肝动脉化疗栓塞术联合射频消融术治疗原发性肝癌

目的分析肝动脉化疗栓塞术联合射频消融术治疗原发性肝癌的临床疗效及安全性。方法原发性肝癌的患者60例,随机分为对照组(行肝动脉化疗栓塞术)30例,病例组(行肝动脉化疗栓塞术联合射频消融术)30例,对比研究两组的临床疗效及安全性。结果病例组总有效率显著高于对照组(P0.05);两组患者第1年生存率比较差异无统计学意义(P0.05);病例组第2、3、5年生存率显著高于对照组(P0.05);两组不良反应发生率比较差异无统计学意义(P0.05)。结论肝动脉化疗栓塞术联合射频消融术治疗原发性肝癌具有较好的临床疗效,能提高患者远期生存率,安全性与单一行肝动脉化疗栓塞术无显著性差异。     

TACE联合MWA治疗原发性肝癌疗效分析

目的 观察肝动脉化疗栓塞术(TACE)联合超声引导下微波消融术(MWA)治疗原发性肝癌疗效分析。方法 收集南京中医药大学附属南京医院/南京市第二医院近2年单发性原发性肝癌96例,其中仅给予肝动脉栓塞化疗术的46例(对照组),在此基础上联合超声引导下微波消融术治疗的50例(治疗组),比较术后的血清总胆红素(TBil)、血清丙氨酸氨基转移酶(ALT)、血清天冬氨酸氨基转移酶(AST)、血清甲胎蛋白(AFP)等变化,以及1年内的肝癌复发情况。结果 治疗组血清学指标AFP明显下降(t=34.06,P<0.05),1年内治疗组肝癌复发率18.00%,对照组1年内肝癌复发率89.13%(χ²=48.56,P<0.05),两组血清TBil(t=0.065,P>0.05),ALT(t=0.079,P>0.05),AST(t=0.076,P>0.05)在保肝治疗下总体平稳,差异不大。结论 肝动脉化疗栓塞术联合超声引导下微波消融术疗效远优于单纯肝动脉化疗栓塞术,对肝功能影响不大,但病例选择很重要,应尽量一次性彻底消融干净,否则有肝内外转移风险。     

经导管肝动脉化疗栓塞术对原发性肝癌患者细胞免疫及调节T细胞的影响

目的 探讨原发性肝癌(PLC)患者经导管肝动脉化疗栓塞术(TACE)前后细胞免疫及调节T细胞(Treg)的变化及其临床价值.方法 采用流式细胞术检测健康志愿者及PLC患者介入治疗术前1 d与术后1个月外周血CD4+、CD8+T细胞及调节T细胞的比例变化;ELISA法检测外周血IL-35的含量.结果 PLC患者外周血中C...     

复方斑蝥胶囊对肝癌患者TACE治疗前后细胞免疫功能的影响

目的:探讨原发性肝癌(HCC) 患者肝动脉插管化疗栓塞术(TACE) 治疗前后及TACE 后应用中成药复方斑蝥胶囊后细胞免疫功能变化.方法:所有HCC 患者TACE 治疗前及治疗后1 wk 、1 mo,服用复方斑蝥胶囊前及用药后4 wk 用检测外周血T淋巴细胞亚群、NK 细胞及ALT 、AST 、TBIL.结果:HCC...     

中西医结合治疗原发性肝癌的生存指导意义

目的肝动脉化疗栓塞术联合中药原发性肝癌的生存指导意义。方法选取我院2014年10~2106年3月接收并诊治的原发性肝癌患者200例分为研究组100例与对照组100例。所有患者均给予肝动脉化疗栓塞术进行治疗;研究组加用中成药物支持治疗。比较观察两组的生存率。结果研究组近期疗效优于对照组,且组间差异拥有统计学意义(P0.05);两组治疗1年后、2年后、3年后的生存率比较差异具有显著性(P0.05),支持治疗配合肝动脉化疗栓塞术治疗原发性肝癌有利于提高患者生存率;两组肝功能指标(TBIL、ALP、ALA、ASA)比较差异具有统计学意义(P0.05)。结论肝动脉化疗栓塞术治疗原发性肝癌具有较好的治疗效果,在此基础上,加用中成药物支持则可进一步提高生存率,改善患者肝功能,具有临床参考价值。     

