肝癌组织碱性磷酸酶糖链结构的研究

目的 探讨肝癌组织碱性磷酸酶(ALP)N-糖链结构的改变及与肝癌侵袭性的关系。方法 用凝集素亲和层析法检测9例正常肝组织、16例肝癌组织和16例肝癌癌旁组织中ALP的多种凝集素结合率。凝集素包括L型红腰豆凝集素(L-PHA)、小扁豆凝集素(LCA)、蔓陀萝凝集素(DSA)、E型红腰豆凝集素(E-PHA)和黑接榾凝集素(SNA)等。结果 肝癌组织ALP的L-PHA、LCA、DSA、E-PHA和SNA结合率分别为22.94％±5.30%、55.97％±13.72％、38.16％±8.87％、11.56％±4.81％和69.80％±13.71％,均明显高于正常肝组织(5.89％±2.75％、36.20％±11.58％、17.90％±6.71％、5.38％±2.20％和57.32％±11.27%),t值分别为8.94、3.64、5.94、3.62和2.32,P值均<0.01;侵袭性肝癌组织ALP的L-PHA结合率(25.84％±4.67％)明显高于非侵袭性肝癌组织(18.10％±3.64％),t 3.71,P<0.01。结论 肝癌组织ALP的糖链结构发生改变,且ALP的L-PHA结合率与肝癌侵袭性有关。     

血清糖链抗原50对原发性肝癌的诊断价值

测定54例正常人、52例原发性肝癌(PHC)、40例肝硬化、29例肝囊肿和28例肝海绵状血管瘤患者血清糖链抗原50(CA50)含量。结果为PHC组血清CA50含量显著高于其他各组(P均<0.01),对PHC诊断的敏感性为86.5％,特异性为88.6％,阳性预计值为71.4％。在19例甲胎球蛋白(AFP)阴性PHC中16例CA50阳性,阳性率为84.2％。在小肝癌中CA50阳性率为71.4％。正常人假阳性率为3.7％。提示血。清CA50测定有助于PHC(尤其是AFP阴性和小肝癌者)的诊断,并对肝内占位性病变有鉴别诊断价值     

多天线N-糖链对双表型肝细胞癌的辅助诊断价值

目的 探讨双表型肝细胞癌（DPHCC）患者血清中多天线N-糖链（Multi-glycan）的表达及其临床意义。方法 收集2019年6月—2020年12月福建医科大学孟超肝胆医院65例DPHCC、80例原发性肝细胞癌（HCC）及120例肝硬化（LC）血清样本,采用基于DNA测序仪的荧光毛细管电泳（DSA-FACE）技术检测三组血清中N-糖链的表达,正态分布的计量资料两组间比较采用t检验,多组间比较采用方差分析;非正态分布的计量资料两组间比较采用 Mann-Whitney U检验,多组间比较采用 Kruskal-Wallis H检验。计数资料组间比较采用χ²检验。采用logistic回归方法建立常见指标模型。采用受试者工作特征（ROC）曲线评价AFP、PIVKA-Ⅱ、CEA、CA19-9及Multi-glycan诊断DPHCC的效能,ROC曲线下面积（AUC）比较采用Z检验。结果 在DPHCC组及HCC组比较中,仅Multi-glycan差异有统计学意义（P<0.001）,而AFP、PIVKA-Ⅱ、CEA、CA19-9及SUM差异均无统计学意义（P值均>0...     

血清癌胚抗原,糖链抗原及血清铁蛋白检测地大肠癌的诊断价值

用放射免疫法检测４１例大肠癌患者和２０例结肠炎患者血清ＣＥＡ、ＣＡ１９－９、ＳＦ含量。结果显示：大肠癌三项标记测定植均明显高于对照组（Ｐ〈０．０１）。三项指标中除ＣＥＡ在Ａ２期较高外，基本符合病理进行程序越深，肿瘤标记物检出率越高的标点。组织学分类中ＣＥＡ阳性率粘液腺癌〉乳头状腺癌，ＣＡ１９－９粘液腺癌〉管状腺癌〉乳头状腺癌，ＳＦ则管状腺癌明显〉乳头状腺癌（Ｐ〈０．０５）。三项标记物联合检测时其敏     

