青石棉致胸膜间皮瘤42例临床分析

分析42例资料完整的接触青石棉致胸膜间皮瘤病例的临床症状及诊断方法,并结合该病的发病机理,探讨本地区胸膜间皮瘤高发的原因。     

石棉肺合并恶性胸膜间皮瘤1例

介绍1例石棉肺合并恶性胸膜间皮瘤患者的临床资料、胸膜活检病理结果,探讨恶性胸膜间皮瘤的病因。     

青石棉诱发大鼠胸膜间皮瘤

本文采用右胸腔内注入染尘法，对大鼠染青石棉尘４０ｍｇ。收集１９例胸膜间皮瘤标本，提取标本中ＤＮＡ，用人工合成的寡核苷酸引物行ＰＣＲ体外扩增，再用ｒ－（３２）ＰＡＴＰ标记正常和两种空变Ｋｉ－ｒａｓ１２位探针，杂交，放射自显影。结果表明，７例正常对照组标本Ｋｉ－ｒａｓ１２位点突变为阴性；１９例间皮瘤标本中，２例突变阳性，其中１例由ＧＧＴ（Ｇｌｙ）突变为ＡＧＴ（Ｓｅｒ），１例由ＧＧＴ（Ｇｌｙ）突变为ＴＧＴ（Ｃｙｓ）。     

青石棉污染与间皮瘤

本文对某县乡镇企业发展后青石棉污染及其危害进行了调查。近年来临床发现10余例间皮瘤病人,其中5人经活检,尸解证实。发病到死亡最短3个月,最长23个月,发病年龄最小仅24岁。横断面调查发现胸膜斑包括胸膜斑钙化,检出率高达19.8%(40岁以上),另有16例农民石棉肺。回顾性队列流行病学调查表明,肺癌标化死亡比(SMR)为6.93,死亡年龄45岁,比全国肺癌死亡年龄提前14年。胸膜间皮瘤年发病率为85/百万/年。动物实验大鼠胸膜间皮瘤诱发率为56%,与UICC青石棉相似(57%)。     

大姚县青石棉污染区肺癌、间皮瘤危险因素的病例对照研究

目的：探索云南省大姚县肺癌、间皮瘤高发的主要危险因素，为预防控制工作提供依据。方法：采用1：2配比病例对照研究的方法，对当地发现的47例病例（31例肺癌和16例间皮瘤）和匹配了性别、年龄的94例对照的各种可能与肺癌、间皮瘤有关的危险因素（包括吸烟习惯、石棉暴露情况及肿瘤家族史等）进行调查，用条件Logistic回归模型对资料进行分析。结果：资料分析显示，家庭环境中石棉污染、吸烟同肺癌和间皮瘤之间关联差异有显著性，OR分别为3．60（95％CI 1．03，12．62）和3．30（95％CI 1．90 ，10．02）；在石棉污染的几个因素中，使用石棉炉与肺癌的关联差异有显著性，OR为1．63（95％CI 1．30，20．24）。单因素分析发现，使用石棉炉时间的长短与肺癌有关，使用石棉炉在11－20年、21－30年及31年以上者的OR分别是5．34（95％CI 1．12，25．47）、8．50（95％CI0．78 ，93．23）、14．09（95％CI0．91，218．61）。结论：大姚县肺癌和间皮瘤的高发可能与当地的石棉环境污染有关，特别是与生活中石棉炉的使用有关。     

青石棉污染区农民恶性肿瘤死亡率的回顾队列调查

目的：了解在生活环境中接触低浓度青石棉、农民患恶性肿瘤,特别是间皮瘤和肺癌之间的关系。方法：采用回顾队列调查方法对青石棉污染区的农民进行恶性肿瘤死亡率的调查,以该县无石棉污染的农民为对照,结果：观察组有5人死于间皮瘤死亡率为36．46／10万人年,而对照组无1例发生;肺癌死亡率为43．75／10万人年,与对照组比较,差别有非常显著性意义（P＜0．001）,结论：间皮瘤死亡率在青石棉污染区很高,青石棉与间皮瘤,肺癌之间存在很强的病因学联系。     

