D-二聚体、C反应蛋白、血沉与老年社区获得性肺炎严重程度的关系

目的探讨血浆D-二聚体、C反应蛋白（CRP）和血沉水平与老年社区获得性肺炎（CAP）严重程度的关系。方法收集130例老年CAP患者的临床资料,按不同的病情严重程度评分标准对患者进行分组,分别测定患者血浆D-二聚体、CRP、血沉水平,分析其在不同分组间的差异。结果不同肺炎严重度指数（PSI）分级间、不同CURB-65分组间D-二聚体、CRP水平比较差异均有统计学意义（P〈0．05）,重症肺炎组D-二聚体、CRP水平均显著高于非重症肺炎组（P〈0．01）。血沉水平在以上不同分组间比较差异均无统计学意义。血浆D-二聚体与CRP水平显著相关（r=0．368,P〈0．01）。结论血浆CRP、D-二聚体水平与CAP的严重程度有一定的相关性,可作为判断病情的指标。     

血浆D-二聚体在急性主动脉夹层诊断中的价值

目的探讨血浆D-二聚体在急性主动脉夹层诊断中的价值。方法回顾分析2005年1月至2011年10月在我院确诊的69例急性主动脉夹层患者（简称主动脉夹层组）、同期70例急性肺栓塞患者（肺栓塞组）和70例因胸痛住院的其他患者（胸痛组）的血浆D-二聚体等临床资料,比较D-二聚体在不同类型患者中的水平差异,分析D-二聚体水平与急性主动脉夹层预后的关系。结果所有急性主动脉夹层患者D-二聚体均超过500μg／L,敏感性100％;死亡患者血浆D-二聚体浓度高于存活患者（P〈0．05）。血浆D-二聚体浓度主动脉夹层组、肺栓塞组和胸痛组分别为（3479．2±2200．0）μg／L、（1560．7±940．0）μg／L和（179．8±167．0）txg／L,三组比较P〈0．01,每两组比较P〈0．05。结论急性主动脉夹层患者血浆D-二聚体明显升高,其平均浓度超过急性肺栓塞患者。D-二聚体阴性有助于排除急性主动脉夹层的诊断;D二聚体升高对判断预后有-定的指导价值。     

D-二聚体、血尿酸与主动脉夹层的关系

目的研究D-二聚体、血尿酸与主动脉夹层的相关性。方法选择经计算机断层血管摄影术（CTA）确诊的主动脉夹层患者45例为研究对象。收集性别、年龄、体质量指数等与主动脉夹层组相匹配的非主动脉夹层患者45例为对照组。检测两组血浆中的D-二聚体及血尿酸浓度并进行比较。应用Logistic回归分析D-二聚体、血尿酸及其他危险因素与主动脉夹层的关系。结果主动脉夹层组血浆D-二聚体及血尿酸浓度明显高于正常对照组。差异有统计学意义（P〈0．05）。Logistic回归分析结果显示,D-二聚体及血尿酸与主动脉夹层显著相关（0R=2．834,P〈0．01：DR=2．087,P〈0．01）。结论D-二聚体及血尿酸与主动脉夹层密切相关,是主动脉夹层的危险因素。     

D-二聚体定量检测对判定急性冠脉综合征血栓形成的研究

目的：探讨D-二聚体定量检测对于判定急性冠脉综合征（ACS）血栓形成的意义。方法：选择住院不稳定型心绞痛（UAP）患者36例,急性心肌梗塞（AMI）患者13例,稳定型心绞痛（SAP）患者23例,采用胶体金标法动态检测患者静脉血中的D-二聚体含量。结果：D-二聚体含量：UAP组（0．95±0．32）mg／L,AMI组（1．82±0．63）mg／L,UAP组与SAP组（0．39±0．15）mg／L比较有显著差异（P〈0．05）,AMI组与SAP组比较,差异非常显著（P〈0．01）。结论：D-二聚体定量检测是判定ACS血栓形成相对特异的敏感指标。     

