Fascin在肺癌中的表达及临床探讨

Objective To investigate Fascin expression in human lung cancer tissues and its clinical significance.Methods Immunohistochemistry was performed in 62 patients with different histological types and clinical stages of lung cancer and 92 cases with other malignant tumors.Fascin positive rate in each group was calculated and the differences of pathological characters between the two groups were analyzed.Results Fascin expression in lung cancer tissues was significantly higher than that in normal lung tissues(P ＜ 0.05),its expression varied by different clinical stage of lung cancer tissue differentiation.As differentiation degree decreased,Fascin positive rate increased.Fascin expression was independent with age,sex,smoking history(P ＞ 0.05).Fascin expression had no significant difference between lung cancer group and other tumor group(P ＞ 0.05).Conclusions Fascin expression raising might be common in malignant tumors.Fascin expression in lung tissues indicated the possibility of lung cancer.In lung tissue,high expression of Fasein was a sign of poor differentiation and malignant status of lung cancer.     

剖宫产术与阴道助产术在足月妊娠临产胎儿窘迫中的应用

Objective To observe the application of cesarean section and vaginal delivery in parturient term pregnancy with fetal distress. Methods One hundred and six cases of parturient term pregnancy with fetal distress were selected, SO cases of cesarean section as group A, 56 cases of vaginal delivery as group B, newborn outcome and condition of the large maternal cervix data when fetal distress between two groups were compared. Results The neonatal asphyxia rate was 14.0% (7/50) in group A and 16.1 % (9/56 ) in group B, there was no significant difference between two groups (P＞0.05); the rate of the large maternal cervix data in delitescence in group A was higher than that in group B [54.0% (27/50) vs. 26.8% (15/56) ](P＜ 0.05); the rate of the large maternal cervix data in active stage deceleration phase in group A was lower than that in group B [4.0%(2/50) vs. 23.2%(13/56)](P＜0.05). Conclusion Cesarean section and vaginal delivery in parturient term pregnancy with fetal distress can get a good neonatal outcomes, maternal clinical condition should select the appropriate surgical approach, and effort to reduce cesarean section rates.     

92例子宫内膜癌的临床特点及预后影响因素分析

目的 探讨子宫内膜癌的临床特点及与预后的相关性,为临床治疗提供依据.方法 回顾性分析手术初治的92例子宫内膜癌患者的临床资料,随访观察5年生存率,并对可能影响预后的临床指标进行单因素和多因素分析.结果 92例患者5年生存率为72.41%.单因素分析显示,病理类型、病理学分期、组织学分级、肌层浸润、宫颈受累、盆腔淋巴结转移与生存时间有显著相关性(P＜0.05).多因素回归分析表明,影响子宫内膜癌患者生存时间的独立预后因素为病理类型、组织学分级和肌层浸润.结论 病理类型、组织学分级和肌层浸润为影响子宫内膜癌患者生存时间的独立预后因素,据此制定规范化个体治疗方案有望提高患者的生存率.

Abstract：

Objective To study the dependablity of clinical characteristics and prognosis in patients with endometrial cancer,so as to apply the basis for the treatment. Methods The clinical and pathological data of 92 patients with endometrial cancer were analyzed retrospectively, 5-year survival rate was followed and observed. Using Cox proportional hazard regression analysis to evaluate the factors related to overall survival. Results The overall 5-year survival rate was 72.41%. Using univariate analysis, the survival time was correlated with histologic type, pathological staging, histologic grade, myometrium invasion,cervical invasion and lymph node metastasis (P＜0.05).Using multivariate analysis, the survival time was correlated with histologic type,histologic grade and myometrium invasion. Conclusions Histologic type, histologic grade and myometrium invasion are independent prognostic factors for survival time of patients. In order to improve the prognosis of the patients, they should be treated by individual therapies.     

