吸烟、职业、膳食与肺癌的前瞻性研究

在1965年～1968年间,7961名日籍美国男子接受了检查和访视,以他们为对列进行了肺癌研究。收集了他们的吸烟史,职业及膳食状况等材料。22年后,其中的227人被诊断为肺癌患者。吸烟明显增大了患肺癌的危险性、显著性,与从不吸烟的人相比,吸烟者患肺癌的相对危险度(用RR表示)曾吸烟者为3.1,而现吸烟者为11.4。我们按组织学类型将肺癌病例区分开,发现现吸烟者中患鳞状小细胞肺癌的相对危险度为16.0,而患腺癌的相对危险度是6.8。不熟练的手工业者患肺癌的相对危险度(RR=1.5;95％置信区间(95％CI)为1.1-2.2)比非手工业者要高。肺癌与人们每天膳食中摄入的总热量、蛋白质、脂肪、胆固醇、糖类及酒无关。但这一结果可能是24小时膳食回顾调查表的缺陷所致。     

CYP2D6基因G4268C单核苷酸多态性与肺癌遗传易感性

目的:研究CYP2D6(cytochromes P450 2D6)基因G4268C单核苷酸多态性与肺癌遗传易感性的关系.方法:应用病例-对照研究及聚合酶链反应-限制性片段长度多态性分析(PCR-RFLP)方法检测肺癌患者和按性别、年龄频数匹配的正常对照各118例的CYP2D6基因G4268C多态性,并应用Logistic回归分析各基因型与肺癌发病危险的关系.结果:肺癌组和对照组人群发生G4268→C的频率可高达69.49%和75.00%;非C4268/C(即G4268/G G4268/C)基因型与肺癌风险升高相关,经年龄、性别、吸烟情况调整OR=1.80(95%CI=1.06～3.06),尤其在腺癌中OR=2.95(95%CI=1.39～6.23);对吸烟情况进行分层分析并经年龄、性别调整后发现,不吸烟者及轻度吸烟者中携带非C4268/C基因型的个体患肺癌的风险显著增高,其OR值分别为2.12(95%CI=1.03～4.36)和3.75(95%CI=1.15～12.22).结论:CYP2D6 C4268/C基因型可能是肺腺癌的遗传保护因素,并可降低不吸烟者、轻度吸烟者患肺癌的危险度.     

热休克蛋白70-hom基因+2 437(T/C)位点基因多态性与肺癌的关系

目的:研究热休克蛋白(HSP)70-hom基因+2 437(T/C)单核苷酸多态性与肺癌遗传易感性的关系,探讨肺癌易感的HSP70-hom基因型.方法:应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法检测159例肺癌患者和202名正常对照人群HSPT0-hom基因+2 437(T/C)位点多态性,采用病例.对照研究分析其与肺癌的关系.结果:病例组与对照组之间HSP70-hom各基因型(TT、TC和CC)频率及T和C的等位基因频率分布,差异均有统计学意义(P<0.05).对病理类型分层分析并经年龄、性别、吸烟状况、饮酒史和肿瘤家族史调整后发现,非TT基因型携带者患肺鳞癌危险性是TT基因型携带者的2.17倍(95%CI:1.17～4.00).对吸烟状况进行分层分析并经年龄、性别、饮酒史、肿瘤家族史调整后发现,吸烟者及重度吸烟者中非TT基因型调整OR值分别为5.19(95%CI:1.57～17.19)和9.23(95%CI:2.52～33.84),与肺癌有强关联,提示TT基因型是吸烟者特别是重度吸烟者的保护因素.结论:HSP70-hom基因+2 437(T/C)位点TT基因型可能是肺鳞癌的遗传保护因素,并可降低吸烟者特别是重度吸烟者患肺癌的危险度.     

