新疆汉族和维吾尔族鼻咽癌组织的PCR和免疫组化检测比较

目的：了解新疆汉族维吾尔族（维）族鼻咽癌（ＮＰＣ）发病因素的差别。方法：用ＰＣＲ与免疫组化技术对７３例ＮＰＣ组织（汉族４１例,维族３２例）分别进行ＥＢ病毒脱氧核糖核酸（ＥＢＶ－ＤＮＡ）、ＥＢ病毒核抗原（ＥＢＮＡ２）、潜伏膜蛋白（ＬＭＰ－１）检测。     

鼻咽癌组织中程序性死亡配体-1的表达及其临床意义

目的:探讨程序性死亡配体-1(PD-L1)在鼻咽癌(NPC)中的表达及其临床意义.方法:采用免疫组织化学染色法检测59例NPC患者的癌组织和10例正常鼻咽黏膜组织中PD-L1的表达,RT-PCR技术检测30例NPC患者的癌组织及其中10例距离肿瘤组织3 cm以外的正常鼻咽黏膜组织中PD-L1mRNA的表达,并对其表达水平与临床病理组织学参数之间的关系进行相关性分析.结果:正常鼻咽黏膜组织中不表达PD-L1分子,而NPC癌组织中免疫组织化学PD-L1阳性表达率为67.8%(40/59),RT-PCR检测PD-L1mRNA的阳性表达率为66.7%(20/30).PD-L1的表达与肿瘤分期及淋巴结转移明显相关(P<0.05),但与患者的年龄、性别无明显相关(P>0.05).结论:PD-L1 NPC组织中的高表达,可能在肿瘤的发生、发展中起到一定的作用,有希望成为NPC免疫治疗的一个新靶点.     

咽拭子检测潜伏膜蛋白1在鼻咽癌诊断中的应用

目的：验证咽拭子法检测EB病毒（EBV）潜伏膜蛋白1（LMP1）在鼻咽癌诊断中应用的可行性;检测LMP1野生型及30bp缺失变异型在鼻咽癌中的分布情况。方法：用咽拭子法收集鼻咽癌组及对照组鼻咽部脱落细胞,微量提取DNA,经PCR扩增人β珠蛋白基因序列验证咽拭子法的可行性,用特异性引物扩增出特异的LMP1序列,验证其在鼻咽癌诊断中的意义。测序分析LMP1变异情况。结果：咽拭子合格率为96．4％,LMP1基因作为鼻咽癌的检测指标,灵敏度为91．7％,特异性为95．6％,其中变异型LMP1在鼻咽癌中的表达频率为80．6％,野生型为11．1％。结论：咽拭子法可作为一种基因检测手段,LMP1基因的检测可以协同EB病毒壳抗原（EBVCA）-IgA作为鼻咽癌诊断的辅助指标,在LMP1（＋）的鼻咽癌患者中LMP1—30bp缺失突变普遍存在。     

Prognostic factors in metastatic nasopharyngeal carcinoma

IntroductionNasopharyngeal carcinoma has the highest metastatic potential of all head and neck cancers. The survival time of patients with nasopharyngeal carcinoma has improved significantly in the last decades due to the use of combination of chemotherapy and radiotherapy, as well as advances in radiotherapy techniques. However, appropriately 30% of patients with nasopharyngeal carcinoma suffer a poor prognosis, mainly due to distant metastasis.ObjectiveThe study aimed to identify the survival and prognostic factors in metastatic nasopharyngeal carcinoma.MethodsA retrospective analysis was conducted in patients treated for synchronous metastatic nasopharyngeal carcinoma or metachronous metastatic nasopharyngeal carcinoma for 14 years (2003–2016). Overall survival was analyzed using the Kaplan-Meier method and compared using the log-rank test for the whole population and both groups of patients. Multivariate analysis was performed using the Cox model; p-values < 0.05 were considered to indicate statistical significance.ResultsOne hundred and twelve patients with metastatic nasopharyngeal carcinoma were included (51 patients with metastatic nasopharyngeal carcinoma, and 61 patients with metachronous metastatic nasopharyngeal carcinoma). In the whole population, the median overall survival was 10 months (1–156 months). In the multivariate analysis, female gender, poor performance status (WHO > 1) and metachronous metastasis were independent prognostic factors. In the metastatic nasopharyngeal carcinoma patients, the median overall survival was 13 months (1–156 months). In multivariate analysis, independent prognostic factors were non-oligometastatic disease, severe (G3?G4) chemotherapy toxicity and the lack of nasopharyngeal and metastatic site irradiation. In the metachronous metastatic nasopharyngeal carcinoma patients, the median overall survival was 7 months (1–41 months). In multivariate analysis, the poor performance status (WHO > 1) was an independent metastatic nasopharyngeal carcinoma prognostic factor.ConclusionOligometastatic patients with synchronous metastatic nasopharyngeal carcinoma had better survival. The locoregional treatment of primitive nasopharyngeal carcinoma improved survival in patients with metastatic nasopharyngeal carcinoma who responded to induction chemotherapy. Local irradiation of metastatic sites improved survival of metastatic nasopharyngeal carcinoma patients. Grade 3 or 4 chemotherapy toxicity altered survival among patients with synchronous metastatic nasopharyngeal carcinoma.     