Effects of oxidative stress and NF-κB levels in peripheral blood mononuclear cells on development of silicosis

Objective To investigate the change of indicators of oxidative stress in serum and NF-κB in peripheral blood mononuclear cells of patients with silicosis, and explore the mechanism of the development of silicosis. Methods The subjects were divided into (1) 200 workers exposed to SiO2 for at least 1 years in a foundry served as the dust-exposure group; (2) 130 cases with silicosis (Ⅰ phase silicosis 64 cases, Ⅱ phase 46 cases Ⅲ phase 20 cases) served as the silicosis goup; (3) 32 cases with 0+ phase silicosis in the foundry served as the observed group,(4)100 subjects from a hotel served as the control group. The serum including superoxide dismutase (SOD), nitric oxide (NO), serum glutathione peroxidase (GSH-Px), total antioxidant capacity (T-AOC), nitric oxide synthase (NOS), lipid malondialdehyde (MDA) and NF-κB protein levels in peripheral blood mononuclear cells were determined, respectively. Results Compared with the control group,NO levels in dust-exposed group and silicosis group significantly increased, and SOD decreased significantly (P＜0.05 or P＜0.01). Compared with the control group and dust-exposed group, T-AOC, NOS, MDA levels in silicosis group significantly increased (P＜0.05 or P＜0.01). GSH-Px in dust-exposed group and silicosis group were (231.164±36.484) and (270.469±39.228)U/md, respectively which were significantly than that [(223.360±46.838) U/ml] in control group (P＜0.05 or P＜0.01), and there was significant difference of GSHPx between the silicosis group and the dust-exposed group significantly (P＜0.01). GSH-Px level [(290.750±39.129) U/ml] in Ⅲ phase silicosis group were significantly higher than those [(256.906±21.41) and (259.594±34.79) U/ml] in observation group and Ⅰ phase silicosis group (P＜0.05). NF-κB levels [(72.06±9.12) and (85.25±11.64) ng/L] in dust-exposed group and silicosis group were significantly higher than that [(59.71±9.27) ng/L] in control group (P＜0.01), and there was significant difference of between the silicosis group and the dust-exposed group (P＜0.01). There was a positive correlation between serum GSH-Px level and the silicosis stages (r=0.507,P＜0.0l). Also there was a positive correlation between NF-κB level and silicosis stages, age, GSH-Px or NO levels (r=0.376, 0.243, 0.233, 0.221, P＜0.01). Conclusion The imbalance of oxidative and anti-oxidation system and the activation of NF-κB are related with the occurrence and development of silicosis. The monitoring of oxidative stress indicators and NF-κB is beneficial to the prediction and prognosis assessment of silicosis.     

田间作业致有机磷农药中毒与口服中毒的临床比较

目的 探讨田间作业中毒和口服有机磷农药中毒在临床表现及治疗上的差异.方法 回顾性分析我院2007年7月至2010年7月收治的85例中、重度急性有机磷农药中毒患者的临床资料,按中毒途径分为口服组(51例)和非口服组(34例),比较不同途径中毒后的临床表现、治疗特点及预后.结果 口服组中度中毒患者的肌颤肌痉挛和共济失调的发生率(86.4%、90.9%)均明显高于非口服组(50.0%、55.0%),差异有统计学意义(P＜0.05,P<0.01);口服组重度中毒患者的肺水肿、肌颤肌痉挛及昏迷的发生率(100.0%、89.7%、93.1%)均明显高于非口服组(71.4%、64.3%、50.0%),差异有统计学意义(P<0.05 ).非口服组解毒时间[中度:(35.0±6.2)h、重度:(45.0±11.1)h]较口服组[中度:(49.0±7.7)h、重度:(77.0±10.3)h]明显缩短,差异有统计学意义(P＜0.05).治疗后24、48、72 h,中、重度非口服组胆碱酯酶活力明显高于口服组,差异有统计学意义(P<0.05或P<0.01);中、重度非口服组的氯磷定用量、阿托品化用量及阿托品总量明显低于口服组,差异有统计学意义(P＜0.05或P<0.01).结论 田间作业有机磷农药中毒在临床表现上与口服中毒不尽相同,且治疗的阿托品及氯磷定用量相对较少,胆碱酯酶活力恢复较快.