肝硬化门静脉血栓患者血浆D-二聚体水平及其临床意义

目的探讨肝硬化门静脉血栓（PVT）患者血浆D-二聚体水平及其临床意义。方法在77例肝硬化患者中,PVT形成患者31例,无血栓形成患者46例,依据螺旋cT检查诊断PVT,采用乳胶凝集法检测血浆D-二聚体水平。结果血栓组和无血栓组患者血浆D-二聚体水平分别为1．2±0．5mg/l和0．6±0．4mg／l（P〈0．01）;血栓组伴中重度食管静脉曲张患者血浆D-二聚体水平（1-3±O．5m鲫）显著高于轻度食管静脉曲张患者（0．9±0．5mg/l,P〈0．05）;血栓形成伴消化道出血和死亡患者血浆D-二聚体水平显著高于无出血和生存患者（P〈0．01）。结论肝硬化患者血浆D-二聚体水平升高可能与PVT形成有关,并严重影响预后。     

脑梗死患者血栓前血浆D-二聚体、同型半胱氨酸及血黏度的改变

目的观察脑梗死患者发病前血浆D-二聚体（D-Dimer）、同型半胱氨酸（Hcy）及血黏度的变化,探讨其与脑梗死发生的关系。方法采用回顾性统计调查94例脑梗死患者的检测数据,同时选取本院健康体检者102例作为对照组。免疫比浊法测定血浆D-二聚体和纤维蛋白原（FIB）,酶法测定Hcy,放射免疫法测定叶酸（FA）及维生素B12（VitB12）含量。结果 脑梗死患者发病前72h内血浆D-二聚体、FIB及Hcy水平显著高于对照组（P〈0．05）,FA、VitBl2水平明显低于对照组（P〈0．05）,患者全血及血浆黏度均高于对照组（P〈0．05）。结论血黏度增加伴有高D-二聚体和Hcy血症可能是脑梗死的促发因素之一。     

D-二聚体对老年重症社区获得性肺炎30天死亡率的预测价值

目的探讨D-二聚体水平对住院老年重症社区获得性肺炎（CAP）患者30d死亡率的预测价值。方法152例符合诊断标准的老年重症CAP患者纳入研究,人院后即进行D-二聚体、c-反应蛋白（CRP）检测及肺炎严重度指数（PSI）评分,记录患者30d死亡率。采用受试者工作特征曲线（ROC）分析D-二聚体对30d死亡率的预测价值,计算曲线下面积（AUC）。结果PSI评分Ⅳ级患者的D-二聚体水平为（961．55±186．49）μg／L,V级为（1122．53±197．98）μg／L,两者差异有明显统计学意义（t=5．159,P〈0．001）;死亡患者的D-二聚体水平（1112．59±215．25）μg／L明显高于存活患者的D-二聚体水平（920．46±126．89）μg／L（t=6．239,P〈0．001）。Pearson相关性分析显示,D-二聚体和PSI有明显相关性（r=0．47,P〈0．0001）;ROC分析表明D-二聚体的AUC为：0．79（95％CI：O．72～0．85）,和PSI的AUC相比差异无统计学意义（0．85,95％CI：0．78～0．91,P=0．095）。结论D-二聚体水平对住院老年重症CAP患者30d死亡率有较好预测价值。     

高血压脑出血术后D-二聚体动态变化的临床研究

目的研究高血压脑出血术后患者血液中D-二聚体的动态变化与病情程度及预后的关系。方法采用磁珠法对89例高血压性脑出血术后患者的血浆D-二聚体水平进行检测,与36例健康体检者进行对照,并分析其与病情、预后的关系。结果各型脑出血患者血浆D-二聚体含量间差异有统计学意义（P〈0.01）。好转组与无好转组D-二聚体异常率间差异有统计学意义（P〈0.01）。结论动态观察D-二聚体的变化对高血压性脑出血术后的病程、病情判定及评价预后有重要意义,是判断高血压脑出血术后患者病情程度及预后情况的有效指标之一。     