白细胞介素-10-592C/A基因多态性与非小细胞肺癌易感性的关系

目的 研究白细胞介素-10-592C/A基因多态性与中国汉族人群非小细胞肺癌遗传易感性之间的相关性.方法 应用PCP-RFLP技术检测116例中国汉族非小细胞肺癌患者和120例健康人的白细胞介素-10-592C/A多态性的分布频率,并分析了这种基因多态性与中国汉族人群非小细胞肺癌遗传易感性之间的相关性,以及与吸烟在非小细胞肺癌易感性中的交互作用.结果 在不吸烟人群中,与携带A/A基因型相比,携带C/C基因型者患非小细胞肺癌的风险会增加,其校正OR值为3.15(95%CI:1.30～7.72,P<0.01).以携带A/A基因型且不吸烟者作为参照,吸烟指数>400且携带A/A基因型或C/A基因型者患非小细胞肺癌的风险均会提高,其校正OR值分别为2.61(95%CI:1.53～4.23,P<0.01)、2.41(95%CI:1.35～4.25,P<0.01).结论 IL-10-592C/A基因多态性多态性可能对非小细胞肺癌易感性产生影响,并可能与吸烟有一定的协同作用.     

GSTM1基因缺失及吸烟与非小细胞肺癌的易感性

目的:探讨谷胱甘肽硫转移酶μ基因(GSTM1)缺失与肺癌遗传易感性的关系.方法:采用病例对照研究方法和PCR检测手段分析GSTM1基因缺失在213例病例和199例对照中的分布情况,并分析其与吸烟共同作用在肺癌发生中的作用.结果:GSTM1基因缺失率在肺癌病例组为61%,对照组为48%,OR=1.7(95%CI1.2～2.5),P=0.007.吸烟组肺癌患者与非肺癌患者相比,GSTM1基因缺失的OR=1.9(95%CI1.2～3.0),P=0.011.吸烟量≥30包×年的OR=5.9(95%CI2.6～13.0),P<0.01.结论:GSTM1基因缺失是肺癌发生的重要危险因素,吸烟与GSTM1基因缺失联合作用可增加患肺癌的风险,并有显著的剂量效应关系.     

肺癌患者外周血白细胞端粒DNA相对长度检测

目的:探讨外周血白细胞端粒DNA相对长度与肺癌的关系。方法:采用SYBRGreenⅠRealTimePCR方法检测54例肺癌患者(病例组)和77例健康对照(对照组)外周血白细胞端粒DNA的相对长度。结果:病例组外周血白细胞端粒DNA的相对长度为(3.43±0.87),短于对照组(3.86±1.46),差异有统计学意义(t=2.093,P=0.038)。进一步应用logistic回归分析,把端粒长度按百分位数P33和P66从短到长依次分为T1、T2、T3三层,调整吸烟与年龄因素后,以T3层为参考水平,结果显示T2层患肺癌危险度为3.933(95%CI1.139～13.580),T1层患肺癌危险度为4.684(95%CI1.377～15.936),P<0.05。结论:端粒DNA相对长度缩短可能与肺癌的发生有关。     

芳烃羟化酶与肺癌的遗传易感性研究

目的：探讨芳烃羟化酶（ＡＨＨ）与肺癌遗传易感性的关系。方法：采用ＡＨＨ直接测定法检测肺癌患者４０例、肺癌患者亲属２６例及健康人４５例血液淋巴细胞中ＡＨＨ的诱导力。结果：①肺癌组及肺癌患者亲属（一级亲属２４人，二级亲属２人）高ＡＨＨ诱导力型升高（２２．５％，１５．４％），肺癌组高ＡＨＨ诱导力型与对照组（６．７％）相比有上升趋势（Ｐ＝０．１２，χ＾２检验）。②不吸烟者中，肺癌组、肺癌患者亲属及对照组高     

吸烟与胃癌关系的Meta-分析

目的探讨吸烟与胃癌的关系。方法运用Meta分析技术进行综合定量分析,并按研究类型(病例对照和队列研究)和性别(男、女)分层进行合并分析。根据资料一致性检验,采用随机效应模型(D-L法)计算合并相对危险度(RR)及其95%的可信区间(95%CI)。结果吸烟与胃癌之间总合并RR为2.14(95%CI:1.12～4.06),男性吸烟与胃癌之间总合并RR为1.70(95%CI:1.34～2.14),女性吸烟与胃癌之间总合并RR为1.83(95%CI:0.10～33.09)。结论吸烟是胃癌发病的危险因素之一,男性吸烟可能增加患胃癌的危险性,女性吸烟与胃癌的关系还需进一步研究。     

