康莱特注射液对胃肠道恶性肿瘤患者免疫功能的影响

目的　探讨康莱特注射液对胃肠道恶性肿瘤患者免疫功能的影响。方法　对 ５０ 例胃肠道恶性肿瘤病人分别于术前、术后３ 周抽取外周血对 Ｔ 淋巴细胞亚群和血清 Ｓ Ｉ Ｌ２ Ｒ 水平表达进行检测,随机将 ５０ 例患者分为单纯手术组（２８ 例）和应用康莱特组（２２ 组）,并与 ４２ 例健康人对照比较。结果　与正常对照组相比胃肠道恶性肿瘤病人 Ｔ 淋巴细胞亚群中 Ｃ Ｄ３＋ 细胞、 Ｃ Ｄ４＋ 细胞减少, Ｃ Ｄ４＋ ／ Ｃ Ｄ８＋ 细胞比值下降（ Ｐ＜ ０．０５）,血清 Ｓ Ｉ Ｌ２ Ｒ 水平升高（ Ｐ＜ ０．０１）;手术切除肿瘤后, Ｃ Ｄ３＋ 细胞、 Ｃ Ｄ４＋ 细胞增加, Ｃ Ｄ４＋ ／ Ｃ Ｄ８＋ 细胞比值升高（ Ｐ＜ ０．０５）,血清 Ｓ Ｉ Ｌ２ Ｒ 水平降低（ Ｐ＜ ０．０１）。使用康莱特注射液后, Ｃ Ｄ３＋ 细胞、 Ｃ Ｄ４＋ 细胞明显增加, Ｃ Ｄ４＋ ／ Ｃ Ｄ８＋ 细胞比值增高（ Ｐ＜ ０．０５）, Ｓ Ｉ Ｌ２ Ｒ水平下降（ Ｐ＜ ０．０５）。结论　康莱特注射液能明显提高胃肠道恶性肿瘤患者的免疫功能。     

NK和sIL-2R在肺癌化疗中的临床价值

为了评价肺癌患者化疗后血清ＮＫ细胞活性及ｓＩＬ－２Ｒ水平变化的临床价值，作者采用ＬＤＨ释放法和双抗体夹心ＥＬＩＳＡ法检测４７例肺癌病人和４１例正常对照者的血清ＮＫ细胞活性和ｓＩＬ－２Ｒ水平。结果显示，与正常人相比，肺癌病人血清ｓＩＬ－２Ｒ水平增高（Ｐ＜０．０１），ＮＫ细胞活性降低（Ｐ＜０．０５），且化疗后有效病人血清ｓＩＬ－２Ｒ水平明显低于化疗前（Ｐ＜０．０１）。结果提示血清ＮＫ细胞活性和ｓＩＬ－２Ｒ水平可以作为判断肺癌疗效和预后的指标。     

CD3AK细胞和LAK细胞治疗晚期恶性肿瘤的临床和实验研究

将５１例晚期恶性肿瘤患者（男性２３例，女性２８例）分成两组，其中一组（３１例）以ＣＤ３ＭｃＡｂ（ＣＤ３单克隆抗体）和小剂量ＩＬ－２（５００ｕ／ｍｌ）共同诱导的ＣＤ３ＡＫ细胞治疗，另一组（２０例）输注大剂量ＩＬ－２（１０００ｕ／ｍｌ）诱导的常规ＬＡＫ细胞治疗，以探讨降低ＩＬ－２用量、提高杀伤细胞细胞毒活性的可能性。结果显示ＣＤ３ＡＫ组患者生活质量改善、症状缓解均优于ＬＡＫ组。ＣＤ３ＡＫ组ＰＲ＋ＭＲ率较ＬＡＫ组高２９．０％，Ｓ＋Ｐ率和死亡率分别较ＬＡＫ组低１２．４％和９．６％。同时比较了ＣＤ３ＡＫ细胞与ＬＡＫ细胞的体外增殖和细胞毒活性，结果表明ＣＤ３ＡＫ细胞增殖率高于ＬＡＫ细胞（Ｐ＜０．０１），靶细胞抑制率二者在０．０５水平无显著差异。提示ＣＤ３ＭｃＡｂ在刺激杀伤细胞活性，尤其在提高其增殖能力方面，具有显著的作用，ＣＤ３ＡＫ／ＩＬ－２能更有效地治疗晚期恶性肿瘤。     