Abstract：

Objective To investigate the differences of clinical manifestation and therapy of organophosphorus pesticide poisoning (OPP) between oral exposure and occupational exposure in field work. Methods From July 2007 to July 2010, 85 patients with acute severe OPP were treated in a hospital, which were divided into oral poisoning group (51 cases) and non-oral poisoning group (34 cases). The differences of clinical manifestations, curative effects and prognosis between two groups were compared. Results The rates of myoclonus and ataxia in cases with moderate poisoning of oral poisoning group were 86.4% and 90.9%, which were significantly higher than those (50.0% and 55.0% ) of non-oral poisoning group (P<0.05 or P< 0.01). The rates of myoclonus, lung fluid and coma in cases with severe poisoning of oral poisoning group were 100.0%, 89.7% and 93.1%, respectively, which were significantly higher than those (71.4%, 64.3% and 50.0%) of non-oral poisoning group (P<0.05). The mean detoxification hours in cases with moderate poisoning and cases with severe poisoning of non-oral poisoning group were (35.0±6.2) and (45.0±11.1) hours which were significantly lower than those [(49.0±7.7) and (77.0±10.3) hours] in cases with moderate poisoning and cases with severe poisoning of oral poisoning group (P<0.05). In 24, 48 and 72 h after treatment, the cholinesterase (ChE) activities of non-oral poisoning group were higher than those of oral poisoning group (P< 0.05 or P<0.01). The used doses of pyraloxime methylchloride (PAM-Cl) or atropine and the used total dose of atropine in non-oral poisoning group were lower than those in oral poisoning group (P<0.05 or P<0.01). Conclusions The clinical manifestation of non-oral poisoning group is different from the clinical manifestation of oral poisoning group due to the high morbidity of OPP occurred at field site in summer. The used doses of atropine and PAM-Cl are less and the ChE activity recovers quickly for non-oral poisoning group.     

慢性胃炎与胃癌组织中微血管密度和黏附分子表达的对比研究

目的 探讨慢性胃炎与胃癌组织中微血管密度、黏附分子的表达及对比意义.方法 选取56例慢性浅表性胃炎患者(慢性浅表性胃炎组)、55例胃癌无淋巴结转移患者(胃癌无淋巴结转移组),57例胃癌有淋巴结转移患者(胃癌有淋巴结转移组)的病理组织蜡块,用免疫组织化学Envision法显示微血管密度CD34和细胞黏附分子Syndecan-1的表达情况,112例胃癌患者中高、中分化47例,低分化65例.结果 CD14表达以微血管密度计算:慢性浅表性胃炎组为(13 ± 10)个/高倍镜视野(HP),胃癌无淋巴结转移组为(27 ± 11)个/HP;胃癌有淋巴结转移组为(28 ±10)个/HP.慢性浅表性胃炎组与胃癌无淋巴结转移组及胃癌有淋巴结转移组比较差异有统计学意义(t=7.044、7.908,P＜0.05),胃癌无淋巴结转移组与胃癌有淋巴结转移组比较差异无统计学意义(t=0.506,P＞0.05.慢性浅表性胃炎组、胃癌无淋巴结转移组、胃癌有淋巴结转移组Syndecan-1阳性表达率分别为96.43%(54/56)、45.45%(25/55)、24.56%(14/57),慢性浅表性胃炎组与胃癌无淋巴结转移组及胃癌有淋巴结转移组比较差异有统计学意义(X2=163.560、17.197,P＜0.01).胃癌无淋巴结转移组与胃癌有淋巴结转移组比较差异有统计学意义(x2=5.340,P＜0.05).结论 微血管密度增加与胃癌的发生有关;细胞黏附分子syndecan-1表达下调与胃癌的发生、发展有关,并可能进一步促进胃癌转移,检测微血管密度CD34及细胞黏附分子Syndecan-1的表达变化情况有助于胃癌的诊断及预后判断.