食管及贲门癌变患者亚甲基四氢叶酸还原酶、胸腺嘧啶合成酶基因多态性分析

目的:探讨血清叶酸代谢关键酶亚甲基四氢叶酸还原酶(MTHFR)与胸腺嘧啶合成酶(TS)基因多态性与食管及贲门癌易感性的关系.方法:选取安阳地区病理证实的275例食管鳞癌(SCC)及129例贲门腺癌(GCA)患者和315例年龄性别与其匹配的正常对照人群,采用PCR基础上的限制性片段多态检测法(PCR-RFLP)对其NTHFR和TS各基因型进行分析.结果:①对照组MTHFR677 CC、CT及TT基因型的分布频率分别为24%、45%和31%;SCC组分别为19%、38%和43%;GCA组分别为19%、35%和46%.对照组TSER3R/3R(4R)、2R/3R及2R/2R基因型的分布频率分别为64%、34%和2%;SCC组分别为62%、35%和4%;在GCA组,分别为63%、30%以及7%.②与MTHFR677 CC及MTHFR677 CT两基因型相比,TT携带者患SCC的危险度升高1.62倍(OR=1.62,95%可信区间(CI)为1.15～2.30,P=0.006),而GCA OR=1.81(95%CI为1.17～2.81,P=0.008).③与其他基因型相比,纯合突变型(TSER 2R/2R)患SCC的危险度升高2.44倍(OR=2.44,95%CI为0.89～6.73,P=0.084),患GCA的危险度升高3.94倍(OR=3.94,95%CI为1.29～12.0,P=0.016).④相对于无基因突变者,仅有MTHFR677 TT者患SCC的危险度升高1.60倍(95%CI为1.13～2.28),患GCA的危险度升高1.84倍(95%CI为1.17～2.88),仅有TSER 2R/2R者患SCC的危险度升高1.89倍(95%CI为0.62～5.79),差异无统计学意义,但患GCA的危险度升高3.56倍(95%CI为1.03～12.3),双突变型组合(MTHFR677 TT和TSER 2R/2R)携带者在SCC组中占1.5%,在GCA组中占3.1%,在对照组中未检测到.结论:突变型MTHFR677 TT及TSER 2R/2R增加安阳地区人群SCC与GCA的易感性,当二者共同存在时,肿瘤的易感性更高.MTHFR与TS基因多态的存在可能是SCC与GCA地理分布一致性的遗传学基础之一.     

社区人群吸烟和肥胖交互作用与高血压的关联分析

目的:探讨体重异常?腹型肥胖?吸烟与高血压之间的关联以及两者之间的交互作用对高血压的影响?方法:调查对象资料来自2012年常州市钟楼区社区诊断资料,共7 437例18岁以上对象被纳入本研究?运用Logistic回归模型分析腰围(WC)?体质指数(BMI)和吸烟及其交互作用与高血压发病的关系,采用Andersson等编制的Excel表计算相对超额危险度比(RERI)?归因比(AP)和交互作用指数(SI)等相加交互作用指标,并估计可信区间?结果:调整性别?年龄?饮酒?高血压家族史?职业?饮食等因素后,与BMI正常组相比,BMI异常组发生高血压的OR(95%CI)分别为2.75(2.46~3.12);腹型肥胖人群发生高血压的OR(95%CI)为2.41(2.13~2.71);与不吸烟人群相比,吸烟人群发生高血压的OR(95%CI)为1.37(1.16~1.63)?交互作用分析中,与不吸烟的非腹型肥胖人群相比,吸烟的腹型肥胖人群发生高血压的OR(95%CI)为3.66(3.07~4.36),不吸烟的腹型肥胖人群发生高血压的OR(95%CI)为2.01(1.78~2.03),吸烟的非腹型肥胖人群发生高血压的OR(95%CI)为1.47(1.26~1.71)?交互作用指数SI为1.80(1.35~2.38),RERI为1.18(0.57~1.79),AP为0.322?结论:吸烟人群患高血压的风险显著高于非吸烟人群;另外,吸烟与腹型肥胖之间存在显著的交互作用?     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.