不同肝病病人血清转铁蛋白糖链的变化

目的寻找新的肝癌标志物。方法选择四种凝集素即小扁豆凝集素（ＬＣＡ），欧曼陀罗凝集素（ＤＳＡ），麦胚凝集素（ＷＧＡ）和红腰豆凝集素（ＥＰＨＡ），利用点印迹方法测定了不同肝病病人血清转铁蛋白（Ｔｆ）的糖链结构。结果转移性肝癌和肝脏良性肿瘤无明显变化，慢性肝病活动及原发性肝癌中可有Ｔｆ糖链的变化，包括多天线糖链的增加，含核心岩藻糖及含平分型Ｎ－乙酰氨基葡萄糖糖链的出现，而原发性肝癌病人的Ｔｆ的多天线糖链的含量较肝硬化高。结论提示Ｔｆ的ＤＳＡ结合反应可望成为原发性肝癌的诊断指标。     

N-糖链抑制剂对高糖刺激鼠肾系膜细胞粘着斑激酶表达及透明质酸分泌的影响

目的：观察N-糖链抑制剂衣霉素(TM)和1-deoxymannojirimycin(DMM)对高糖刺激肾小球系膜细胞(GMC)增生、粘着斑激酶(FAK)表达及透明质酸(HA)分泌的影响。方法：体外培养大鼠GMC，分为七组：正常组，高糖组，甘露醇组，高糖加衣霉素组，高糖加DMM组，并设TM、DMM对照组。采用四唑盐比色(MTT)法测定细胞增生，免疫组织化学方法测定粘着斑激酶(FAK)，放射免疫法测定透明质酸(HA)含量。结果：高糖可诱导GMC增生、增加FAK表达及HA分泌。相对于正常培养条件下生长的GMC，N-糖链抑制剂TM和DMM对高糖作用条件下的GMC增生、FAK活性及HA分泌有更为明显的抑制作用。结论：N-糖链抑制剂TM和DMM可通过阻断糖链的合成和改变糖链类型抑制高糖诱导的细胞增生、FAK活性及HA分泌的作用。     

肺癌患者异常糖链糖蛋白与传统肿瘤标志物的相关性分析

目的通过回顾性分析肺癌患者异常糖链糖蛋白(TAP)水平以及传统肿瘤标志物癌胚抗原(CEA)、鳞状细胞癌抗原(SCC)、糖类抗原125(CA125)、神经元特异性烯醇化酶(NSE)和细胞角蛋白19片段(CYFRA21-1)水平,探讨肺癌患者TAP与传统肿瘤标志物之间的相互关系。 方法分别采用凝聚素亲和法及电化学发光免疫分析法检测我院呼吸内科经治的181例肺癌患者TAP和5种血清学肿瘤标志物的水平,对所得TAP与5种血清学肿瘤标志物的数据进行spearman相关性检验分析。 结果肺癌患者TAP与CEA呈正相关(P＝0.016),而与SCC、CA125、NSE及CYFRA21-1之间没有相关性(P值均>0.05);亚组分析,腺癌、鳞癌患者的TAP与CEA均呈正相关(P值分别为0.021,0.044),腺癌、鳞癌、小细胞癌及未分类癌患者的TAP与CA125均呈正相关(P值分别0.046,0.007,0.001,0.006),而这四类癌的TAP与SCC、NSE和CYFRA21-1之间没有明显相关性(P值均>0.05)。 结论肺癌患者TAP值是CEA、CA125等多种肿瘤异常蛋白水平的综合体现,尤其在肺腺癌患者中与传统肿瘤标志物具有较好的正相关性。     

类风湿关节炎IgG糖链结构的变化在临床诊断中的价值

随着糖免疫学快速发展 ,人们发现血清中ＩｇＧ分子Ｆｃ段ＣＨ 2域Ａｓｎ 2 97位连接一条“双天线”糖链 ,正常人糖链末端多为两个半乳糖 (ＩｇＧ2 ) ,而类风湿关节炎 (ｒｈｅｕｍａｔｏｉｄａｒｔｈｒｉｔｉｓ ,ＲＡ)患者大多数两个半乳糖全部缺失 (将之定义为ＩｇＧ0 ) [1] 。半乳糖缺失后 ,Ｎ 乙酰葡糖胺 (ＧｌｃＮａｃ)暴露 ,蘑菇凝集素(ｐｓａｔｈｙｒｅｌｌａｖｅｌｕｔｉｎａｌｅｃｔｉｎ ,ＰＶＬ)作为与Ｎ 乙酰葡糖胺专一结合的凝集素 ,在ＩｇＧ0 的检测中起关键作用。人们发现ＩｇＧ0 不但与ＲＡ疾病的活动度密切相关 ,而且可以预测…     