Abstract：

Objective To investigate the clinical significance of the expression of microvessel density and adhesion molecules in the tissue of chronic gastritis and gastric cancer. Methods Fifty-six patients with chronic superficial gastritis (chronic superficial gastritis group), 55 cases of gastric cancer without lymph node metastasis (gastric cancer without lymph node metastasis group) and 57 patients with gastric cancer and lymph node metastasis (gastric cancer with lymph node metastasis group) were included in this study. Gastric pathology paraffin blocks was studied using immunohistochemical Envision method. Microvessel density CD34 and cell adhesion molecule Syndecan-1 expression was examined. In 112 gastric cancer patients, 47 patients were highly differentiated, and 65 patients were poorly differentiated. Results Microvessel density CD34 results:in chronic superficial gastritis group was (13 ± 10)/HP,in gastric cancer without lymph node metastasis group was (27 ± 11 VHP, in gastric cancer with lymph node metastasis group was (28 ± 10)/HP. There were significant differences between chronic superficial gastritis group and gastric cancer without lymph node metastasis group,and between chronic superficial gastritis group and gastric cancer with lymph node metastasis group (t = 7.044,7.908, P ＜0.05), but there was no significant difference between gastric cancer without lymph node metastasis group and gastric cancer with lymph node metastasis group (t = 0.506,P ＞ 0.05). In chronic superficial gastritis group, gastric cancer without lymph node metastasis group and gastric cancer with lymph node metastasis group, Syndecan-1 positive expression ratewas 96.43%(54/56),45.45%(25/55),24.56%(14/57),and there was significant difference between chronic superficial gastritis group and gastric cancer without lymph node metastasis group,and between chronic superficial gastritis group and gastric cancer with lymph node metastasis group (x2 = 163.560,17.197,P＜ 0.01). There was significant difference between gastric cancer without lymph node metastasis group and gastric cancer with lymph node metastasis group (x2 = 5.340, P ＜ 0.05). Conclusions Microvessel density is related with the occurrence of gastric cancer;adhesion molecule Syndecan-1 expression reduces the incidence of gastric cancer development, and might further promote the metastasis of gastric cancer. Detecting the expression changes of microvessel density CD34 and cell adhesion molecule Syndecan-1 facilitates the diagnosis and prognosis of gastric cancer.     

高压氧联合化疗对卵巢上皮性癌疗效研究

Objective To discuss the therapentic efficacy of hyperbaric oxygen combined with PC program in newly diagnosed epithelial ovarian cancer patients. Methods Fifty-eight patients with epithelial ovarian cancer were divided into two groups by random digits table: HBO group(30 cases) and PC group(28cases). HBO group were exposed to hyperbaric oxygen of 2 standard atmospheric pressure 60 min, then given chemotherapy 25-30 min after extravehicular: cyclophosphamide 1000 mg/m2 + cisplatin 75 mg/m2.PC group with the same regimen without hyperbaric oxygen therapy were analyzed. The two groups were compared in the efficacy and 3-year survival rate, progression-free survival and adverse reactions. Results The total effective rate, not controlled rate, recurrence rate,recurrence time, 3-year survival rate in HBO group [83.3%(25/30),6.7%(2/30),33.3%(10/30), (21.0 ± 0.8) months,43.3%(13/30)] were better than those in PC group [67.9% (19/28), 17.9% (5/28), 46.4% (13/28), (18.0 ± 0.6) months, 17.9% (5/28)] (P ＜0.05), progression-free survival and overall survival time in HBO group were longer than those in PC group (P ＜0.05) and adverse reactions rate in HBO group was lower than that in PC group (P ＜0.05).Conclusions The hyperbaric oxygen combined with PC programs are better than PC programs in advanced epithelial ovarian cancer chemotherapy response rate, progression-free survival time and 3-year survival rates in ovarian cancer adjuvant chemotherapy. HBO can significantly reduce the PC's hematological toxicity and toxicity of the digestive system.     

哺乳期瘢痕子宫早孕流产方式的临床研究

Objective To estimate abortion ways and announcements of early-staged gestation termination in lactation scarred uterus. Methods A retrospective analysis was made on clinical date of 312 early-staged gestation termination cases in lactation scarred uterus. These cases were divided into three groups based on abortion ways: induced abortion group (group A,92 cases), drugs abortion group (group B,98 cases), misoprostol combined uterine aspiration group (group C,122 cases). The abortive efficiency,operation time, operative bleeding, colporrhagia time, postoperative infection and drug adverse reaction were observed and compared. Results Complete abortion rates in group A (97.8%,90/92) and group C(99.2%,121/122) were significantly higher than that in group B (77.6% ,76/98),colporrhagia times in group A [(5.9 ± 1.1) d] and group C [(5.6 ± 1.2) d] were significantly lower than that in group B [(12.4 ± 1.8) d],postoperative infection and drug adverse reaction rate were lower in group A and group C, with significant difference compared to group B (P ＜ 0.05). The operation time was shorter, bleeding was less,third-grade pain rate was lower in group C, there was significant difference between group A and group C (P ＜ 0.05).Conclusions Misoprostol combined uterine aspiration terminated early-staged gestation in lactation scarred uterus is effective and safe, makes the operation easy and simple, decreases the blood loss. The influence to mother and infant is smaller, it is the best abortion style.     