小剂量IL-2和IFNα与TNFα联合治疗恶性肿瘤的免疫学与临床研究

目的:研究小剂量细胞因子在恶性肿瘤免疫治疗中的意义。方法:全身应用小剂量重组干扰素(ＩＦＮα２ｂ)、白细胞介素－２(ＩＬ－２)和肿瘤坏死因子(α－ＴＮＦ)联合治疗多种恶性肿瘤６０例。应用ＡＰＡＡＰ法和免疫单向扩散法(ＲＩＤ)分析了治疗前后患者外周血中Ｔ、Ｂ淋巳细胞、ＮＫ细胞、免疫球蛋白(Ｉｇ)和补体Ｃ３活性。结果:治疗１个疗程后外周血中ＣＤ４＋的Ｔ淋巴细胞和ＣＤ２３＋的Ｂ淋巴细胞显著的高于治疗前水平(Ｐ＜０．０５);ＣＤ４＋/ＣＤ８＋比值也明显增高(Ｐ＜０．０１)。免疫球蛋白(ＩｇＭ)活性亦显著的高于治疗前水平(Ｐ＜０．０５)。ＫＰＳ积分较治疗前明显增高(Ｐ＜０．００１)。治疗后细胞因子加化疗组的ＫＰＳ积分平均增高２８．５分(Ｐ＜０．００１);ＣＲ ２６例(６５．０%);ＰＲ １１例(２７．５%),总有效率８２．５%。单纯细胞因子治疗组的ＫＰＳ积分平均增高２３分(Ｐ＜０．００１);ＰＲ １３例(６５．０%),总有效率６５．０%。结论:本方案可以显著的提高多种恶性肿瘤患者的细胞免疫和体液免疫。有可能提高肿瘤的化疗效果和患者的生存质量,延长生存期。     

低剂量IL-2诱导的人胚胎脾脏CD_3AK细胞治疗晚期恶性肿瘤效果及实验研究

用ＣＤ３ＭｃＡｂ和低剂量ＩＬ－２（５００Ｕ／ｍｌ）诱导的人胎脾ＣＤ３ＡＫ细胞治疗４３例晚期恶性肿瘤患者，取得疗效。经２～８疗程治疗，多数患者症状缓解，生活质量改善，ＰＲ＋ＭＲ１８例（４１．９％），Ｓ＋Ｐ２５例（５８．１％），死亡９例（２０．９％）。全组无严重毒副反应发生。同时比较ＣＤ３ＡＫ细胞和常规ＬＡＫ细胞体外增殖及其杀伤活性，表明前者１４４ｈ增殖力高于后者（Ｐ＜０．０１），靶细胞抑制率二者无显著差异（Ｐ＞０．０５）。初步表明ＣＤ３ＡＫ／ＩＬ－２疗法效果肯定，毒副作用小，可能成为继ＬＡＫ／ＩＬ－２之后更为有效的肿瘤辅助治疗。     

癌性渗出液中IL-2、IL-6、IL-8、TNFα·论著·和IFNγ活性分析

目的与方法应用ＥＬＩＳＡ法研究了１８例癌性渗出液（ＭＯＦ）中内源性ＩＬ－２、ＩＬ－６、ＩＬ－８、ＩＦＮγ和ＴＦＮα的生物学活性,并与恶性肿瘤病人（ＭＴＤ）血清、正常人、结核性胸膜炎（ＴＢＰ）和肝硬化病人（ＣＲＳ）进行了比较分析。结果ＭＴＤ血清中ＩＬ－６活性高于与正常成人组（Ｐ＜０．０５）;ＩＬ－２和ＩＦＮγ活性亦低下（Ｐ＜０．５）。ＭＴＤ血清中ＩＬ－２、ＩＬ－６ＴＮＦα活性显著低于ＴＢＰ（Ｐ＜０．００１）;ＩＬ－８和ＩＦＮγ活性亦降低（Ｐ＜０．０５）。ＭＯＦ中的ＩＬ－６、ＩＦＮγ水平显著高于ＴＢＰ组（Ｐ＜０．０１;Ｐ＜０．０５）;ＩＬ－２却明显降低（Ｐ＜０．０５）。ＭＴＤ血清中ＩＬ－２、ＩＬ－６低于ＣＲＳ组（Ｐ＜０．０５）;ＭＯＦ中ＩＬ－６、ＩＮＦγ水平高于ＣＨＡＤ组（Ｐ＜０．００１;Ｐ＜０．０５）;ＩＬ－２和ＩＬ－８则低于ＣＲＳ组（Ｐ＜０．０５;Ｐ＜０．０１）。结论ＭＴＤ血清和ＭＯＦ中ＩＬ－２、ＩＬ－６、ＩＬ－８和ＩＦＮγ活性反映了ＭＴＤ抗肿瘤免疫的功能状态。ＩＬ－６和ＩＬ－８活性对于ＭＴＤ预后的估计具有重要的意义。     