肺腺癌患者血清CEA和糖链抗原肿瘤标记物联合测定的临床意义

目的为了探讨85例肺腺癌患者血清CEA和糖链抗原肿瘤标记物水平联合测定的临床意义。方法化学发光免疫分析测定85例肺腺癌、35例肺鳞癌、42例小细胞肺癌和49例良性肺部疾病血清CEA和糖链抗原(CA125、CA199和CA153)水平,并进行了比较性研究。结果 162例肺癌患者中,85例肺腺癌、35例肺鳞癌、42例小细胞肺癌患者血清CEA水平较之49例良性肺部疾病明显增高(P0.001、P0.01和P0.001),以肺腺癌增高最为明显。血清糖链抗原(CA125、CA199和CA153)水平亦然,也以肺腺癌血清CA125、CA199和CA153水平增高最为显著。四项肿瘤标记物的联合测定对85例肺腺癌的敏感性为95.29%和准确性83.76%较之单项肿瘤标记物明显增高(P均0.01),而特异性为75.23%适中。结论四项肿瘤标记物血清CEA和糖链抗原(CA125、CA199和CA153)水平的联合测定,是诊断肺腺癌的有效指标,而且提高了敏感性和准确性。     

胰腺癌的早期诊断

胰腺癌恶性程度高,预后极差,目前临床早期诊断困难。回顾了胰腺癌发生、发展及转移过程中恶性分子生物学特征的变化及机制,从中分析可能用于胰腺癌临床诊断的靶点。归纳了胰腺癌的临床表现、高危因素、肿瘤标志物、联合检测及新设备在早期诊断中的作用,提出了合理联合应用血清学、影像学检查方法,研究、探寻新的肿瘤标志物均是目前提高临床胰腺癌早期诊断率的重要方法。     

Recent advances in the surgical treatment of pancreatic cancer

INTRODUCTIONPancreatic cancer remains the fourth commonest cause ofcancer related death in the western world.The prognosisremains dismal due partly to late presentation,with associatedlow resectability rates,and the aggressive biological nature ofthese tumors.The median survival time from diagnosis inunresectable tumors remains only 4-6 months.For those patients amenable to surgical resection over thelast 20 years have seen marked improvements in postoperativemortality and morbidity,especially in specialist pancreatic     

胰腺癌患者血清相关蛋白质差异表达的研究

目的 利用肿瘤血清蛋白质组分析方法 (serologic proteome analysis,SERPA)对胰腺癌患者血清和正常人血清进行蛋白质组的分析,寻找胰腺癌特异的肿瘤标记物.方法 利用HPLC柱去除血清中的自蛋白,通过双向电泳分离蛋白质,经图像采集与分析,切取胰腺癌患者血清和正常人血清的差异蛋白质点,进行质谱分析鉴定.结果 共获得4个差异蛋白质.正常人血清含量高而胰腺癌患者血清含量低的蛋白质为胍裂解环化酶激活蛋白2(guanylate cyclase-activating protein 2).胰腺癌患者血清含量高而正常人血清含量低的蛋白质3个,分别为结合珠蛋白2α(haptoglobin 2 alpha)、转甲状腺素蛋白(transthyretin)及KIAA1018蛋白.结论KIAA1018有望成为胰腺癌筛选和早期诊断的肿瘤标记物.     

Adjuvant therapy in pancreatic cancer

The outlook for patients with pancreatic cancer has been grim. There have been major advances in the surgical treatment of pancreatic cancer, leading to a dramatic reduction in post-operative mortality from the development of high volume specialized centres. This stimulated the study of adjuvant and neoadjuvant treatments in pancreatic cancer including chemoradiotherapy and chemotherapy. Initial protocols have been based on the original but rather small GITSG study first reported in 1985. There have been two large European trials totalling over 600 patients (EORTC and ESPAC-1) that do not support the use of chemoradiation as adjuvant therapy. A second major finding from the ESPAC-1 trial (541 patients randomized) was some but not conclusive evidence for a survival benefit associated with chemotherapy. A third major finding from the ESPAC-1 trial was that the quality of life was not affected by the use of adjuvant treatments compared to surgery alone. The ESPAC-3 trial aims to assess the definitive use of adjuvant chemotherapy in a randomized controlled trial of 990 patients.     