血液灌流结合连续性静脉-静脉血液滤过对急性百草枯中毒疗效的研究

Objective To explore the therapic effects of hemoperfusion (HP) with continuous venovenous hemofiltration (CVVH) on the patients with acute paraquat poisoning. Methods Nighty-one patients with acute paraquat poisoning were randomly divided into HP group (49 cases) and HP-CVVH group(42 cases). The mortality, survival duration and the death causes between the two groups were compared and analyzed. Results There were no significant differences in mortality (59.2% versus 61.9%) between the two groups. The mean time between poisoning and death in HP-CVVH group was (4.9±3.1) days, which was significantly longer than that (3.5 ±2.0) days in HP group (P＜0.05).The death proportion on 4th day after poisoning in HP group was 62.1%(18/29), which was significantly higher than that (30.8%, 8/26) in HPCVVH group (P＜0.05). The hypoxia appeared in 4.3±2.5 days after poisoning in HP-CVVH group, which was significantly longer than that (3.2±1.9) days in HP group (P＜0.05). The mortality due to respiratory failure in HP group was 20.4%(10/49),which was significantly lower than that (40.5%, 17/42) in HP-CVVH group (P＜0.05). The incidence of acute renal failure in HP group was 63.3%(31/49), which was significantly higher than that (40.5%,17/42) in HP-CVYH group (P＜0.05). Conclusion The combined therapy of HP and CVVH can prevent the patients with acute paraquat poisoning from early death and prolong the survival duration, but can not reduce mortality for the patients with acute paraquat poisoning.     

三阴乳腺癌与非三阴乳腺癌预后的比较分析

Objective To assess whether survival differed among patients who had triple-negative breast cancers compared with patients who had non-triple-negative breast cancers.Methods The clinicopathologic data of 684 patients with operable breast cancer,who were treated with multimodal therapy from December 1998 to June 2007 were analyzed.Of these patients,107 cases were confirmed to have triple-negative tumor histology(triple-negative group),577 cases were confirmed to have non-triple-negative tumor histology(non-triple-negative group).The 7 years cumulative survival and disease-free survival were analyzed by Kaplan-Meier method and compared by Log-rank test.The prognosis Was analyzed by COX regression model.Results The 7 years overall survival rates for triple-negative group and non-triple-negative group were 51.4%(55/107),74.2%(428/577),respectively,there Was significant difference between the two groups(P＜0.01).However,the 7 years overall survival rates of patients with triple-negative group and those who with Her-2 positive were 51.4%(55/107)and 53.1%(43/81)respectively,there Was no significant difference between them (P＞0.05).Univariate analysis revealed that the factors affecting the disease-free survival included age,menopausal status,tumor size,lymph nodes metastasis,estrogen,progesterone,and Her-2 receptors status.Multivariate analysis showed minor size,lymph nodes metastasis,estrogen,progesterone,and Her-2 receptors status were independent prognostic factors.Conclusions This study has shown a trend towards a poorer outcome for patients with triple-negative breast cancer similarity to patients with Her-2 positive cancers.Triple-negative breast cancer is an independent predictor factor of survival.     

225例子宫内膜癌患者生存预后相关因素的分析

目的：探讨子宫内膜癌的预后及其相关因素,为子宫内膜癌的临床诊治提供参考。方法：回顾性分析2003年1月—2010年6月北京协和医院妇产科收治的225例子宫内膜癌患者的临床资料,计算生存率,Kaplan-Meier法筛选危险因素,用比例危险度回归模型（Cox回归）对危险因素进行多因素分析。结果：225例患者5年累积生存率为90.6%。单因素Kaplan-Meier分析显示,子宫内膜癌生存率与手术病理分期、组织学分级、肌层浸润深度、病理类型、术后辅助治疗、淋巴结转移和腹腔细胞学有关（P＜0.05）。各手术分期患者中,行淋巴结剔除者和未行淋巴结剔除者的生存率差异无统计学意义（P＞0.05）。早期子宫内膜癌患者术后接受辅助治疗和未接受辅助治疗的患者生存率差异无统计学意义（P＞0.05）。Cox回归行多因素分析显示,手术分期、病理类型、组织学分级是影响子宫内膜癌预后的独立危险因素（P＜0.05）,非子宫内膜样癌、手术病理分期晚和组织学分级差的患者预后差。结论：子宫内膜癌总体预后良好,手术分期晚、非子宫内膜样癌、组织学分级差是子宫内膜癌预后的独立危险因素,肌层浸润深度、腹腔冲洗液等与其预后无关。     