高血压性脑出血与D-二聚体及高敏C反应蛋白的关系探讨

目的探讨高血压性脑出血病人急性期血浆D-二聚体、血清高敏C反应蛋白（hs-CRP）的动态变化及临床意义。方法采用磁珠法对60例高血压性脑出血急性期病人血浆D-二聚体水平进行检测，采用免疫比浊法测定hs-CRP含量，并与40名健康体检者进行比较。结果高血压性脑出血病人急性期D-二聚体、hs-CRP水平均高于健康对照组（P〈0.01）；hs-CRP水平病情重者升高更明显，病情好转组血清hs-CRP水平显著低于无好转组（P〈0.01）。治疗后恢复期hs-CRP水平较健康对照组无统计学意义（P〉0．05）。结论动态观察D-二聚体和hs-CRP水平对高血压性脑出血的病程、病情判定及评价预后均有重要意义。     

慢性阻塞性肺疾病急性加重期二氧化碳分压与D-二聚体的相关性研究

目的探讨COPD患者在急性加重期PaCO2和D-二聚体的相关性,为临床治疗提供科学依据和指导。方法选择2011年1月至2013年1月在鄂州市中心医院住院治疗的46例COPD急性加重期患者作为观察对象,设为观察组,测定治疗前后血浆D-二聚体、PaCO2水平;选择46例健康志愿者作为对照组,检测其血浆D-二聚体、PaCOz水平,比较两组血浆D-聚体、PaCO。水平。结果观察组治疗前D-二聚体、PaCO2水平分别为（353±220．8）μg／L、（64．7±16．2）mmHg,对照组D-二聚体、PaCO2水平分别为（73．6±21.1）μg／L、（40．3±4．5）mmHg,观察组均明显高于对照组,两组比较差异显著（P值均〈0．05）;观察组治疗后D-S聚体、PaCO2水平分别为（96．4±24．8）μg／L（46．3±7．4）mmHg,各项与对照组n二聚体（73．6±21．1）μg／L、PaCO。水平（40．3±4．5）mmHg差异无统计学意义（P值均〉0．05）。结论COPD急性加重期患者血浆D二聚体、PaCO2水平明显较健康人群高,因此在对COPD患者治疗过程中,要密切监测患者的血浆D-二聚体、PaCO2水平,以了解患者病情进展情况。     

Cyclin D1 Expression Is Useful as a Prognostic Indicator for Advanced Esophageal Carcinomas, but Not for Superficial Tumors

The purpose of the present study was to define the overexpression of cyclin D1 in superficial and advanced esophageal carcinomas and to investigate whether the expression of this molecule indicates a poor prognosis. This study included 41 patients with superficial esophageal carcinomas (Tis and T1) and 48 patients with advanced esophageal carcinomas (T2, T3, and T4). The expression of cyclin D1 in surgically resected specimens was evaluated immunohistochemically with a monoclonal antibody. Positive immunoreactivity was found in 31 of 89 cases (35%). Overexpression of cyclin D1 did not correlate with TNM classification or histologic type. Of the 48 patients with advanced esophageal carcinomas, 32 patients with cyclin D1-negative tumors survived longer than did 16 patients with cyclin D1-positive tumors (P = 0.0017). In contrast, we observed no survival difference between patients with cyclin D1-positive and -negative superficial esophageal carcinoma. These results suggest that cyclin D1 indicates a poor prognosis in cases of advanced esophageal carcinoma but not in cases of superficial esophageal carcinoma.     

