超声引导经皮集束电极射频消融冶疗中小肝癌

目的：探讨超声引导经皮集束电极射频消融(RFA)治疗中小肝癌(直径≤5cm)的疗效。方法：利用RF-2000^TM肿癌射频治疗系统，在B超引导下对29例中小肝癌患者34个肿块进行经皮肝穿刺射频热凝冶疗，并用B超及CT检查以了解RFA治疗效果，随访观察其复发和生存情况。结果：RFA治疗后93．3％(28／30)的肿块血供消失(另4个直径≤3cm的肿块治疗前即无血供)，且94．1％(32／34)的肿块呈完全凝固性坏死。对有血供的2个肿块再次进行了RFA治疗。随防6月～3年，29例中现存活25例，半年生存率100％。存活的25例中，已有6例生存半年，7例生存1年，7例生存2年，5例生存3年。结论：集束电极RFA治疗中小肝癌创伤小，安全，疗效可靠。     

射频消融治疗肝癌31例临床分析

采用RF2000^TM型射频治疗仪及集束电极针,在B超引导下经皮或开腹直视下行射频消融（RFA）治疗肝癌患者31例。31例患者共43个肿块,完成36次治疗,平均1.16次。治疗效果采用术后2周-6个月超声、增强CT或MRI检查。结果本组肿瘤完全消融（CA）62.8%,其中肿瘤≤3 cm者85.7%（18/21）,3.1-5 cm者77.7%（7/9）,5 cm以上者15.4%（2/13）;随访3-29个月,局部复发32%,远处转移43%,术后常见并发症主要为肝区疼痛、发热、肝功能损伤,无射频治疗相关的死亡。提示RFA是一种安全有效治疗肝癌的方法。     

经皮射频消融治疗肝脏肿瘤近期疗效观察

目的：探讨经皮射频消融(PRFA)对肝脏恶性肿瘤的治疗效果。方法：利用RF—2000^TM肿瘤射频治疗系统，在B超或CT引导下对55例肝恶性肿瘤患者73个肿块进行经皮肝穿刺射频热凝治疗，并用B超及CT检查以了解PRFA治疗效果。结果：PRFA治疗后60．9％(42／9)的肿块血供消失，61．6％(45／73)的肿块呈完全凝固性坏死。其中直径小于3cm中的20个肿块(另4个治疗前即无血供)全部血供消失(100％)，24个肿块呈完全凝固性坏死(100％)；直径为3-5cm的18个肿块中16个血供消失(88．9％)，14个完全凝固性坏死(77．8％)；而直径大于5cm的肿瘤则治疗后肿块血供完全消失及完全凝固性坏死率均显著降低。肿瘤直径小于5cm的患者生存期较长。结论：集束电极PRFA治疗肝脏恶性肿瘤创伤小，安全，疗效可靠。肿瘤越小治疗效果越好。     

中晚期原发性肝癌患者的集束射频治疗

目的:了解在超声引导下集束射频(RF)治疗中晚期原发性肝癌的疗效。方法:对58例原发性肝癌(PHC)患者接受RF治疗前后肿瘤大小、AFP值、肿瘤血供以及超声情况进行调查。结果:58例PHC于治疗1周后超声检查提示72.2％的患者肿块缩小30％以上,1个月后复查缩小40％以上。所有病例肿块内的血供消失。AFP值下降者占66.5％。其中6例随访3年肿块缩小均在80％以上,AFP均维持在正常值。结论:RF治疗中晚期PHC的近期疗效优于其他治疗方法。     

集束射频治疗肝癌36例疗效分析

了解集束射频治疗（RF）肝癌的近期疗效。检查36例原发性肝癌（PHC）患者接受RF治疗前后肿瘤大小、AFP值、肿瘤血供以及超声情况。超声检查提示，36例PHC中有26例治疗一周后肿块缩小30%以上。一个月缩小40%以上。所有病例肿块内的血供消失。治疗一个月后AFP值下降400mg/L以下者A组占66.5%，B组占59.8%。RF治疗中晚期PHC的近期疗效较其他治疗好。     

超声引导下射频治疗肝癌的临床观察

目的:探讨射频毁损治疗肝癌的临床疗效。方法:对156例肝癌患者行超声引导下射频毁损治疗,观察治疗前后癌肿超声和CT的图像、大小,患者体重和自觉症状的改变及并发症等。结果:所有病例治疗后肿块缩小,其中5例完全消失。声像图显示肿瘤治疗区由稍高回声向低回声或无回声转变,病灶内血流信号消失或减少;CT检查提示治疗区内无强化。272个病灶未见原位复发,复发率为2.86％。85％患者体重增加,食欲改善。无严重并发症发生。结论:射频毁损疗法是肝癌局部非手术治疗的一种有效方法。     