GnRH拮抗剂方案对新鲜移植周期子宫内膜容受性影响的回顾性分析

目的：通过回顾性分析应用促性腺激素释放激素激动剂（GnRHa）长方案或GnRH拮抗剂（GnRHA）方案进行体外受精-胚胎移植（IVF-ET）助孕的患者，比较2种方案的人绒毛膜促性腺激素（hCG）日子宫内膜厚度、临床妊娠率和胚胎着床率等相关指标，以期寻找GnRHA是否会对子宫内膜容受性产生影响的临床证据。方法：选择2015年1月-2017年6月于大连市妇女儿童医疗中心第一周期行IVF-ET助孕，应用GnRHa长方案（长方案组，1 459例）或者GnRHA方案（拮抗剂方案组，395例）的患者。比较2组患者的基本特征，根据年龄分为＜30岁组（352例），30～35岁组（781例），35～40岁组（601例）及≥40岁组（120例）；根据获卵数分为低反应组（获卵≤3枚，218例），正常反应组（获卵4～14枚，1 535例）、高反应组（获卵≥15枚，101例）；比较各组患者hCG日子宫内膜厚度、临床妊娠率、胚胎着床率、早期流产率。结果：长方案组与拮抗剂方案组患者的体质量指数（BMI）差异无统计学意义（P＞0.05），但年龄、不孕年限、基础卵泡刺激素（bFSH）、窦卵泡数（AFC）和平均移植胚胎数比较，差异有统计学意义（均P＜0.05）。＜30岁及≥40岁的人群，2种方案的hCG日子宫内膜厚度、胚胎着床率比较，差异无统计学意义（均P＞0.05），＜30岁人群长方案组临床妊娠率高于拮抗剂方案组（P＜0.05）。30～35岁及35～40岁人群，长方案组hCG日子宫内膜厚度、胚胎着床率和临床妊娠率高于拮抗剂方案组，差异有统计学意义（均P＜0.05）。在低反应组中长方案移植胚胎数少，胚胎着床率高，差异有统计学意义（均P＜0.05）。在正常卵巢反应组中，长方案hCG日子宫内膜厚度、胚胎着床率和临床妊娠率大于拮抗剂方案组，差异有统计学意义（均P＜0.05）。在卵巢高反应组2种方案各项指标比较差异无统计学意义（均P＞0.05）。结论：在30～40岁及正常卵巢反应人群拮抗剂方案可能降低子宫内膜容受性，减少胚胎着床率及临床妊娠率。 【关键词】     

子宫内膜癌组织中COX-2表达、血管生成和细胞增殖及其相互关系

目的探讨子宫内膜癌组织中环氧合酶-2(COX-2)表达、血管生成和细胞增殖及其相互关系。方法采用免疫组织化学S-P法,分别检测20例正常子宫内膜组织、20例子宫内膜癌前病变组织、60例子宫内膜癌组织标本中COX-2表达,并检测其微血管密度(CD34标记)和癌细胞增殖指数(Ki-67标记)。结果子宫内膜癌组织中COX-2阳性表达率、微血管密度及Ki-67指数均显著高于癌前病变及正常子宫内膜组织;COX-2的表达与组织学分级、病理类型有关,与肌层浸润深度、临床分期及有无淋巴结转移无关;微血管密度与组织分级、肌层浸润深度及有无淋巴结转移有关,与临床分期及病理类型无明显相关;Ki-67指数与组织分级、临床分期、肌层浸润深度及有无淋巴结转移有关,而与病理类型无明显相关;COX-2的表达阳性者其微血管密度值显著高于COX-2表达阴性者(P<0.01),而COX-2的表达阳性组织中Ki-67指数较阴性组织显著增高(P<0.01)。结论COX-2过度表达、肿瘤新生血管的形成及癌细胞过度增殖共同参与子宫内膜癌的发生、发展和转移,COX-2过度表达与子宫内膜癌组织新生血管的形成和细胞增殖有密切关系,三者可作为反映子宫内膜癌生物学行为的有效指标,为子宫内膜癌的临床预防、治疗及预后判断提供参考。     