青石棉诱发大鼠胸膜间皮瘤Ki—ras癌基因点突变研究

本文采用右胸腔内注入染尘法，对大鼠染青石棉尘４０ｍｇ。收集１９例胸膜间皮瘤标本，提取标本中ＤＮＡ，用人工合成的寡核苷酸引物行ＰＣＲ体外扩增，再用ｒ＾３２ＰＡＴＰ标记正常和两种空变Ｋｉ－ｒａｓ１２位探针，杂交，放射自显影。结果表明，７例正常对照组标本Ｋｉ－ｒａｓ１２位点突变为阴性；１９例间皮瘤标本中，２例突变阳性，其中１例由ＧＧＴ（Ｓｅｒ），１例由ＧＧＴ（Ｇｌｙ）突变为ＴＧＴ（Ｃｙｓ）。     

石棉肺合并胸膜间皮瘤1例报道

石棉肺合并胸膜间皮瘤１例报道罗景星石棉可引起人和动物的肺癌、胸和腹膜恶性间皮瘤已被大量流行病学调查和动物实验证实。但在实际临床中,石棉肺合并胸膜间皮瘤的病例较少见,现将收治的１例报道如下。１病例介绍王某,男性,６８岁,住院号１０４５０５３。某石棉厂退...     

青石棉污染区恶性肿瘤9年回顾队列研究

为了证实非职业性环境接触青石棉与恶性肿瘤，特别是肺癌和间皮瘤危险的关系，采用回顾性队列调查方法对大姚县青石棉污染区进行９年的死亡率调查。选择同省无石棉污染的禄丰县作为对照。结果表明：恶性肿瘤的死亡率为１８２．６０／１０万，其中肺癌死亡率为５３．２６／１０万，相对危险度高于对照，ＲＲ分别为１．４７，２．１４（Ｐ＜０．０１）；观察组中７例死于间皮瘤。提示：间皮瘤的死亡率在青石棉污染区是很高的，在３０岁以上人中，年死亡率为１７．７５／１０万人年，而对照组中未观察到间皮瘤。     

Identification of a new potential plasmatic biomarker panel for the diagnosis of malignant pleural mesothelioma

Background:Malignant pleural mesothelioma (MPM) is a rare, highly aggressive tumor strongly associated with asbestos exposure and characterized by poor prognosis. Currently, diagnosis is based on invasive techniques; thus, there is a need to identify non-invasive biomarkers to detect the disease. In the present study, we measured the plasmatic concentrations of Mesothelin, Fibulin-3, and HMGB1 protein biomarkers and of hsa-miR-30e-3p and hsa-miR-103a-3p Extracellular-Vesicles- embedded micro RNAs (EV-miRNAs). We tested the ability of these biomarkers to discriminate between MPM and PAE subjects alone and in combination.Methods:The study was conducted on a population of 26 patients with MPM and 54 healthy subjects with previous asbestos exposure (PAE). Mesothelin, Fibulin-3, and HMGB1 protein biomarkers were measured by the enzyme-linked immunosorbent assay (ELISA) technique; the levels of hsa-miR-30e-3p and hsa-miR-103a-3p EV-miRNAs was assessed by real-time quantitative PCR (qPCR).Results:The most discriminating single biomarker resulted to be Fibulin-3 (AUC 0.94 CI 95% 0.88-1.0; Sensitivity 88%; Specificity 87%). After investigating the possible combinations, the best performance was obtained by the three protein biomarkers Mesothelin, Fibulin-3, and HMGB1 (AUC 0.99 CI 95% 0.97-1.0; Sensitivity 96%; Specificity 93%).Conclusions:The results obtained contribute to identifying new potential non-invasive biomarkers for diagnosing MPM. Further studies are needed to validate the evidence obtained to assess the reliability of the proposed biomarker panel.     

Pleural plaques as risk indicators for malignant pleural mesothelioma: A necropsy-based study

Pleural plaque is recognized as a reliable marker of previous exposure to asbestos. However, it is controversial whether pleural plaque is a risk indicator for asbestos-related malignancies. In the present study, the thoracic cavities were examined for pleural plaques in 3,005 necropsies performed at the Monfalcone Hospital in people aged 15 years or older. Plaques were classified into three classes: 1, small (plaques measuring 1–4 cm in major diameter); 3, large (plaques involving a major part of a hemithorax); and 2, moderate (intermediate conditions). The prevalences of pleural plaques were 70.9% among men, and 24.0% among women. The prevalences of plaques (total plaques, various classes) among subjects with pleural mesothelioma were compared with those observed in the remaining cases. The series included 92 subjects with malignant pleural mesothelioma (82 men and 10 women). Mesothelioma cases showed higher prevalences of total plaques as well as higher prevalences of classes 1, 2, and 3, when compared with controls. These differences reached the statistical significance for total plaques, and classes 2,3. The present data are consistent with the idea that pleural plaque is a risk indicator for pleural mesothelioma. Am. J. Ind. Med. 32:445–449, 1997. © 1997 Wiley-Liss, Inc.     