双介入化疗联合精准肝切除术在原发性肝癌治疗中的应用

目的探讨经肝动脉、门静脉化疗栓塞,肝段染色联合精准肝切除术在原发性肝癌手术治疗中的安全性和有效性。方法对我院2010年3月-2011年1月收治的需手术切除的60例原发性肝癌患者随机分为2组,治疗组30例,对照组30例。治疗组开腹后先在DSA引导下,行门静脉置管、肝动脉置管、肝段染色,以确定切除范围,并在双化疗栓塞后行精准肝切除。对照组则采用常规肝切除术。比较两组手术时间、术中出血量、手术并发症及死亡率、住院时间和术后1年期复发率。结果治疗组与对照组的手术时间比较,有显著性差异(P<0.05);与对照组比较,治疗组的肝门阻断时间明显缩短,术中失血量明显减少,差异具有显著统计学意义(P<0.05);治疗组手术死亡率、住院时间、术后1年期复发率明显降低(P<0.05)。结论应用经肝动脉、门静脉化疗栓塞,肝段染色联合精准肝切除术,在原发性肝癌手术治疗中,可明显减少术中出血,缩短患者住院时间,降低手术死亡率及复发率。     

肝动脉化疗栓塞联合内生场热疗治疗原发性肝癌的临床研究

目的 评价肝动脉化疗栓塞术(TACE)联合内生场热疗治疗原发性肝癌的有效性和安全性.方法 46例原发性肝癌患者随机分成两组,治疗组和对照组.对照组采用阿霉素、丝裂霉素、5氟尿嘧啶和栓塞剂(碘化油、明胶海绵)行肝动脉化疗栓塞治疗,治疗组除上述治疗外同时加用内生场热疗(每周二次).根据WHO标准评价近期客观疗效及其毒性.结果 治疗组与对照组的有效率分别为69.6%与39.1%,有差异显著(P＜0.05).中位生存期分别为14个月和8个月,1年生存率为65.2%和34.8%.毒副反应较轻,主要为Ⅰ、Ⅱ度的骨髓抑制及消化道反应,偶有发热,治疗组低于对照组.结论 热疗联合肝动脉化疗栓塞术(TACE),可增强疗效,提高生存率、减轻毒副作用,安全可靠.     

体外热疗与TACE结合治疗中晚期肝癌的临床研究

中晚期原发性肝癌的疗效仍不理想,肝动脉插管灌注化疗加碘油药物栓塞术的疗效虽肯定但易复发,影响远期疗效,一年生存率在30%~60%,2年生存率在20%~40%[1]。本文收集60例肝动脉化疗栓塞(TACE)术结合体外热疗,与单纯TACE术治疗50例报道如下:1材料与方法两组病例均符合:(1)确诊为原     

温脾汤治疗肝癌介入术后腹痛的疗效分析

目的：观察温脾汤对治疗原发性肝癌肝动脉灌注化疗栓塞术（TACE）术后以及原发性肝癌肝动脉灌注化疗栓塞＋部分脾栓塞术（PSE）术后出现腹痛的治疗效果。方法：回顾性研究符合入选标准的33例77人次肝癌介入（单纯TACE或者TACE＋PSE）术后腹痛患者，分成治疗组（n=46）和对照组（n=31）。治疗组采用消炎痛栓塞肛和中药温脾汤为基本方随证加减口服治疗，连用5天。对照组采用消炎痛栓塞肛，连用5天。结果：两组腹痛缓解程度和缓解持续时间比较差异有显著性意义。结论：中药温脾汤随证化裁可以减轻肝癌患者介入术后出现的腹痛。     

原发性肝癌

金龙胶囊联合肝动脉化疗栓塞治疗原发性肝癌疗效观察；热休克蛋白-抗原肽复合物疫苗预防肝癌术后复发32例；肝切除、冷冻及射频治疗对肝细胞癌血源性播散影响的研究；Survivin，Caspase-3蛋白在原发性肝癌中的表达及意义；AFP、AFU、SF联检对原发性肝癌的诊断价值；原发性肝癌并门静脉癌栓的肝动脉化疗栓塞治疗。[编按]     

Urinary neopterin measurement as a non-invasive diagnostic method in pulmonary tuberculosis.