CT引导经皮肝穿射频治疗肝癌

研究集束电极射频 (radiofrequency ,RF)治疗肝癌的方法及疗效。在CT引导下将中空金属钛多极穿刺针经皮直接穿刺置入瘤体 ,分点一次或多次对瘤体进行射频治疗 ,术中直视肿瘤射频治疗后的图像及CT值 ,术后观察患者的瘤体血供情况、肿瘤大小及AFP值的变化。瘤体直径 <5cm的肝癌 ,术后 1- 5个月大部分瘤体血供消失 ,瘤体缩小 ,瘤体直径 >5cm的肝癌 ,配合介入栓塞治疗 ,多数瘤体缩小。CT引导多弹头射频治疗肝癌定位准确 ,近期疗效安全有效     

CT引导下经皮射频毁损治疗肺肿瘤近期疗效观察

为观察CT引导下经皮射频毁损治疗肺肿瘤的近期疗效，并探讨其治疗机理、优点及适应症，应用RT－2000型射频治疗仪、Leven多弹头射频电极，于CT引导下经皮穿刺毁损，对30例肺肿瘤患者进行50次治疗；分别观察其毁损范围、肺功能及并发症情况。结果显示，原发性肺癌直径＜5cm者，1次治疗完全毁损率为50％，2次治疗完全毁损率为18.75%，总毁损率为68.75%；肿瘤直径5－10cm者，1次完全毁损率为14.29%，2次完全毁损率为42.86%，总毁损率为57.14%；其余11例经2次治疗肿瘤组织部分或大部分毁损。并发症发生率为16.67%。表明经皮射频毁损治疗肺肿瘤是一种安全有效的治疗方法；大部分患者治疗后肿瘤组织可安全毁损，少部分患者治疗后肿瘤组织明显减小。     

腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用

目的:探讨腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用.方法:2007-09/2008-11我院对25例肝癌患者的43个肝内肿瘤在腹腔镜超声和经皮超声引导下行射频消融治疗.肿瘤直径2.7-7.5(平均3.8)cm.本组中,HBV(+)14例,HCV(+)2例,合并有不同程度肝硬化16例,胆囊结石13例.其中1个癌灶14例,2个癌灶3例,3个癌灶4例,4例多发.术后采用超声检查及螺旋CT增强扫描评价RFA疗效.结果:25例患者顺利完成腹腔镜超声引导下射频消融治疗,有4例射频治疗部位复发和3例肝内新发病灶又采取经皮超声引导下射频消融治疗.全部病例中,11例同时行胆囊切除术,在腹腔镜超声引导下,单个肿瘤平均射频治疗时间为39.3±12.1 min,平均总手术时间95.5±25.8 min,平均总出血量148.5±84.3 mL.在经皮超声引导下,单个肿瘤平均射频治疗时间28.3±10.3 min,平均总手术时间50.2±11.5min,治疗后超声检查肝周、腹腔未见明确积液.患者术中、后均未出现严重并发症.术后随访,有3例CT提示原发性肝癌复发,外科医生建议行肝移植,其余22例随访至2008-11均存活.结论:腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用,使患者的远期疗效比较满意.     

原发性肝癌

原发性肝癌术后复发的射频和无水酒精治疗——赖东明等（中山大学附属第二医院肝胆外科广州510120）；《中国普外基础与临床杂志》2006，13（2）：167-169,172[目的比较原发性肝癌术后复发患者的射频（RF）治疗和无水酒精注射（PEI）治疗，探讨RF治疗的疗效。方法回顾性分析我院诊断为原发性肝癌并行根治性手术治疗后肝内复发但没有肝外转移的患者137例，共161个病灶，     