Alteration of cyclin D1 in gastric carcinoma and its clinicopathologic significance

AIM: To detect the genetic alteration and abnormal expression of cyclin D1 in gastric carcinoma and investigate its clinicopathologic significance in advanced gastric carcinoma. METHODS: Proteins of cyclin D1 were detected by immunohistochemistry in 42 cases of advanced gastric carcinoma with their follow-up data available, 27 cases of early stage carcinoma, 21 cases of gastric adenoma, 22 cases of hyperplastic polyp and 20 cases of normal mucosa adjacent to adenocarcinomas. Genetic alteration of cyclin D1 was detected by Southern blot and expression of cyclin D1 mRNA was detected by PT-PCR in 42 cases of advanced gastric carcinoma. RESULTS: Cyclin D1 protein was not expressed in normal mucosa, hyperplastic polyp and gastric adenoma, while it was only positively expressed in gastric carcinoma. The expression rate of cyclin D1 protein in early stage gastric carcinoma, advanced gastric carcinoma and lymph node metastasis was 48.1%, 47.4% and 50.0%, respectively. The amplification of cyclin D1 gene was detected in 16.6% of advanced gastric carcinomas. The overexpression of cyclin D1 mRNA was detected in 40.5% of the samples. There was no significant correlation between cyclin D1 protein expression and age, lymph-node metastasis and histological grading in patients with advanced gastric carcinoma (chi2 = 0.038, 0.059, 0.241, P>0.05). Significant correlation was observed between the expression of cyclin D1 protein and the 5-year survival rate (chi2 = 3.92, P<0.05). CONCLUSION: Detection of cyclin D1 protein by immunohistochemistry may be useful in the diagnosis of early gastric carcinomas. Patients with positive expression of cyclin D1 protein tend to have a worse prognosis.     

Expresion of cell adhesion molecule CD44 in primary tumors of the liver: an immunohistochemical study

Abstract: CD44, a widely distributed integral membrane protein, has been implicated in tumor invasion and metastatic spread in some human carcinomas and lymphomas. In this study, 35 cases of hepatocellular carcinoma from 32 patients (11 cholangiocarcinomas, 9 hepatic adenomas, and 5 cases of focal nodular hyperplasia, a non-neoplastic lesion) were examined by imunohistochemical methods for expression of CD44. The mouse monoclonal antibody A3D8 was used on formalin-fixed, paraffin-embedded tissue; this antibody does not distinguish between standard CD44 and splice variants. Positive membrane staining was seen in 13 of 35 cases of hepatocellular carcinoma (12 of 32 patients), 8 of 11 cases of cholangiocarcinoma, and 1 of 9 cases of hepatic adenoma. The strongest staining for CD44 was seen in two cases of fibrolamellar carcinoma, but CD44 expression was otherwise not related to degree of tumor differentiation. All five cases of focal nodular hyperplasia were negative for CD44. In non-neoplastic liver, hepatocytes were negative; sinusoidal lining cells and portal lymphocytes were positive; bile ducts and proliferating bile ductules were focally positive in some cases. Anatomic stage at time of presentation was similar in both groups of patients, with most patients presenting with stage III or IV disease. A trend towards slightly longer survival in patients whose hepatocellular carcinomas were CD44 negative was noted. These results show that aberrant CD44 expression is present in a subset of hepatocellular carcinomas and in most cholangiocarcinomas. The relationship between CD44 expression and tumor spread is unclear in this group of tumors, but is unlikely to be a simple association between CD44 expression and metastatic potential.     

脑出血和脑梗死患者止、凝血分子标志物的检测及意义

应用ELISA法对60例脑梗死患者,30例脑出血患者和对照组50例健康体检查进行血浆TM,ET－1,P－selection,D-Dimer测定,PC活性以发色底物法测定,结果发现,脑梗死组TM,ET－1,P-selection含量显著高于对照组（P＜0．05或P＜0．01）,脑出血组PC活性及D－Dmier含量均显著高于对照组（P＜0．05或P＜0．01）,TM,ET－1含量增高提示脑梗死患者有较严重的血管内皮损伤,P－selection含量增高则提示脑梗死患者血小板被激活,为临床抗血小板聚集及保护血管内皮治疗提供了理论依据,,而高水平的PC和D－Dimer则说明脑出血患者存在抗凝系统及纤溶系统的异常。     

Immunohistochemical expression of Cyclin D1, Cyclin E,p21/waf1 and p27/kip1 in inflammatory bowel disease: correlation with other cell-cycle-related proteins (Rb,p53, ki-67 and PCNA) and clinicopathological features