子宫腺肌病合并子宫内膜癌的临床病理分析

目的 研究子宫腺肌病合并子宫内膜癌患者的临床病理特征,并比较子宫腺肌病合并子宫内膜癌患者与单纯的子宫内膜癌患者的高危影响因素及其对复发与预后意义.方法 对凉山州第二人民医院妇产科2005年2月至2015年7月期间治疗的307例子宫内膜癌患者的临床病理资料进行了回顾性分析,其中子宫腺肌病合并子宫内膜癌患者31例(A组,10.1％),其余276例为单纯的子宫内膜癌患者(B组,89.9％),比较两组患者手术病理分期、病理类型、肌层浸润深度、雌激素受体和孕激素受体的表达、细胞学分型、腹水细胞学、淋巴结转移,复发率、3年无病存活率、3年总存活率等资料.结果 A组相比于B组,其肌层深度浸润较浅、组织分化程度好、PR阳性检测率高、ER阳性检测率高、复发率低、3年无病存活率高、3年总存活率高,差异均具有统计学意义(x2值分别为4.065、6.285、4.480、6.813、4.98、12.45、17.87,均P＜0.05).两组患者手术病理分期、年龄、绝经率、体重指数、腹水细胞学阳性率、淋巴结转移及病理类型比较差异均无统计学意义(x2值分别为1.47、2.31、1.22、1.76、1.21、2.04、2.57,均P＞0.05).结论 子宫腺肌病合并子宫内膜癌可能为雌激素依赖性肿瘤,肌层浸润较浅,组织分化好,相较单纯的性子宫内膜癌患者其高危因素少.患者术后复发率低,3年无病存活率高,3年总存活率高,预后较好.     

P16蛋白和细胞周期素D1在子宫内膜癌中的表达及其临床意义

目的:探讨细胞周期素D1、P16蛋白在子宫内膜癌中的表达及其临床意义。方法:采用免疫组化法(SP法)检测CyclinD1、P16蛋白在52例子宫内膜癌和26例正常子宫内膜中的表达,并对比两者在子宫内膜癌不同的病理分级、肌层浸润、临床分期中的表达差异。结果:CyclinD1基因在子宫内膜癌组织中阳性表达率为55.8%(29/52),显著高于对照组的11.5%(3/26)(P<0.01)。子宫内膜癌CyclinD1阳性表达患者的肿瘤细胞分化程度低且多有肌层浸润。P16蛋白在内膜癌组阳性表达率为57.7%(30/52),显著低于对照组的88.5%(23/26),其在子宫内膜癌不同组织分化程度、不同临床分期及有无淋巴转移组间表达阳性率比较有统计学差异(P<0.05)。内膜癌组CyclinD1与P16协同异常表达率为30.8%,协同正常表达率为32.7%。经等级相关分析,CyclinD1与P16表达未见相关关系。结论:子宫内膜癌组织中P16蛋白和CyclinD1的表达异常,检测结果有助于分析子宫内膜癌的分化程度、转移侵蚀及预后。两者协同异常表达表明肿瘤发生是多因素、多步骤、多阶段、多种癌基因和抑癌基因参与的复杂病理过程。     

子宫内膜癌组织中叶酸受体α与CA125的表达及临床意义

目的：检测子宫内膜癌（EC）组织中叶酸受体α（FRα）和糖类抗原125（CA125）的表达,分析其在EC发生、进展和预后中的作用。方法：选取2015年7月—2018年12月我院收治的62例EC患者作为EC组,选取同期42例子宫内膜非典型增生患者为非典型增生组,42例正常子宫内膜患者为正常对照组。采用免疫组织化学方法测定对比3组子宫内膜组织中FRα、CA125的高表达率情况,并比较EC组患者不同肿瘤大小、分化程度、临床分期、淋巴结转移、肌层浸润深度者FRα、CA125的表达差异,观察EC组子宫内膜组织中FRα与CA125表达的相关性。同时对EC组中术后满1年患者共53例进行随访,分析组织FRα、CA125表达与EC患者术后1年复发率的关系。结果：EC组中FRα、CA125的高表达率均高于非典型增生组及正常对照组（P＜0.05）;EC组患者不同肿瘤大小、有无淋巴结转移者之间FRα、CA125的表达差异无统计学意义（P＞0.05）;肿瘤分化程度为G2～G3、临床分期为Ⅲ～Ⅳ期、肌层浸润深度≥1/2的EC组患者FRα、CA125高表达率均高于肿瘤分化程度为G1、临床分期为Ⅰ～Ⅱ期、肌层浸润深度＜1/2者（均P＜0.05）;经Spearman相关性分析证实,EC组患者子宫内膜组织中FRα与CA125表达呈正相关（rs=0.328,P=0.009）;EC组子宫内膜组织中FRα与CA125呈高表达者术后1年复发率与低表达者比较,差异无统计学意义（P＞0.05）。结论：EC组织中FRα、CA125均呈高表达且有相关性。可尝试检测FRα和CA125表达,作为EC病理诊断、恶性程度评价的指标。     