原发性肝癌患者微波消融治疗后外周血T淋巴细胞亚群的变化

目的：观察原发性肝癌患者微波消融治疗前后外周血T淋巴细胞亚群的变化。方法152例原发性肝癌患者在微波消融治疗前1d、治疗后1 w和4 w,以流式细胞术检测患者外周血CD4＋和CD8＋淋巴细胞数量,采用全自动生化免疫分析仪检测甲胎蛋白水平。术后1 m进行肝脏CT增强扫描观察。结果在微波消融治疗后1 w和4 w,患者外周血CD4＋T淋巴细胞上升至（26.5±3.8）%和（32.3±5.1）%,CD4＋/CD8＋比值上升至（1.12±0.43）和（1.51±0.40）,而CD8＋T淋巴细胞下降至（47.2±7.7）%和（28.1±7.3）%,与治疗前1d时基线水平[CD4＋、CD8＋和CD4＋/CD8＋分别为（21.4±4.1）%、（58.6±7.8）%和（0.98±0.45）]比,变化有统计学意义（P均〈0.05）;甲胎蛋白水平由基线水平[（1109±727） ng/ml]下降,术后1w和4w分别为（890±681） ng/ml 和（215±18） ng/ml（P〈0.01）;微波消融后1m行增强CT检查,示病灶完全灭活率为97.4%（148/152）。结论微波消融治疗使原发性肝癌患者外周血T淋巴细胞亚群向CD4＋T淋巴细胞优势转变,可能对治疗效果的取得发挥了作用。     

Clinical efficacy analysis and safety evaluation of ultrasonographically guided percutaneous radiofrequency ablation in liver cancers

OBJECTIVE : To assess the clinical efficacy of radiofrequency (RF) ablation in treating liver cancers. The indications, contraindications and side-effects of the technique were also evaluated. METHODS : One hundred and fifty-four patients with liver cancers were treated between May 1999 and July 2000. One hundred and thirty-two cases were hepatocellular carcinomas (HCC) and 22 cases were metastatic liver cancers. The diameter of the cancers ranged from 1.5 to 19.0 cm, with a mean diameter of 7.07 cm. All patients were treated with RF2000TM RF under ultrasonographic guidance and the results and side effects were evaluated. RESULTS : One hundred and fifty-four patients were treated 182 times, with the average number of treatments for each patient being 1.18 and the average number of therapeutic points was 5.74. Symptoms improved after therapy and the levels of α-fetoprotein (AFP) dropped from 1553.68 to 883.70 ng/mL. The AFP level declined in 60.8% of patients, remained unchanged in 32.7% of patients and was elevated in 6.5% of patients. After RF ablation, the size of the tumor was reduced in 87 cases (56.6%), stabilized in 52 cases (33.7%) and enlarged in 15 cases (9.7%). The common side-effects of RF were local pain, fever and leukocytosis; no life-threatening complications were observed. CONCLUSIONS : Percutanous RF ablation of liver cancers is a simple, safe, effective method. It can be curative for small liver cancers but for large liver cancers multiple treatments combined with arterial chemoembolization therapy may be needed to enhance its effectiveness.     

Is diagnostic iodine-131 scanning with recombinant human TSH useful in the follow-up of differentiated thyroid cancer after thyroid ablation?