青少年鼻咽血管纤维瘤45例临床分析

目的：探讨如何减少青少年鼻咽血管纤维瘤（JNA）术中出血量,以及如何防止术后肿瘤复发的措施与方法。方法：回顾性分析我科1980年2月～2001年12月间收治的45例男性青少年JNA患者的临床资料,将45例患者分为两组,实验组包括术前行颈外动脉结扎患者10例,数字减影血管造影（（DSA）血管栓塞术8例;对照组为术前未作任何血管处理的患者（27例）。手术进路经传统或改良的腭问、鼻侧切开及颅面联合进路。术后放疗6例。结果：全部患者术后均随访6～84个月。治愈36例,复发9例,复发率为20．0％,其中有6例经再次手术完全切除肿瘤,3例未完全切除肿瘤,术后追加放疗,随访1～3年无复发。术前颈外动脉结扎、血管栓塞组的术中出血量与对照组比较无统计学意义。结论：①手术进路依肿瘤分期选择,绝大部分手术可经传统或改良的经腭及鼻侧切开进路完成;②术前颈外动脉结扎及血管栓塞组的术中出血量与对照组比较差异无统计学意义;③术中出血量、术后复发与肿瘤分期有关;④肿瘤残瘤复发及晚期患者采用放疗是有效的辅助疗法。     

鼻咽癌放疗对前庭功能的影响

目的：观察鼻咽癌放疗对前庭功能的影响。方法：对２０例鼻咽癌患者行常规根治放疗,剂量为７０Ｇｈ,３例放疗量〉７０Ｇｙ。结果：９例（４５％）出现前庭功能异常,其中３例记录到自发性眼震;患者前庭功能减弱４例;双侧前庭功能减弱和双侧前庭功能丧失各２例。另１１例（５５％）前庭功能正常。结论：鼻咽癌放疗后可损害前庭,在进行职业鉴定时要考虑此因素,并应对前庭功能,听功能和咽鼓管功能分别予以评价。     

鼻咽癌放疗前后腭帆张肌横截面积的改变与放射性中耳炎的相关性

目的 探讨鼻咽癌放疗前后腭帆张肌横截面积的改变与放射性中耳炎的相关性。方法 回顾性分析苏州市吴江区第一人民医院2007年1月至2011年1月就诊的36例接受放射性治疗的鼻咽癌患者的临床资料,于放疗前后分别测量所有患者上腭帆张肌及翼内肌的横截面积,比较放疗前后的差异,并分析患者于放疗后发生放射性中耳炎与腭帆张肌受损之间的相关性。结果 放疗后共24例(44耳)并发分泌性中耳炎;放疗后STVP、SLTVP、SRTVP、SLTVPM、SRTVPM、SLTVPF、SRTVPF、SMP、SLMP及SRMP与放疗前相比明显下降(P<0.05);腭帆张肌萎缩耳中分泌性中耳炎的发生率明显高于腭帆张肌无萎缩耳者(72.92% vs 37.50%, χ2=8.445, P=0.004)。结论 放疗后鼻咽癌患者的腭帆张肌与翼内肌会发生萎缩,而放疗后分泌性中耳炎的发生与腭帆张肌的萎缩可能有一定的相关性。     