“可能切除的”胰腺癌的外科治疗策略

“可能切除的”胰腺癌介于“可切除”与“不可切除”之间,其定义的主要内涵是肠系膜上静脉、门静脉、肠系膜上动脉或肝总动脉是否为肿瘤侵犯及是否可切除重建,是目前的热点课题。“可能切除的”胰腺癌所涉及的外科相关问题包括：联合血管切除的安全性、有效性;淋巴清扫范围;标本切缘检测的标准化等。治疗方面建议对此类患者行新辅助放化疗,以增加R0切除的几率及可能性,但具体方案尚不统一,亦无RCT研究佐证。在目前多学科治疗模式及理念下,R1切除的价值及意义值得重新审视。     

自身免疫性胰腺炎与胰腺癌的鉴别诊断

自身免疫性胰腺炎（AIP）是慢性胰腺炎的一种特殊类型。尽管关于 AIP 的各种临床指南相继推行,但在临床上,AIP 与胰腺癌的鉴别仍十分困难。参考 AIP 的指南及最新的相关文献,总结了关于 AIP 与胰腺癌的临床表现、血清学改变、影像学改变及激素反应四个方面的鉴别诊断要点。通过综合分析上述鉴别要点,胰腺占位患者的正确诊断可以得以明确,一些 AIP 患者也可以避免不必要的开腹手术。     

Palliative pancreatectomy with postoperative gemcitabine for patients with advanced pancreatic cancer

Background The prognosis of patients with advanced pancreatic cancer remains very poor. This study was designed to evaluate palliative pancreatic resection with postoperative gemcitabine chemotherapy. Methods A total of 127 patients underwent palliative pancreatectomy or palliative nonresectable treatment with gemcitabine at Kobe University Hospital and were analyzed. Results The median survival of patients receiving palliative pancreatectomy with gemcitabine was 15 months, and the 1- and 3-year survival rates were 60% and 13%, respectively, while that of patients receiving gemcitabine alone was only 8 months, and their 1- and 3-year survival rates were 26% and 0%. Multivariate analysis showed that gemcitabine was the strongest factor in survival, and no distant metastasis and pancreatectomy were also significant factors. In addition, the median survival of patients undergoing microscopically incomplete resection with gemcitabine was 22 months, and the 1- and 3-year survival rates were 60% and 40%. Pancreatectomy with gemcitabine improved the performance status 3 months after surgery, with longer survival compared with the gemcitabine alone group. Conclusions Microscopically incomplete pancreatectomy with postoperative gemcitabine chemotherapy has a possible role in advanced pancreatic cancer.     

胰腺癌患者血清 Dickkopf-1水平检测及其临床意义

目的：探讨Dickkopf-1（ DKK-1）在胰腺癌辅助诊断中的价值。方法采用ELISA法检测50例胰腺癌患者（胰腺癌组）和50例健康查体者（对照组）血清DKK-1水平,采用电化学发光法检查检测CA19-9水平;比较两组DKK-1表达情况及DKK-1、CA19-9诊断胰腺癌的敏感度、特异度和准确性。结果胰腺癌组血清DKK-1水平及阳性率均明显高于对照组（P均＜0．05）;DKK-1与CA19-9诊断胰腺癌的敏感度分别为52％、78％,P＜0．05;特异度分别为92％、84％,P＞0．05;准确性分别为72％、81％,P＞0．05;若两者联合检测则敏感度和准确性分别提高至90％和84％。结论胰腺癌患者血清DKK-1水平明显增高,可作为临床中胰腺癌的辅助诊断指标;血清DKK-1与CA 19-9联合检测有助于提高胰腺癌的诊断水平。     

Serum tumor markers not useful in screening patients with pancreatic mucinous cystic lesions associated with malignant changes

BACKGROUND: Serum cancer antigen 19-9 (CA19-9) pro-vides additional information about mucinous cystic pancre-atic neoplasm (MPN). This study was undertaken to assess both CA19-9 and carcinoembryonic antigen (CEA) serum concentrations in consecutive patients affected by MPNs and other chronic benign and malignant pancreatic diseases. We also evaluated whether serum CA19-9 and CEA determina-tions provide additional information such as the presence of invasive carcinoma in MPN patients.
METHODS: Serum CA19-9 and CEA from 91 patients with pancreatic diseases were tested by commercially available kits at the time of diagnosis. The upper reference limit of serum CA19-9 was 37 U/mL and that of serum CEA was 3 ng/mL.
RESULTS: Thirty-ifve patients was diagnosed with chronic pancreatitis (CP), 32 with MPN, and 24 with pancreatic ductal adenocarcinoma (PDAC) conifrmed histologically. Surgery was carried out in 5 CP patients, in 10 MPN patients (7 of them had severe dysplasia), and 9 PDAC patients. Serum CA19-9 activity was high in 12 (34.3%) CP patients, in 7 (21.9%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.089). High se-rum CEA concentrations were noted in 6 (17.1%) CP patients, in 6 (18.8%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.010). In the 7 MPN patients associated with histological-ly conifrmed severe dysplasia, 3 (42.9%) patients had elevated serum activity of serum CA19-9, and 2 (28.6%) patients had high levels of CEA.
CONCLUSION: Serum determination of oncological markers is not useful in selecting MPN patients with malignant changes.