Measuring serum Tg and performing a diagnostic whole body scan (DxWBS) has become the standard for follow-up of patients with differentiated thyroid carcinoma. The primary aim of this study was to determine whether recombinant human TSH (rhTSH)-stimulated Tg alone is sufficiently sensitive to identify residual cancer in patients with no clinical evidence of disease and undetectable or very low serum Tg levels during thyroid hormone (TH) therapy. A secondary aim was to investigate the frequency of tumor in such patients. One hundred and seven consecutive patients, aged 10.9-85.3 yr (median, 36.3), at the time of initial surgery who had Tg levels on TH therapy that were undetectable (95% < or =0.5 ng/ml) or low (4% 0.6 ng/ml, 1% 1.0 ng/ml) and who underwent rhTSH-stimulated testing 10 months to 35 yr (median, 3.5 yr) after initial thyroidectomy and (131)I ablation were retrospectively studied. Many (50%) were at high risk of tumor recurrence, and 5 had distant metastases during the course of their disease. In response to rhTSH, Tg ranged from 0.5 or less to 17.9 ng/ml, remaining at 0.5 ng/ml or less in 68 (64%) patients and increasing to levels between 0.6 and 2 ng/ml in 19 (18%) others and to levels higher than 2 ng/ml in 20 (19%) patients. Eleven patients (10%), all of whom had rhTSH-stimulated serum Tg levels above 2 ng/ml, were found to have persistent tumor in lung (4 patients), lymph nodes (5 patients, 3 with cervical central compartment, 1 bilateral cervical, and 1 with mediastinal nodes) identified by fine needle cytology, surgical pathology, posttherapy whole body scans, or computed tomography and, in two patients, with high serum Tg values alone (4.6 and 7.0 ng/ml after rhTSH and, respectively, 28.5 and 70.6 ng/ml after TH withdrawal), although in neither could the tumor site be identified. Thirteen patients (12%) were treated with surgery or (131)I, and in some cases both, as a result of the rhTSH studies; 10 had tumor, 1 had residual uptake in the thyroid bed visible on rhTSH-stimulated diagnostic whole body scan (DxWBS), and 2 had high serum Tg levels, presumably originating from a tumor site that could not be identified. A patient's tumor status, even in retrospect, usually was not predictable on the basis of Tg during TH therapy or tumor node metastasis status: among patients found to have tumor after rhTSH, serum Tg during TH therapy was 0.5 ng/ml or less in 55% and 0.6 ng/ml in 36%, and tumor node metastasis status was T2N1 or less in 82%. In no case did the rhTSH-stimulated DxWBS show the site of persistent tumor. There were correlations between visible thyroid bed uptake on DxWBS and quantitated (131)I uptake (r(2) = 0.11; P = 0.001), between DxWBS and rhTSH-stimulated Tg (r(2) = 0.54; P = 0.001), and between rhTSH-stimulated Tg and (131)I uptake (r(2) = 0.66; P = 0.0001). There was no statistically significant difference (P = 0.4) in bed (131)I uptake in patients with rhTSH-stimulated serum Tg levels of 0.5 ng/ml or less compared with that in subjects with higher rhTSH-Tg levels. An rhTSH-stimulated Tg level greater than 2 ng/ml had a sensitivity of 100%, a negative predictive value of 100%, and a false positive rate of 9%. The rhTSH Tg had a substantially better performance than the other studies; the false negative rates were 64% for Tg higher than 0.5 ng/ml on TH therapy, 73% for rhTSH-stimulated DxWBS showing uptake, and zero for an rhTSH-stimulated Tg more than 2 ng/ml. In conclusion, of 107 patients who were clinically free of disease, 10% had persistent tumor (4 with pulmonary metastases and 5 with regional disease) that was only identified with an rhTSH-stimulated serum Tg level greater than 2 ng/ml. This study shows that tumor amenable to early therapy may be found when rhTSH-stimulated serum Tg rises above 2 ng/ml without performing a DxWBS, which merely provides data concerning the completeness of thyroid ablation, but not persistent tumor. An elevated rhTSH-stimulated Tg greater than 2 ng/ml warrants further study.     

内镜疗法后续应用粉防己碱预防食管静脉曲张破裂再出血的研究

目的:研究内镜套扎术和(或)硬化剂治疗后续用粉防己碱预防肝硬化食管静脉破裂出血患者再出血的作用.方法:90例肝硬化并发食管胃底静脉曲张破裂出血患者,分成治疗组及对照组,2组均接受内镜治疗,继而都予以一般对症、保肝治疗,而治疗组加用粉防己碱(20 mg,3次/d),疗程12个月,随访治疗期间出血复发率及静脉曲张复发率,同时实验前及实验结束时2组患者均行血流动力学检测及内镜检查.结果:治疗组患者出血复发率及静脉曲张复发率均明显低于对照组(P＜0.05),治疗组患者血流动力明显改善(P＜0.05),而对照组血流动力学无明显变化.结论:内镜套扎术和(或)硬化剂治疗后续用粉防己碱可明显降低肝硬化并食管静脉曲张出血患者的再出血率及静脉曲张复发率,其作用机制可能与抑制钙离子通道、提高一氧化氮合酶活性及抑制胶原纤维合成有关.     

Revisiting serum thyroglobulin in the follow-up of patients with differentiated thyroid carcinoma

This study analyzed serum thyroglobulin (Tg) during hypothyroidism in 207 patients with differentiated thyroid carcinoma treated with total thyroidectomy and radioiodine ablation and undetectable anti-Tg antibodies. Disease staging was defined by clinical examination, stimulated Tg, pre- and post-ablative radioiodine scanning, and other imaging methods (X-Ray, US, CT and MIBI-scan). The average interval from initial therapy was 2.3 years. 153 patients (74%) had no evident disease, 34 (16.4%) presented neck/mediastinal disease, and 20 (9.6%) had distant metastases (Mt). The best cut-off for Tg was 1 ng/ml, showing 100% sensitivity for distant Mt and 88.2% for local recurrence or lymph node Mt, and 88.8% specificity for any Mt and 74.8% for distant Mt. In patients with Tg <1 ng/ml, 2.8% showed cervical lymph nodes Mt. Cervical or mediastinal disease were 26% of cases with Tg between 1 and 5 ng/ml. Tg from 5 to 10 ng/ml was associated to distant Mt in 14.2% of the cases and others showed lymph nodes Mt. In patients with Tg >10 ng/ml, 51.3% presented distant Mt. We suggest the need for neck US even in cases with Tg <1 ng/ml. In addition, patients with Tg levels <5 ng/ml should be investigated by neck US and mediastinal CT only, and empirical therapy should be limited to patients with a minimum Tg level >5 ng/ml.     