Background and aims The expression patterns of cyclins D1 and E as well as cyclin-dependent kinase inhibitors p21/waf1 and p27/kip1 and their correlation with clinical parameters and other cell cycle regulators was investigated in inflammatory bowel disease (IBD).Patients and methods These molecular markers were localized immunohistochemically using the monoclonal antibodies anti-cyclin D1 (DCS-6), anti-cyclin E (13A3), anti-p21 (4D10) and anti-p27 (1B4) in 70 patients with IBD, 30 patients with colorectal cancer and eight healthy subjects. Data were analyzed statistically using the software program.Results Cyclin D1 expression was higher in both UC and CD compared with the healthy control group. In addition, CD cyclin D1 expression was higher compared with UC cases and colorectal carcinomas. Cyclin D1 expression was correlated with disease activity and cell proliferation in UC cases. A positive relationship of cyclin D1 with p27/kip1 in both UC and CD was detected. Cyclin E expression was higher in UC, CD and carcinomas compared with healthy control group and its expression correlated with proliferative activity in both UC and CD cases. p21/waf1 expression was higher in IBD cases compared with that of the control group, while a decreased p21/waf1 expression in the group of carcinomas was noted. This expression was correlated with disease activity in UC and the proliferative activity in both UC and CD. The expression of cyclins D1 and E as well as p21/waf1 was also correlated with the existence of dysplastic lesions. A lower p27/kip1 expression in the group of carcinomas compared with IBD cases and healthy controls was found.Conclusions The expression patterns of cyclin D1, cyclin E, p21/waf1 and p27/kip1 in IBD may indicate their contribution in epithelial cell turnover and their possible implication in IBD-related dysplasia-carcinoma.     

p62 Expression in primary carcinomas of the digestive system

AIM: To characterize p62 expression and define the relationship between p62 expression and cell proliferation in primary carcinomas of the digestive system. METHODS: p62 expression was characterized in surgically resected tumor specimens from 60 patients with primary carcinomas of the digestive tract (including 22 esophageal carcinomas, 17 gastric carcinomas, and 21 colorectal carcinomas) and 40 patients with hepatocellular carcinoma (HCC) by immunohistochemistry (IHC). The cell proliferation was determined by IHC of Ki-67 in 40 patients with HCC. RESULTS: Twenty-two cases of esophageal carcinoma were histopathologically diagnosed as squamous cell carcinoma. We combined the gastric and colorectal carcinomas based on the equivalent histology. The 38 tumors in the combined groups, consisted of 17 well-differentiated, eight moderately differentiated, nine poorly differentiated carcinomas, and four mucinous adenocarcinomas. According to the criteria of Edmondson and Steiner, 40 patients with HCC were graded (2 grade Ⅰ,17 grade Ⅱ and 21 grade Ⅲ). p62 expression in primary carcinomas of the gastrointestinal tract (60/60,100%) was higher than that (27/40, 67.5%) of HCC (P<0.01, %2 = 19.63). High expression levels of p62 were positively correlated with histological grades in gastric and colorectal carcinomas (P<0.0001) and inversely associated with those in HCC (P = 0.0322). No significant correlations were observed for esophageal carcinomas (P = 0.8246). p62 expression was also detected in the cytoplasm of morphologically normal columnar epithelial cells adjacent to the cancer foci of gastric and colorectal carcinomas. In 40 HCC specimens, the mean Ki-67 labeling index (LI) was (19.6±16.0)%. It was (28.3±18.73)% in 12 cases with high p62 expression (+++), (7.53±14.83)% in 13 cases without p62 expression(-). Patients with a high p62 expression showed a significantly higher level of Ki-67 staining than those without p62 expression (P<0.05, t = 2,069). CONCLUSION: p62 expression is common in carcinomas of the digestive system and higher in carcinomas of the gastrointestinal tract than in primary HCC. p62 is a cellular differentiation-related protein. Cancer cells with a high p62 expression exhibited highgrowth fractions in HCC.     