恶性淋巴瘤患者脑脊液可溶性白细胞介素2受体水平的动态观？…

用双抗体夹心ＥＬＩＳＡ方法动态监测４６例恶性淋巴瘤（ＭＬ）患者脑脊液（ＣＳＦ）中可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平变化。发现ＭＬ患者脑脊液中ｓＩＬ－２Ｒ比正常人显著升高（Ｐ〈０．００１），且６例有中枢神经系统（ＣＮＳ）浸润者ｓＩＬ－２Ｒ与无ＣＮＳ浸润者相比有显著性差异（Ｐ〈０．０１）；而治疗达ＣＲ或ＰＲ后ｓＩＬ－２Ｒ显著降低（Ｐ〈０．０５），与正常人者相比Ｐ〉０．０５，脑脊液ｓＩＬ－２Ｒ水     

恶性淋巴瘤患者脑脊液可溶性白细胞介素2受体水平的动态观察及其临床意义

用双抗体夹心ＥＬＩＳＡ方法动态监测４６例恶性淋巴瘤（ＭＬ）患者脑脊液（ＣＳＦ）中可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平变化。发现ＭＬ患者脑脊液中ｓＩＬ－２Ｒ比正常人显著升高（Ｐ＜０．００１），且６例有中枢神经系统（ＣＮＳ）浸润者ｓＩＬ－２Ｒ与无ＣＮＳ浸润者相比有显著性差异（Ｐ＜０．０１）；而治疗达ＣＲ或ＰＲ后ｓＩＬ－２Ｒ显著降低（Ｐ＜０．０５），与正常人者相比Ｐ＞０．０５，脑脊液ｓＩＬ－２Ｒ水平与血清中ｓＩＬ－２Ｒ水平无显著相关性。认为动态监测ＭＬ患者脑脊液ｓＩＬ－２Ｒ水平有助于估价病变严重程度、ＣＮＳ有无浸润及疗效评定     

胃癌患者血清sIL—2R测定的临床价值

应用双抗加心法对７８例胃癌患者血清可溶性白介素２受体（ｓＩＬ－２Ｒ）进行临床研究。结果发现：胃癌患者ｓＩＬ－２Ｒ水平明显高于胃良性疾病患者和正常人（Ｐ〈０．０１）；Ⅲ、Ⅳ期高于Ｉ、Ⅱ期（Ｐ〈０．０５）；手术切除后（根治或姑息）ｓＩＬ－２Ｒ显著下降（Ｐ〈０．０１）；手术后复发和转移患者血清ｓＩＬ－２Ｒ升高（Ｐ〈０．０１）；如果患者血清ｓＩＬ－２Ｒ高于１０００Ｕ／ｍｌ，生存期短。提示胃癌患者ｓＩＬ－２     

胃癌病人血清sIL－2R水平与红细胞免疫功能的相关性研究

作者采用双抗体夹心ＥＬＩＳＡ法和红细胞Ｃ３ｂ酵母多糖法检测４７例胃癌病人血清可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平与红细胞免疫功能的变化，并与正常对照组４０例相比较，结果显示：胃癌病人血清ｓＩＬ－２Ｒ水平增高（Ｐ＜０．０１），红细胞免疫功能低下（Ｐ＜０．０１）；血清ｓＩＬ－２Ｒ水平与ＲＢＣＣ３ｂＲ呈负相关（ｒ＝－０．６７，Ｐ＜０．０１）。提示：胃癌病人有免疫功能的紊乱，血清ｓＩＬ－２Ｒ水平的增高和红细胞免疫功能的低下可能与胃癌的发生发展有关。     