Heterochronous development of intrahepatic cholangiocellular carcinoma following hepatocellular carcinoma in a hepatitis B virus carrier

A 68-year-old Japanese woman was admitted to our hospital in September 1995, because of a mass detected by ultrasonography during a follow-up examination for chronic hepatitis B. Hepatocellular carcinoma (HCC) in the right liver lobe was diagnosed based on imaging studies and elevated alpha-fetoprotein (AFP). Percutaneous ethanol injection therapy (PEIT) was performed. PEIT was repeated in November 1998, because the tumor had enlarged and serum AFP was re-elevated. Follow-up ultrasonography (US) demonstrated low echoic mass in the left liver lobe in August 1999; serum AFP was normal, but serum carbohydrate antigen 19-9 (CA19-9) was elevated to 420 U/ml. In October 1999, radiofrequency interstitial tissue ablation (RITA) was performed after tumor biopsy. Pathological findings revealed adenocarcinoma and pathological diagnosis was made as intrahepatic cholangiocellular carcinoma (ICC). Three weeks later, her serum CA19-9 was remarkably decreased (180 U/ml). The patient has been well for 5 months. Her latest AFP and CA19-9 in the serum were 2 ng/ml and 89 U/ml, respectively. The incidence of double cancer in the liver is rare. This is also the first case report to discuss ICC treated with RITA.     

极低频率电磁场下Fe3O4纳米磁流体对小鼠种植性肝癌杀伤作用研究

目的 探讨在极低频率电磁场(ELF-EMF)下Fe₃O₄纳米磁流体对小鼠种植性肝癌的杀伤作用。方法 建立Bel-7402肝癌细胞裸鼠种植肿瘤模型,然后将荷瘤裸鼠随机分成对照组、磁场组和纳米磁流体组,每组20只。在对照组不行任何处理,在磁场组仅接受磁场作用下处理,在纳米磁流体组,给予裸鼠瘤内直接注射PEG-PEI/Fe₃O₄纳米磁流体0.1 ml,并接受0.7 mT的磁场下干预1 h,2次/d,作用15 d。采用放射免疫法检测血清血管内皮生长因子(VEGF)、缺氧诱导因子1α(HIF-1α)、白细胞介素 2受体(sIL-2R)和基质金属蛋白酶-2(MMP-2)水平。结果 在处理后7 d和15 d,纳米磁流体处理组裸鼠肿瘤体积分别为(113.5±12.2)mm³和(97.6±9.7)mm³],显著小于对照组 [(204.6±13.5)mm³和(452.8±16.5)mm³或磁场组(146.7±13.4)mm³和(118.8±13.6)mm³,P<0.05];对照组、磁场组和纳米磁流体处理组裸鼠肿瘤质量分别为[(2.0±0.2) g、(1.4±0.1)g和(0.8±0.1) g ,P＜0.05],差异显著,磁场组和纳米磁流体组抑瘤率分别为26.2%和56.9%(P<0.05);纳米磁流体组血清VEGF、HIF-1α、sIL-2R和MMP-2水平分别为[(127.4±14.2)pg/ml、(32.4±5.2)ng/L、(227.5±23.7)ng/L和(132.4±15.7)pg/ml,显著低于对照组[分别为(294.6±18.6)pg/ml、(107.5±12.7)ng/L、(823.6±38.7)ng/L和(453.6±25.4)pg/ml,P<0.05]或者磁场组[分别为(215.7±14.3)pg/ml、(72.4±7.5)ng/L、(426.3±24.4)ng/L和(214.3.±18.4)pg/ml,P<0.05];对照组肿瘤细胞生长旺盛,细胞密度极大,排列紊乱,磁场组细胞生长受限,细胞排列稀疏,纳米磁流体干预组肿瘤组织呈大片坏死,肿瘤细胞显著减少。结论 在ELF-EMF下Fe₃O₄纳米磁流体对裸鼠种植性肝癌细胞血管生成有着显著的抑制作用,可显著抑制肿瘤生长,促进肝癌细胞凋亡。     

