘤的直接死亡原因,收集自1964-1986年间,经临床或病理确诊208例,男157,女51,年龄自10-85岁,以肝、胃、肺、食管等分为6组进行观察。其中,中、晚期81.2％,呈现不同程度恶病质96.7％。非肿瘤死亡36例(17.3％):手术死亡15例,化、放疗后死亡8例,间发其他疾病9例;肿瘤死亡172例(82.7％):并发症36例,广泛转移及重度恶病质39例,肿瘤脏器衰竭42例,伴发其他脏器衰竭55例。     

肿瘤患者血清铜锌及其比值测定的意义

目的探讨恶性肿瘤患者血清铜、锌水平和铜／锌比值的应用价值。方法 本文采用美国ＰＥ公司３０３０型原子吸收分光光度计,对１２３０例恶性肿瘤患者,２１０例良性疾病患者和１００例健康成人,进行血清铜、锌水平和铜／锌比值的测定。结果 恶性肿瘤口才的血清铜水平和铜、锌比值明显高于良性疾病组和健康对照组,而血清锌低于健康对照组,有统计学意义。血清铜／锌比值对卵巢癌诊断阳性率为８１．４８％;宫颈癌为７１．０％;肝     

Clinical Significance of Serial Measurement of the Serum Levels of Soluble Interleukin-2 Receptor and Soluble CD8 in Malignant Lymphoma

We serially measured the serum levels of soluble interleukin-2 receptor (sIL-2R) and soluble CD8 (sCD8) in 36 patients with malignant lymphoma (33 non-Hodgkin's lymphoma cases and three Hodgkin's disease cases). The level of serum sIL-2R was significantly elevated in patients with active disease (18) compared to those in remission (18), and correlated with the clinical stage of the lymphoma. The temporal profile of the sIL-2R level reliably represented the disease status, which was judged clinically, during the course of the disease. In three patients, the tumor bulk paralleled the sIL-2R level. On the other hand, a less significant correlation was found between the serum sCD8 level and disease activity. The serial measurement of sCD8 appeared to be less useful for monitoring the disease activity, although there was a significant correlation between the sCD8 and sIL-2R levels. This study indicates that serial measurement of the serum sIL-2R level may be useful for monitoring the tumor burden in response to treatment and for early detection of disease progression in malignant lymphoma.     

绿脓杆菌MSHA菌毛株菌苗对恶性淋巴瘤的治疗及其机制初探

绿脓杆菌MSHA菌毛株菌苗是一种新型的微生物免疫调节剂，首次应用于恶性淋巴瘤化疗的辅助治疗。结果显示：在化疗同时进行菌苗治疗组其治疗有效率（95．56％）明显高于仅进行化疗的对照组（69．77％），而感染率（17．78％）则明显低于对照组（37．21％），P值均小于0．05。菌苗治疗组IL－2水平，NK细胞活性及CD4 ／CD8 比值也明显高于对照组，且其抵抗多种不同菌属的革兰氏阴性杆菌抗体水平亦显著高于对照组，提示该菌苗是通过调整或增强患者自身细胞免疫或体液免疫水平，达到抗肿瘤．抗感染的功效。作者认为该菌苗是恶性淋巴瘤患者化疗的良好辅助药物。     

Stage IB Malignant Thymoma in a Lynch Syndrome Patient with Multiple Cancers: Response to Incidental Administration of Oxaliplatin and 5-Fluorouracil

Abstract

Chemotherapy is active against malignant thymomas, improving the respectability rate and the outcome of the advanced stages. The CAP and ADOC schemes are considered the standard schedules today, but these regimens can have important side effects in patients treated with combined approaches, such as toxic deaths due to congestive heart failure or hepatic insufficiency. We report the case of a 55 yearold woman with a history of multiple neoplasms including a mixed malignant thymoma WHO type B2 and three synchronous adenocarcinomas of the colon. The patient refused to undergo surgical resection of her mediastinal mass. However, 8 cycles of chronomodulated oxaliplatin, 5-fluorouracil and leucovorin as adjuvant treatment for her colon cancers resulted in a >30% decrease in the longest diameter of the mediastinal mass. This occasional observation may be important for clinicians and especially for those faced with relapsed, cisplatin-refractory disease or when planning new studies aiming to reduce overall toxicity of multimodal schedules.     