不同年龄阶段妇女子宫内膜癌的临床分析

目的分析不同年龄子宫内膜癌患者的临床病理特点及预后,探讨年轻患者的理想治疗方案。方法回顾分析本院2004年6月～2009年6月诊治的32例（年龄〈40岁）子宫内膜癌患者（研究组）和47例（年龄≥60岁）的子宫内膜癌患者（对照组）的临床病理资料及预后。结果研究组患者有高血压、糖尿病仅占6.2%,明显低于对照组（P〈0.05）,以异常阴道流血为主要症状,有子宫内膜癌家族史者为28.1%,高于对照组（P〈0.05）。早期（I期）病例较多,占84.4%,高于对照组（P〈0.05）。组织病理类型以子宫内膜样腺癌为主（93.8%）,非子宫内膜样腺癌少见,与对照组差异有显著性（P〈0.05）。组织学分级为高中分化者占93.8%,高于对照组（P〈0.05）。浸润肌层深度〈1/2或局限于内膜内者占71.9%,高于对照组（P〈0.05）。淋巴结转移率低。结论年轻子宫内膜癌患者以子宫内膜样腺癌为主,临床分期早,预后好,多数患者能够长期生存,治疗应遵循个体化、人性化的原则,保留其生育功能的手术可以尝试。     

cerbB-2、PCNA在子宫内膜癌中的表达及临床意义

目的探讨原癌基因人类表皮生长因子受体2（cerbB-2）、增殖细胞核抗原（PCNA）在子宫内膜病变中的表达及其临床意义。方法应用免疫组织化学SP法检测cerbB-2、PCNA在20例正常子宫内膜、20例子宫内膜非典型增生及66例子宫内膜癌中的表达,分析其表达及与临床分期、组织学分级、肿瘤肌层浸润相关性。结果cerbB-2、PCNA表达阳性率在正常子宫内膜、子宫内膜非典型增生与到子宫内膜癌的表达逐渐升高,正常子宫内膜和子宫内膜非典型增生分别与子宫内膜癌表达阳性率比较,差异均有统计学意义（χ2值分别为39．29、30．66、15．93、5．98,均P〈0．05）;随临床分期、肌层浸润、组织学分级的增高而升高,差异均有统计学意义（均P〈0．05）。结论cerbB-2、PCNA与子宫内膜癌的发生、发展及预后相关。     

人组织激肽释放酶4在子宫内膜癌中的表达和预后的关系

目的 探讨人组织激肽释放酶4（ KLK4）在子宫内膜癌中的表达和对预后的影响,为改善子宫内膜癌的预后提供新的思路。方法 免疫组化法检测81例子宫内膜癌、30例不典型增生的子宫内膜和30例正常子宫内膜中KLK4的表达情况,收集患者临床病理资料,结合随访资料做生存分析,并分析KLK4的表达和子宫内膜癌预后的关系。结果 KLK4在正常内膜、不典型增生内膜和子宫内膜癌中的高表达率分别为30％、53％、67％,差异有统计学意义（χ^212．059,P＝0．002）;KLK4的高表达和子宫内膜癌的分化程度及深肌层浸润相关（χ^2=7．985,P＝0．021;χ^2=4．629,P＝0．031）,与年龄、临床分期、淋巴结转移无关（χ^2分别为0．266、1．761、0．277,均P＞0．05）;KLK4高表达组的5年无进展生存率较低表达组更低,差异有统计学意义（P＝0．032）。结论 KLK4的高表达可能与子宫内膜癌细胞的分化和局部侵袭有关,其高表达提示早期复发,KLK4有可能作为预测子宫内膜癌早期复发的标志物。