维生素D及其受体在非小细胞肺癌发病中的表达及意义

目的通过检测非小细胞肺癌(non-small cell lung carcinoma,NSCLC)患者血清中维生素D(Vitamin D,VD)的水平,以及肺癌组织与癌旁正常组织中维生素D受体(Vitamin D receptor,VDR)的表达差异,探讨VD及VDR在NSCLC发病中的表达及意义。方法选取2015年1月-2016年1月在我院呼吸科住院确诊NSCLC的患者80例为病例组,选取80例本院同期健康体检者为对照组。病例组中行外科手术切除的患者60例,根据分化程度分为高、中、低分化三组。采用酶联免疫吸附测定法检测NSCLC患者及健康人群血清中的VD水平;采用免疫组化法分析NSCLC患者的癌组织与癌旁正常组织中VDR的表达差异,并分析其与分化程度之间的关系。结果 NSCLC患者的血清VD水平较健康人群低(P0.05)。NSCLC患者肺癌组织中的VDR阳性表达显著低于正常癌旁组织(P0.05),且VDR的表达水平与癌组织的分化程度之间有显著关联。高、中、低分化3组VDR的表达水平呈依次降低的趋势(P0.05)。结论 VD可能是NSCLC发病中的一个保护性因素,并且VDR的表达水平和NSCLC的分化程度相关。     

Neuropilin-1在食管鳞癌中的表达及其意义

目的探讨Neuropilin-1(NRP-1)在食管鳞癌中的表达及其生物学和临床意义.方法取42例新鲜原发食管鳞癌和邻近正常食管粘膜标本,所有的标本均经病理诊断确诊.用RT-PCR方法检测每例患者癌组织和相应癌旁正常组织中NRP-1mRNA的表达.癌与癌旁正常组织表达值之间的比较采用配对t检验,癌组织的表达值与临床病理因素之间的关系采用成组t检验,检验结果以P＜0.05为有意义.结果在42例患者中,37例NRP-1mRNA表达强于相应癌旁正常组织,占89.00%,肿瘤直径≥3 cm组、外膜浸润组和淋巴结转移组的NRP-1mRNA表达明显增高.癌组织中NRP-1mRNA的表达与肿瘤分化程度和性别无关.结论在食管鳞癌中NRP-1mRNA的表达明显高于癌旁正常组织,并且与食管鳞癌的发展、浸润和转移有关.     

胃癌患者检测表皮生长因子及受体的意义

目的:探讨表皮生长因子(EGF)及其受体(EGFR)的表达与胃癌发生及胃癌生物学行为的关系。方法:采用免疫组化S-P法对50例胃癌进行研究。结果:EGF和EGFR在早期胃癌中的阳性率均为20％(2/10),在进展期胃癌的阳性率分别为62.5％(25/40)和60％(24/40),进展期胃癌EGF和EGFR的阳性率均显著高于早期胃癌(P<0.05)。有转移组的EGF及EGFR阳性率高于无转移组(P<0.05)。EGF及EGFR的表达与胃癌的组织学类型有关。结论:EGF及EGFR阳性的肿瘤可能具有更强的浸润与转移能力,检测EGF和EGFR有助于判断胃癌预后。     

慢性肝炎及肝炎相关肿瘤与血浆血管内皮生长因子表达的研究

前瞻性评估慢性乙型肝炎及乙肝相关肿瘤与血浆血管内皮细胞生长因子(VEGF)表达的关系。采用酶 联免疫夹心法(ELISA)测定血浆VEGF,分别对20例健康成人、20例慢性乙型肝炎及40例HCC患者测量血浆VEGF 水平。结果显示:乙肝患者VEGF水平显著高于健康成人;乙肝患者VEGF水平低于HBsAg阴性肿瘤;HBsAg阳性 肿瘤患者VEGF水平显著高于HBsAg阴性患者。VEGF表达水平与肝病严重程度成正相关,HBsAg阳性肝细胞癌血 浆VEGF表达显著增加。