A Novel Algorithm to Differentiate Between Multiple Primary Lung Cancers and Intrapulmonary Metastasis in Multiple Lung Cancers With Multiple Pulmonary Sites of Involvement

IntroductionDifferentiating between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IPM) is critical for developing a therapeutic strategy to treat multiple lung cancers with multiple pulmonary sites of involvement.MethodsWe retrospectively included 252 lesions (126 pairs) from 126 patients with surgically resected multiple lung adenocarcinomas. Each pair was classified as MPLC or IPM based on histopathologic findings as the reference standard. A novel algorithm was established with four sequential decision steps based on the combination of computed tomography (CT) lesion types (step 1), CT lesion morphology (step 2), difference of maximal standardized uptake values on positron-emission tomography/CT (step 3), and presence of N2/3 lymph node metastasis or distant metastasis (step 4). The diagnostic accuracy of the algorithm was analyzed. Performances of 11 observers were assessed without and with knowledge of algorithm.ResultsAmong 126 pairs, 90 (71.4%) were classified as MPLCs and 36 (28.6%) as IPMs. On applying the diagnostic algorithm, the overall accuracy for diagnosis of IPM among conclusive cases up to step 4 was 88.9%, and 65 and 44 pairs were correctly diagnosed based on step 1 and step 2, respectively. Specificity and positive predictive value for diagnosis of IPM increased significantly in all observers compared with reading rounds without the algorithm.ConclusionsApplication of the algorithm based on comprehensive information on clinical and imaging variables can allow differentiation between MPLCs and IPMs. When both of two suspected malignant lesions appear as solid predominant lesions without spiculation or air-bronchogram on CT, IPM should be considered.     

良性肿瘤和恶性实体瘤患者血浆Lp（a）和其它脂类的变化

本文对５７例良性肿瘤、５２例恶性实体瘤患者和８０例正常人血浆中Ｌｐ（ａ）和ＴＣ、ＴＧ、ＡｐｏＢ、ＡｐｏＡ－Ⅰ的水平进行了比较。结果发现，上述指标在良性肿瘤与正常人之间无统计学差异。恶性实体瘤患者的Ｌｐ（ａ）水平明显高于良性肿瘤患者和正常人，ＴＣ水平明显低于良性肿瘤患者和正常人，ＡｐｏＢ和ＡｐｏＡ－Ⅰ明显低于正常人。本文认为，Ｌｐ（ａ）可能通过影响凝血系统而对肿瘤的生长和转移发挥一定的促进作用，Ｌｐ（ａ）和ＴＣ水平有可能成为恶性肿瘤辅助诊断的生化指标。脂质、脂蛋白和载脂蛋白与肿瘤的关系，值得进一步研究。     

血清可溶性白细胞介素2受体与恶性肿瘤相关性研究

目的　探讨血清可溶性白细胞介素２ 受体（ＳＩＬ－ ２Ｒ）与恶性肿瘤临床分期、临床疗效的关系。方法　采用双抗体夹心ＥＬＩＳＡ法测定了８２例恶性肿瘤患者血清ＳＩＬ－ ２Ｒ水平。结果　８ 种不同恶性肿瘤患者血清ＳＩＬ－ ２Ｒ水平（６０８．０±２７５．７～１１３５．０±６５７．６Ｕ／ｍ ｌ）较之健康对照组（２５０．０±１２８．９Ｕ／ｍ ｌ）均明显升高,且与临床分期及临床疗效密切相关。结论　血清ＳＩＬ－ ２Ｒ检测有助于判断恶性肿瘤患者临床疗效、病情严重程度及估计预后。     

胃癌、食管癌患者血浆及粘膜组织中ET-1浓度的测定

 目的　探讨内皮素在上消化道肿瘤中的作用。方法　本文测定了19例胃癌及10例食管癌患者血浆及组织内ET-1的浓度。结果　胃癌及食管癌组织中ET-1的含量显著增高(57.41±29.94)。与对照组(8.57±3.32)比较P<0.01。血浆ET-1的浓度亦增高，分别为27.01±5.95及27.45±6.24，与对照组比较P<0.01。但各细胞学类型之间血浆ET-1的含量无差异。结论　ET-1可能参与了肿瘤的发生及发展，这为进一步研究内皮素对消化道肿瘤的作用提供了一线索。