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。     

高尔基蛋白73、甲胎蛋白异质体3、甲胎蛋白和α-L-岩藻糖苷酶在肝脏疾病中的诊断价值

目的比较高尔基蛋白73(GP73)、甲胎蛋白异质体3(AFP-L3)、甲胎蛋白(AFP)和α-L-岩藻糖苷酶(AFU)在不同肝脏疾病患者中的意义及其单项或联合检测诊断肝癌的价值。方法对2013年1-12月收治的272例肝癌患者、203例肝硬化患者、248例慢性肝炎患者及210例健康体检者血清中的GP73、AFP-L3、AFP和AFU水平进行检测。非正态分布的数据多组间比较采用Kruskal-Wallis H检验,组间两两比较采用Mann-Whitney U检验,率的比较用卡方检验。ROC曲线绘制分别以健康人组和非肝癌组(健康体检、慢性肝炎、肝硬化)为对照。联合指标先进行Logistic拟合后再做ROC曲线。结果 GP73水平肝硬化组[177.0(116.0,247.0)ng/ml]较肝癌组[141.0(83.3,218.8)ng/ml])和慢性肝炎组[151.0(83.0,235.3)ng/ml]高(U=22 116.5、21 052.0,P均0.05);AFP-L3和AFP在肝癌组中的水平[11.3(4.3,21.2)%,78.4(7.1,2455.8)ng/ml]明显高于肝硬化组[6.0(4.0,8.0)%,10.0(3.8,49.5)ng/ml]和慢性肝炎组[7.0(5.0,9.0)%,18.8(4.4,79.6)ng/ml](P均0.05)。以健康人血清样本为对照绘制的诊断肝癌的ROC曲线,GP73、AFP-L3、AFP和AFU的ROC曲线下面积(AUC)分别为0.827、0.817、0.901和0.680。由此可知在鉴别健康人和肝癌患者方面,前3者比AFU有较高的准确性。以非肝癌患者血清样本为对照绘制的诊断肝癌的ROC曲线,4个指标对应的AUC分别为0.573、0.734、0.753和0.552,可见AFP-L3和AFP对于诊断肝癌有一定的准确性,其敏感性和特异性达到最大时的cut off值依次为8.55%(56.6%,84.9%),49.88 ng/ml(57.7%,80.9%)。结论 GP73的上升与肝损伤及长期纤维化有关,其在诊断肝脏疾病中有较好的敏感性,AFP-L3和AFP在诊断肝癌方面特异性较好,AFP-L3和AFP两者联合应用可提高肝癌的诊断敏感性至62.1%。     

Follow-up of high-risk patients with differentiated thyroid cancer without persistent disease after initial therapy

This study evaluated the follow-up of high-risk patients with thyroid cancer after initial therapy. A total of 125 high-risk patients (tumor >4 cm and/or extrathyroid invasion and/or lymph node metastases, and age >45 years), with complete resection of the tumor, were selected. All patients underwent total thyroidectomy and ablation with (131)I[3.7-5.5 GBq (100-150 mCi)]. Eighteen patients (14.8%) presenting metastases on post-dose whole-body scan (RxWBS) were excluded. The negative predictive value of stimulated Tg < or =1 ng/ml in combination with neck US during first assessment (612 mo. after ablative therapy) was 96.2% for the absence of recurrence up to 5 years. This value increased to 98.7% when adding WBS performed with 185 MBq (5 mCi) (131)I (DxWBS). The positive predictive value (PPV) of stimulated Tg >1 ng/ml was 52% for the detection of the presence of metastases up to 5 years; however, considering only patients with initially negative DxWBS and US, the PPV was 19% (9% if Tg of 110 ng/ml vs. 40% if Tg >10 ng/ml). Tg levels decreased spontaneously in patients with stimulated Tg >1 ng/ml during first assessment, negative US and DxWBS, and no recurrence during follow-up, with Tg being undetectable in half these patients at the end of 5 years. Twenty patients presented uptake in the thyroid bed upon DxWBS during the first year after ablative therapy, with stimulated Tg and US being negative, and were not treated with 131I; these patients did not relapse and no uptake on DxWBS was observed in 60% after 5 years. Recurrence after 5 years was only 1.3% in patients without apparent disease (negative US and DxWBS) and stimulated Tg <1 ng/ml. An algorithm for the follow-up of high-risk patients after initial therapy is presented in this study.