Gastric cancer

To prove the efficacy of adjuvant therapy for curatively resected advanced gastric cancer, large-scale randomized control trials are necessary based on the idea of EBM (Evidence Based Medicine). We had a long history of adjuvant therapy and many trials were conducted so far. However, many problems were also pointed out in past trials, even in the several trials with positive results. After accumulation of the knowledge of a good clinical trial, we started to organize study groups like JCOG (Japan Oncology Group) for high-quality clinical trials in Japan. The positive result of the National Surgical Adjuvant Study of Gastric Cancer (N. SAS-GC) is encouraging after the long period of negative results from adjuvant trials. This trial was well designed randomized clinical trial (RCT) with statistically significant difference of survivals,which suggest the efficacy of the adjuvant chemotherapy with UFT. However, because of the reduced sample size of this trial, we need one more trial with sufficient sample size to prove the efficacy of adjuvant chemotherapy for gastric cancer as the definitive evidence.     

Gastric adenocarcinoma

In spite of the declining incidence of gastric adenocarcinoma observed during the last 30 years in the U.S., this disease continues to carry a very bleak prognosis. Even with the best forms of treatment, the overall survival remains approximately 7%.Epidemiologic data within the past decade have given considerable new insight into the carcinogenesis of gastric cancer in high-risk areas worldwide as it relates to in vivo nitrate conversion to precarcinogens or carcinogenic substances. It is hope that further epidemiologic information will help to identify specific preventive measures to eliminate those environmental dietary factors that contribute to the incidence of gastric cancer in certain endemic areas.The only hope for cure after a diagnosis of gastric cancer is established lies with an extirpative surgical procedure possibly combined with an adjuvant chemotherapeutic regimen. In the presence of incurable disease, the best form of palliation is achieved with resection of the primary tumor, short of total gastrectomy. Palliative bypass procedures do not increase survival and any hope of improving the quality of life is highly question-able.Adjuvant forms of therapy using the known chemotherapeutic agents active against gastric adenocarcinoma provide the most likely means of improving survival associated with gastric cancer.     

Gastric carcinoma

Although gastric cancer is still a worldwide major public health concern, it remains relatively uncommon in the Western countries. Despite improvement in surgical morbidity and mortality, as well as significant advancement of chemotherapy and radiotherapy options, the survival for gastric cancer has not significantly improved over the past decades. In the United States, standard of care for localized resectable gastric cancer is with adjuvant chemoradiotherapy. In this article, we summarize salient randomized and phase II and III clinical trials representing current treatment for gastric cancer.     

Gastric cancer

With the development of related instruments and techniques, laparoscopic surgery has come to be applied to treatment of gastrointestinal malignancies as a minimally invasive surgery. For early gastric cancers with negligible risk of lymph node metastasis, endoscopic mucosal resection (EMR), laparoscopic wedge resection (LWR), and laparoscopic intragastric mucosal resection (IGMR) have been performed. For those with fairly sizable risk of lymph node metastasis, laparoscopy-assisted distal gastrectomy (LADG) is applied. Our studies have suggest that LADG is more useful than open distal gastrectomy in the management of patients with gastric cancer from the viewpoints of curability, minimal invasiveness, and quality of life of patients.     

Gastric carcinoid

PURPOSE OF REVIEW: Gastric carcinoid tumors are rare lesions but have been the focus of much scientific investigation. The incidence of gastric carcinoid appears to be increasing without a corresponding increase in survival, despite utilization of the latest available therapies. Therefore, there is great interest in furthering the understanding of the biologic basis of these tumors, delineating the connection between hypergastrinemia and gastric carcinoids, and most importantly, improving upon current treatment options. RECENT FINDINGS: This review discusses the current biologic understanding of gastric carcinoid tumors, including the role of hypergastrinemia on enterochromaffin-like cell proliferation and its relation to acid-suppressive therapy. Numerous diagnostic and therapeutic modalities including endoscopic ultrasound, somatostatin receptor scintigraphy, long-acting octreotide, hepatic artery embolization, endoscopic mucosal resection, and surgical resection have also been the focus of recent investigations. SUMMARY: Despite the many advances that have been made in both the basic science and clinical arenas, the optimal treatment of gastric carcinoid tumors is still a matter of debate. As the understanding of the biologic basis of gastric carcinoid tumors increases, the treatment will likely be a multimodal approach tailored to individual tumor biology and will incorporate a variety of diagnostic and therapeutic modalities.