SETTING: Pulmonary department of a university hospital in Ankara, Turkey. OBJECTIVE: To investigate the usefulness of neopterin in pulmonary tuberculosis (PTB) as a rapid diagnostic tool. DESIGN: Neopterin concentrations in bronchoalveolar lavage fluid (BAL), serum and urine were measured in patients with PTB, with lung cancer and with pneumonia and in a healthy control group. RESULTS: In the BAL of PTB patients, serum and urine levels of neopterin were significantly higher than all the other groups (P < 0.001). Compared with the lung cancer group, PTB patients had higher neopterin in BAL and urine (P < 0.05). The PTB group had higher levels not only in BAL and urine, but also in serum, than the pneumonia group (P < 0.05). Compared with the pneumonia group and the healthy controls, neopterin levels in serum and urine were significantly higher in the lung cancer group (P < 0.05). In the PTB group, patients with moderately advanced PTB according to radiographic extent had higher levels of urine neopterin than patients with minimal disease (P = 0.01). CONCLUSION: Neopterin levels in BAL, serum and particularly in urine may reflect PTB activity before exact diagnosis of the disease by culture results, and correlates with radiological extent.     

Upregulation of the immune system in primary hypercholesterolaemia: effect of atorvastatin therapy

OBJECTIVES: High levels of plasma high sensitivity C-reactive protein (CRP), sensitive to therapy with statins, have been described in hypercholesterolaemia. In vitro evidence shows that CRP activates the complement system, which, in turn, leads to an increased expression of ICAM-1. Our objectives were to verify whether primary hypercholesterolaemia (PHC) is associated with an upregulation of the inflammatory/immune response, and whether this is sensitive to atorvastatin. METHODS AND RESULTS: We examined the levels of sICAM-1, C3, C4 complement fractions in 48 patients with PHC, with (CAD group) or without (No-CAD group) coronary artery disease (CAD) in comparison with a group of 48 healthy controls. The two patient groups were studied before and after atorvastatin therapy. Both hypercholesterolaemic groups showed higher mean values of sICAM-1, C3 and C4 (P < 0.0001) when compared with the controls. The two groups of patients responded differently to atorvastatin therapy. After 3 months, the C3 levels normalized in both groups of patients (P < 0.02 compared with basal values); C4 was greatly reduced only in the CAD group (P < 0.01). After 12 months of therapy, in CAD group C3 mean levels were still significantly lower than baseline values (P < 0.01); a further decrease in the C4 values (P < 0.05 with respect to levels after 3 months of therapy) and also a substantial reduction in sICAM-1 values (P < 0.001 with respect to basal values) were observed. CONCLUSIONS: High plasma values of C3 and C4 in PHC cluster with high values of sICAM-1, distinguish subjects with CAD and could be used to monitor the anti-inflammatory effect of statin therapy in these patients.     

Elevated serum neopterin levels in atherosclerosis.

Plasma levels of neopterin were determined in patients with different clinical stages of atherosclerosis. Non-hospitalized patients with atherosclerosis had serum and plasma neopterin levels within the normal range of the assay (6 +/- 2 nM). These values were not significantly different from those reported for healthy blood donors (5 +/- 2 nM). In contrast, about 50% (29 out of 61) of hospitalized patients undergoing conservative or surgical therapy had neopterin plasma levels, which exceeded the normal range (greater than 10 nM) up to 10-fold. The two groups differ on a significance level of P less than 0.01. For further evaluation hospitalized patients were subgrouped according to neopterin levels. In the subgroup with elevated neopterin levels patients with higher Frederickson types of atherosclerosis were overrepresented compared to patients with normal neopterin levels. Type 4 differed significantly from patients without pathological changes of lipoprotein (P less than 0.05). Only 3 patients suffered from minimal skin necrosis, two of them had elevated neopterin levels. Significantly more patients with peripheral artery occlusions had elevated neopterin levels than patients with occlusions of central arteries (P less than 0.05). All other criteria used for comparison (sex, age, smoking, antioxidant status, diabetes, hypertension, adipositas, hyperuricemia) did not vary significantly in both subgroups. These data indicate that neopterin plasma levels might be a valuable parameter in activity staging and therapeutic follow up of atherosclerotic patients. Additionally, an involvement of the nonspecific immune system in atherogenesis is suggested by the increased plasma neopterin concentrations.     