鼻咽癌组织中bcl-2基因断裂和bcl-2蛋白表达的检测及意义

为探讨ｂｌｃ－２基因与鼻咽癌发生的关系，采用分子原位杂交和免疫组化技术，检测４１例鼻咽癌组织中ｂｃｌ－２基因的两个断裂热点和蛋白表达。结果：４１例鼻咽癌发生ｂｃｌ－２基因表裂者４例，阳性率为９．８％，３４例出现ｂｃｌ－２蛋白阳性表达，阳性率为８２．９％；鼻咽良性病变阴性。ｂｃｌ－２基因断裂和蛋白表达与鼻咽癌组织学分级间无明显关系；ｂｃｌ－２蛋白表达与ｂｃｌ－２基因断裂间无相对应关系。提示：ｂｃｌ－     

Bacteriology of postradiotherapy chronic rhinosinusitis in nasopharyngeal carcinoma patients and chronic rhinosinusitis

The purpose of this study was to investigate and compare the bacteriology of postradiotherapy chronic rhinosinusitis (postRT-CRS) and chronic rhinosinusitis (CRS) by evaluating the aspiration materials of the maxillary sinus of patients with postRT-CRS and patients with CRS. We collected the secretions of the maxillary sinus from 30 nasopharyngeal carcinoma patients with postRT-CRS and 30 patients with CRS for aerobe/facultative anaerobe bacteria culture. The most common isolates in the postRT-CRS group were Streptocuccus viridans, Staphylococcus aureus and Haemophilus influenzae, while those in the CRS group were Haemophilus influenzae, Pseudomonas aeruginosa and Staphylococcus aureus. Isolated Gram-positive coccus rate in postRT-CRS patients was significantly higher than in CRS patients (62.50% compared with 30.00%, respectively; P < 0.05), and isolated Gram-negative bacilli rate in postRT-CRS patients was significantly lower than in CRS patients (31.25% compared with 70.00%, respectively; P < 0.05). However, the incidence of positive cultures was not significantly different between the postRT-CRS group and the CRS group (P > 0.05). This study found that there were some differences in bacteriology between postRT-CRS and CRS. Gram-positive coccus was the predominant aerobic/facultative anaerobe pathogenic bacterium in patients with postRT-CRS, and Gram-negative bacilli was predominant in CRS patients.     

放大喉镜在鼻咽部检查中的应用

目的 评价放大喉镜在鼻咽部检查中的应用价值.方法 对耳鼻咽喉科就诊的6774例患者施行放大喉镜下鼻咽部检查,连接影像工作系统记录图像文字资料,可疑病变在放大喉镜或鼻内镜直视下取活检.结果 患者对放火喉镜的耐受率98.9%(6700/6774)明显优于间接鼻咽镜30.9%(2095/6774),差异有统计学意义(X~2=6872.75,P＜0.005).放大喉镜可清晰呈现鼻咽部多种病变,能及早发现可疑病变.615例曾分别用纤维鼻咽镜(192例)及鼻内镜(423例)检查显示鼻咽部隆起,放大喉镜检查发现其中418例双侧对称,表面光滑,未见异常,经病理检查证实为正常组织;其他197例于放大喉镜下也显示为鼻咽部隆起,经病理检查证实为各种良恶性病变.结论 放大喉镜检查光亮度强,分辨率高,能早期发现鼻咽部病变,诊断准确率和活检阳性率较高,对鼻咽部疾病诊断具有重要价值.     

人类鼻咽癌端粒酶活性的研究及其临床意义

目的　探讨端粒酶在鼻咽癌中的表达及其临床意义。方法　采用TRAP 银染法对 42例鼻咽部低分化鳞状细胞癌、10例鼻咽部正常粘膜和 8例鼻咽纤维血管瘤进行端粒酶活性检测及血清VCA/IgA检测 ,并分析其与临床病理的关系。结果　鼻咽部正常粘膜和鼻咽癌端粒酶阳性率分别为 2 0 %和 88.1% ,8例鼻咽纤维血管瘤均未检测到端粒酶活性。鼻咽癌伴颈部淋巴结转移者端粒酶阳性率高于无颈部淋巴结转移者 (P =0 .0 35 ) ,临床晚期 (III、IV)端粒酶阳性率高于临床早期 (I、II) (P=0 .0 48) ,而端粒酶与鼻咽癌患者的年龄、性别及远处转移均无明显相关性 (P >0 .0 5 )。鼻咽癌患者血清EB病毒VCA/IgA阳性率明显高于鼻咽粘膜正常者 (P <0 .0 0 1)。结论　端粒酶活性表达在鼻咽癌发病机制中起着重要作用。端粒酶活性结合血清EB病毒抗体的检测有利于鼻咽癌的早期诊断。     