恶性间皮瘤免疫组化诊断30例

目的借助免疫组化技术，在光镜下确诊恶性间皮瘤。方法运用胰蛋白酶消化ＳＰ法及商品化的癌胚抗原（ｃａｒｃｉｎｏｅｍｂｒｙｏｎｉｃａｎｔｉｇｅｎ，ＣＥＡ）、角蛋白（ｋｅｒａｔｉｎ）和波形蛋白（ｖｉｍｅｎｔｉｎ），对３０例恶性间皮瘤组织进行了免疫组化研究。结果（１）恶性间皮瘤组织基本不表达癌胚抗原，藉此可以剔除癌的混杂。（２）恶性间皮瘤具有既表达细胞角蛋白（阳性率４３％），又表达波形蛋白（阳性率７０％）的免疫组化特征，藉此可以与其它间叶来源的恶性肿瘤相区别。结论同时运用３种抗体进行免疫组化染色，可为在光镜下确诊恶性间皮瘤提供可靠的诊断依据。     

恶性肿瘤患者手术后医院获得真菌性肺炎的危险因素分析

目的 了解恶性肿瘤患者手术后发生医院获得性真菌性肺炎(HAFP),分析其危险因素,并探讨护理对策.方法 采用回顾性调查方法,对2009年1月—2011年12月接受手术的558例肺癌、食管癌、纵隔肿瘤、胃癌和鼻咽癌患者临床资料进行统计分析,要求HAFP确诊患者应具有肺部感染症状,从痰液或气道刷检液标本中至少2次分离到相同的真菌.结果 3年共发生HAFP患者66例,总感染率为11.8％;感染率以肺癌和食管癌最高,分别为24.2％和16.0％,其次是鼻咽癌、纵隔肿瘤和胃癌,分别为14.3％、11.8％和2.2％;患者年龄、住院时间、机械通气、抗肿瘤药物、激素/免疫抑制剂和抗菌药物的长时间使用是发生HAFP的主要危险因素;HAFP的病原菌主要是假丝酵母菌属,共63株占95.5％.结论 加强对肿瘤患者的心理疏导,加强对其他疾病的治疗,控制侵入性医疗操作,合理使用激素及和抗菌药物,严格各项无菌医疗操作是降低HAFP感染率的有效措施.     

恶性间皮瘤p16蛋白表达的研究

目的研究恶性间皮瘤与ｐ１６蛋白表达的关系。方法利用微波煮沸脱交联ＳＰ法，对３４例恶性间皮瘤病理标本进行了ｐ１６蛋白表达的研究。结果ｐ１６蛋白阳性表达率５３％（１８／３４），４７％（１６／３４）的病例细胞内缺乏ｐ１６蛋白的表达。多数存在ｐ１６蛋白表达的病例没有发现ｐ５３基因的点突变；反之，存在ｐ５３基因的点突变的病例多数都没有ｐ１６蛋白的表达。ｐ１６蛋白表达与ｐ５３基因点突变之间呈明显的负相关关系。结论恶性间皮瘤可能同时存在ｐ５３和ｐ１６基因的异常，肿瘤组织细胞内缺乏ｐ１６蛋白的表达可能与ｐ１６基因的纯合缺失有关。     

A case of malignant mesothelioma in a rice-starch factory

Introduction Recent reports of cases of malignant mesothelioma (MM) in “non-traditional” areas of employment are an indication of the numerous occasions in which exposure to asbestos has occurred in the workplace. We describe an unusual case of occupational exposure to asbestos to stress the importance of careful history taking when assessing a patient’s work history, especially in generic occupations in which there is apparently no exposure to asbestos. Case report Malignant mesothelioma was diagnosed in a woman worker employed in a factory making rice starch. She had worked in the storehouse of the factory for approximately 40 years. From circumstantial interviews with relatives and workmates, it emerged that her job involved retrieving, for re-use, the jute sacks in which the rice was transported. More than one source remembered distinctly that some of the sacks had “Asbestos” written on the outside. Discussion This case provides further confirmation of the importance of careful history taking among workers with mesothelioma to avoid failing to diagnose occupational disease. It also highlights the risk of asbestos exposure represented by recycling asbestos-contaminated sacks in both occupational and non-occupational settings.