冠心病免疫激活的一个指标—新蝶呤

目的　探讨新喋呤与冠心病发病机制的可能关系。方法　前瞻性地对 16例正常献血员测定了外周静脉血清新蝶呤水平并测定了 2 0例经冠状动脉造影证实的冠心病患者外周静脉血及冠状窦血清新蝶呤水平 ,且与冠状动脉造影进行了相关分析。结果　冠心病患者外周静脉血及冠状窦血新蝶呤水平均显著高于正常人 (分别为 (14 .78± 7.17)nmol/L、(2 0 .0 4± 14 .73)nmol/L和 (8.32± 4 .70 )nmol/L ,均P <0 .0 1) ;且两者均随着冠心病患者血管病变支数增加而升高得更明显 ,两者均与血管病变支数呈正相关 (r =0 .4 80 ,P <0 .0 1) ;(r =0 .810 ,P <0 .0 1)。结论　在冠心病患者中有新蝶呤水平显著升高 ,免疫激活可能参与了冠心病的病理生理过程。新蝶呤是冠心病免疫激活的一个新指标。     

Activation of Peripheral Blood CD3⁺ T-lymphocytes in Patients With Atrial Fibrillation

Atrial fibrillation (AF) is a common disease with a poorly understood pathophysiological mechanism. Increasing evidence indicates that AF may be associated with immunologic inflammation responses, but it remains unclear whether activation of peripheral blood CD3⁺ T-lymphocytes plays a role in the pathogenesis of AF. The aim of this study was to evaluate this phenomenon. Fifty paroxysmal AF patients and 56 persistent AF patients who underwent successful electrical cardioversion were enrolled. The percentages of CD69 and human leukocyte antigen DR (HLA-DR) positive peripheral blood CD3⁺ T-lymphocytes, which indicate T-lymphocyte activation, were examined by flow cytometric analysis in the patients and 51 healthy controls. The patient groups had higher levels of CD69 and HLA-DR than the healthy controls. During the 3-month follow-up, 37 patients had recurrence of AF (recurrence group) and 50 patients remained in sinus (sinus group). The CD69 and HLA-DR levels in the sinus group were all significantly down-regulated at follow-up compared with before cardioversion. However, there were no statistically significant differences between the CD69 and HLA-DR levels in the recurrence group at follow-up and before cardioversion. Our findings suggest that activation of peripheral blood CD3⁺ T-lymphocytes was associated with AF, and might be a diagnostic or therapeutic marker.     

辅助性T淋巴细胞1、2、17在慢性乙型肝炎病毒感染状态中的变化

目的 了解慢性HBV感染中辅助性T淋巴细胞(Th)1、Th2、Thl7产生的主要细胞因子的表达,以反映这3种细胞的功能状态.方法 ELISA测定34例慢性乙型肝炎、31例肝硬化、26例原发性肝癌、22例慢性重型乙型肝炎患者及15例健康对照者m清中的1FN-γ、IL-4和IL-17水平,对数据进行t检验和Pearson相关分析.结果 IFN-γ/IL-4在慢性乙型肝炎患者(1.08±0.66)比健康对照者(2.60±0.60)降低(P＜0.01),在慢性重型乙型肝炎患者(4.81±0.87)比健康对照者升高(P＜0.01);IFN-γ/IL-17在慢性乙型肝炎(1.13±0.85,P＜0.01)、肝硬化(1.69±0.92,P=0.010)、肝癌(1.76±0.84,P=0.011)患者比健康对照者(2.66±0.70)降低,在慢性重型乙型肝炎患者(3.68±0.42)比健康对照者升高(P=0.004);IL-4/IL-17在肝硬化(0.72±0.38,P=0.026)、肝癌(0.63±0.19,P＜0.01)患者比健康对照者(1.04±0.23)降低.结论 慢性乙型肝炎患者IL-4的表达占优势;肝硬化、肝癌患者IL-17的表达占优势;慢性重型乙型肝炎患者IFN-γ的表达占优势.     