重组人p53腺病毒注射液（今又生）联合放疗治疗复发性鼻咽癌疗效观察

目的 观察重组人p53腺病毒注射液联合放疗治疗复发性鼻咽癌的疗效及不良反应。方法 以我院2005年1月至2006年12月期间收治的30例复发性鼻咽癌患者为研究对象。用非随机分组法将研究对象分为两组：实验组（15例）,采用重组人p53腺病毒注射液肿瘤局部多点注射联合放疗;对照组（15例）,采用经典放化同步治疗,分别于首次治疗后8周、6月、12月各随访1次,观察两组的疗效差异。通过CT测量肿瘤最大长径以确定肿瘤大小变化,并采用卡氏评分法评估患者生存质量。结果 重组人p53腺病毒注射液联合放疗对复发性鼻咽癌疗效满意,治愈率达20%,临床获益率为100%,除发热外,无其他严重不良反应,疗效及患者生存质量均明显优于放化同步治疗。结论 重组人p53腺病毒注射液联合放疗治疗复发性鼻咽癌安全、有效。     

Tiam1基因表达与鼻咽癌浸润转移的关系

目的:探讨Tiam1基因表达与鼻咽癌浸润转移的关系。方法:应用RT-PCR技术,对41例鼻咽癌组织和20例正常鼻咽部组织进行Tiam1mRNA表达水平的检测。结果:41例鼻咽癌组织的Tiam1mRNA平均表达水平(1.83±0.73)明显高于正常鼻咽部组织(0.87±0.45)(P<0.01);鼻咽癌组织中Tiam1mRNA高表达率与临床分期、T分级呈正相关;有淋巴结转移者Tiam1mRNA高表达率为59.3%(16/27),无淋巴结转移者为21.4%(3/14),二者之间差异有统计学意义(P<0.05)。结论:Tiam1基因在鼻咽癌组织中的表达明显高于正常鼻咽部组织,其过表达与鼻咽癌浸润转移呈正相关。     

A lack of association between p53 mutations and recurrent nasopharyngeal carcinomas refractory to radiotherapy

OBJECTIVE: The object of this study was to determine the incidence of p53 mutation in recurrent nasopharyngeal carcinoma refractory to radiotherapy. STUDY DESIGN: Prospective study. METHODS: There were 31 patients enrolled in this study between 1995 and 1998. All patients had received radiotherapy but none of them had undergone chemotherapy or local salvage surgery previously. RESULTS: The p53 status of each tumor was analyzed by polymerase chain reaction and by sequencing of exons 5 to 8 (codons 126-306). Five (16.1%) of 31 patients had mutations in the p53 gene, of which 2 were non-sense mutations, 2 were transition mutations, and 1 was a frameshift deletion mutation. The majority of the p53 mutations were found in exon 5. There is no significant difference in the incidence of p53 mutation compared with that of the previous reports for the primary disease. Based on the clinicopathologic data, there was no specific difference found between these 5 patients and the others. CONCLUSIONS: This study shows that p53 mutation is an infrequent event and may have no essential role in recurrent nasopharyngeal carcinomas.     

鼻咽癌患者P~(16)/MTS_1抑癌基因失活研究

目的：以原发性鼻咽癌（NPC）患者为研究对象,检测鼻咽癌组织中P16／MTSI抑癌基因失活情况;研究鼻咽癌发生发展规律。方法：采用PCR、多重PCR、限制性内切酶解一PCR方法对34例鼻咽癌患者和34例非肿瘤（腺样体增殖及慢性炎症）患者,进行P基因纯会缺失和异常甲基化检测。结果：34例NPC患者纯缺失率为8．82％（3／34）,异常甲基化率为38．24％（13／34）,34例非肿瘤患者纯缺失未检出（0／34）,异常甲基化率为8．82％（3／34）。结论：本研究鼻咽癌患者P16／MTSI抑癌基因总失活率为47．06％（16／34）,表明P16基因失活在鼻咽癌患者中是较为常见的基因变化。鼻咽癌患者中甲基化异常是P16基因失活的另一重要途径,值得引起重视。     