类风湿关节炎患者外周血高迁移率族蛋白1表达

目的通过检测类风湿关节炎（RA）患者外周血单个核细胞（PBMC）、血浆中高迁移率族蛋白1（HMGB1）表达,为寻找治疗RA的新靶点提供依据。方法采集38例活动期RA患者、24例相对稳定期RA患者和20例健康对照者外周血。RT．PCR检测PBMC HMGB1mRNA表达,Western blot检测PBMC、血浆HMGB1蛋白表达。结果与相对稳定期RA患者、健康对照者相比,活动期RA患者PBMC HMGB1mRNA表达水平差异无统计学意义（F=1．23,P〉0．05）,而HMGB1蛋白表达水平下降（F=70．91,P〈0．01）,血浆HMGB1水平显著增高（P〈0．001）。相对稳定期RA患者与健康对照者之间差异无统计学意义（P〉0．05）。活动期RA患者血浆HMGB1水平与ESR（r．=0．478。P〈0．001）、C-反应蛋白（rs=0．574,P〈0．05）呈正相关。结论HMGB1与RA发病密切相关,并可能成为新的治疗靶点。     

Serum neopterin levels in children with hepatitis-B-related chronic liver disease and its relationship to disease severity

AIM： To evaluate serum neopterin levels and their correlations with liver function tests and histological grade in children with hepatitis-B-related chronic liver disease. METHODS： The study population comprised 48 patients with chronic active hepatitis B, 32 patients with hepatitis-B-related active liver cirrhosis and 40 normal controls. Serum neopterin was measured using an enzyme-linked immunosorbent assay. RESULTS： The mean ＋ SD serum neopterin levels were 14.2 ± 5.6 nmol/L in patients with chronic hepatitis, 20.3 ± 7.9 nmol/L in patients with liver cirrhosis and 5.2 ± 1.4 nmol/L in control group. Serum neopterin levels were significantly higher in patients with chronic hepatitis （P = 0.005） and cirrhosis patients （P = 0.008）, than in control subjects. Cirrhotic patients had significantly higher serum neopterin levels than patients with chronic hepatitis （P = 0.004）. There was a positive correlation between serum neopterin levels and alanine aminotransferase levels in patients with chronic hepatitis （r = 0.41, P = 0.004） and cirrhotic patients （r = 0.39, P = 0.005）. Positive correlations were detected between serum neopterin levels and inflammatory score in patients with chronic hepatitis （r = 0.51, P = 0.003） and cirrhotic patients （r = 0.49, P = 0.001）. CONCLUSION： Our results suggest that serum neopterin levels can be considered as a marker of inflammatory activity and severity of disease in children with hepatitis-B-related chronic liver disease.     

联合检测AFP、C反应蛋白在原发性肝癌诊断中的临床意义

目的通过对血清反应蛋白（CRP）与甲胎蛋白（AFP）联合检测,探讨其在原发性肝癌诊断与鉴别诊断中的价值。方法抽取52例临床确诊的原发性肝癌患者、68例肝硬化患者及50例健康体检者血液,化学发光免疫分析法检测CRP,放射免疫法检测AFP的浓度,以同期50例健康体检者作对照。结果原发性肝癌CRP、AFP水平与肝硬化及正常对照组比较差异均有统计学意义（P〈0.05）。原发性肝癌组单项CRP、AFP阳性检出率分别为76.9%、73.1%;两项联合检测敏感度达94.2%,与AFP单项检测比较,差异有统计学意义（P〈0.01）。结论联合检测CRP与AFP可提高原发性肝癌的检出率,对肝癌的诊断及鉴别诊断具有实用价值。     

Double-faced cell-mediated immunity in β-thalassemia major: stimulated phenotype versus suppressed activity

In this study, the immunologic abnormalities of Iranian β-thalassemia major patients were characterized, considering their clinical parameters including splenectomy status and iron overload. Serum samples and peripheral blood mononuclear cells were collected from 28 patients and 30 age- and sex-matched healthy individuals. Patients with thalassemia showed significantly increased absolute lymphocyte counts compared with the control group. An increased number of activated T cells and higher levels of serum neopterin were also observed in thalassemia patients, which suggest chronic stimulation of immune system. On the contrary, T-cell proliferation and interleukin 2 (IL-2), interferon gamma (IFN-γ), and IL-4 production were suppressed in patients compared to controls. Patients with high serum ferritin levels produced significantly less IFN-γ and IL-2, indicating the immunosuppressive effect of iron overload in β-thalassemia patients. The serum levels of tumor necrosis factor alpha and absolute counts and percentages of B and T cells were higher in splenectomized patients; however, serum levels of neopterin significantly decreased in splenectomized patients compared to the non-splenectomized group. Taken together, T lymphocytes express activated phenotype in polytransfused β-thalassemia major patients, while T cell proliferation and effector function are significantly suppressed. Multiple blood transfusion and continuous immune stimulation could be responsible for making such a double-faced immune response.