癌-睾丸抗原SCP-1 mRNA在人鼻咽癌中的表达

目的：从基因水平了解癌-睾丸抗原SCP-1在人鼻咽癌（NPC）的表达情况。方法：用逆转录-聚合酶链反应（RT—PCR）技术,检测28例NPC组织和40例非癌鼻咽部组织SCP-1 mRNA的表达。随机抽取SCP-1表达阳性的PCR产物进行DNA测序并结合临床指标进行统计学处理。结果：SCP-1 mRNA在NPC的表达率为14．3％（4／28）,在非癌鼻咽部组织无表达;测序结果表明PCR扩增产物序列与目的基因序列相符;SCP-1 mRNA的表达率与NPC患者的年龄、性别和血清抗EB病毒水平无相关性（P〉0．05）。结论：SCP-1 mRNA在NPC组织中有表达,提示SCP-1可能是一种新的NPC肿瘤靶抗原。     

放射性鼻窦炎的手术治疗

目的探讨鼻内镜下手术治疗鼻咽癌(NPC)放射治疗后放射性鼻窦炎的疗效。方法笔者对2005年9月～2008年9月收治的经保守治疗无效的37例放射性鼻窦炎患者(放疗后10个月至8年)行鼻内镜手术治疗,术后随访12～36个月,观察其疗效。结果 37例NPC放射治疗后鼻窦炎患者治愈15例(40.5%),有效20例(54.1%),无效2例,总有效率为94.6%。结论对保守治疗无效的放射性鼻窦炎患者行鼻内镜手术是一种行之有效的治疗方式。     

环氧化酶-2蛋白在鼻咽癌组织中的表达

目的 探讨环氧化酶-2（COX-2）蛋白在鼻咽癌组织中的表达及其临床意义。方法 应用免疫组织化学方法检测45例鼻咽癌组织及20例鼻咽黏膜不典型增生组织中COX-2的表达。结果 鼻咽癌组织中COX-2蛋白阳性表达率为71．1%（32／45），鼻咽黏膜不典型增生中COX-2蛋白阳性表达率为10．0%（2／20），两者比较差异具有统计学意义（P〈0．001）。结论 COX-2蛋白在鼻咽癌组织中表达增高，表明COX-2可能在鼻咽癌的发生发展中起重要的作用。     

Nasopharyngeal carcinoma: our experience

The objectives of our study were to characterize nasopharyngeal carcinoma patients in the Portuguese Institute of Oncology Hospital in Lisbon (IPOLFG) and identify the main factors that interfere with patients survival rate. We performed a retrospective study involving 157 patients (65% male and 35% female) between the years 2000 and 2005, and a histological classification according to Health World Organization. We constructed a Kaplan–Meier survival curve for the studied patients and evaluated the significance of the different studied factors with a Pearson correlation study. With an average age of 53 years, most of the carcinomas were type III (58%), followed by type II (30%) and at last type I (8%). Fifty-one of carcinomas were in stage IV at time of diagnosis. Ninety-five patients (60%) had remission. Five-year actuarial survival rate of all patients was 65.1%. There was a significant difference (P = 0.033) in the actuarial survival rate of staged IV patients treated with adjuvant chemotherapy. Undifferentiated nasopharyngeal carcinoma is the most frequent type in our geographic area. Chemotherapy improves survival rate, mainly in late stages.     

鼻咽癌放疗后长期存活者的听力观察

目的了解鼻咽癌放疗后长期存活者的听力情况。方法对126例(252耳)鼻咽癌放疗后存活5年以上的患者进行纯音听阈、声导抗测试,耳、鼻咽部CT及耳内窥镜检查,对结果进行分析。结果 126例中,放疗后有听力损失87例172耳,占69.05%,其中感音神经性聋26例51耳,占29.89%(26/87),传导性聋5例9耳,占5.75%(5/87),混合性聋56例112耳,占64.37%(56/87);CT示中耳乳突炎121耳(70.35%,121/172);耳内窥镜检查所有鼓膜均浑浊内陷,无穿孔。结论鼻咽癌放疗后长期存活者听力损失的发生率高,以混合性听力损失发生率最高,感音神经性次之,传导性最低。