炎症因子C反应蛋白在甲状腺乳头状癌患者血清中表达的临床意义

目的:研究炎症因子C反应蛋白在甲状腺乳头状癌患者血清中的表达及与临床病理因素的关系。方法:回顾性分析安徽医科大学宿州临床学院耳鼻咽喉-头颈外科与肿瘤外科2015年1月至2018年2月收治的100例甲状腺乳头状癌患者临床资料,测定C反应蛋白在其血清中的表达情况。并分析其表达情况与甲状腺癌临床病理因素之间的关系。结果:C反应蛋白在甲状腺乳头状癌患者血清中表达较高,与对照组相比差异显著。单因素分析中C反应蛋白与肿瘤大小、淋巴结转移等有相关性,差异有统计学意义;与性别、年龄、肿瘤个数无相关性,差异无统计学意义;Logistic回归分析也显示同样结论。结论:炎症因子C反应蛋白表达在甲状腺乳头状癌患者血清中表达较高,并间接提示患者局部复发和预后,值得临床推荐。     

癌性疼痛患者的护理措施

疼痛是癌症患者最主要的问题之一,WHO对癌症患者的调查,认为进展期癌和末期癌患者75%-90%以疼痛为主要临床特征,经过治疗,90%疼痛可缓解[1].护士在控制癌性疼痛方面责任很重,护士应及时执行镇痛处方,采取恰当的安全有效措施,解除或缓解患者的痛苦.     

C反应蛋白与放疗皮肤反应相关性研究

目的：探讨C反应蛋白（CRP）和超敏C反应蛋白（hs-CRP）与放疗皮肤反应之间的相关性。方法：观察103例接受放疗的恶性肿瘤患者的皮肤反应,同时每周检测患者血清中CRP和hs-CRP水平。结果：接受立体定向放疗（SRT）患者的CRP（54.6±10.9 vs 17.3±2.5,P=0.004）和hs-CRP（10.4±1.9 vs 5.6±0.6,P=0.017）水平明显高于接受直线加速器放疗（RT）患者。SRT患者皮肤反应均为0度,RT患者2例皮肤反应为0度,25例为Ⅰ度,29例为Ⅱ度,19例为Ⅲ度,6例为Ⅳ度。对于RT患者,CRP（相关系数0.48,P〈0.001）及hs-CRP水平（相关系数0.25,P=0.05）随皮肤反应级别的增高而增高,其中Ⅱ度以上皮肤损伤患者的CRP水平明显高于Ⅱ度以下患者（33.5±5.9 vs 10.1±1.8,P=0.001）,而hs-CRP水平在这两部分人群中差异不明显（7.5±1.2 vs 4.9±0.7,P=0.06）。结论：放疗可导致CRP和hs-CRP水平增高,其增高与SRT患者皮肤反应无关,而与RT患者皮肤反应呈正相关,其中CRP水平在Ⅱ度以上和Ⅱ度以下皮肤反应患者之间的差异具有统计学显著性。     

癌性疼痛的护理

随着医学模式的转变 ,人们越来越重视生活质量的提高。癌症患者自觉症状中 ,癌痛发生率较高 ,病人在癌症疼痛折磨中艰难度日 ,严重影响患者的治疗和生存质量 ,因此 ,对癌性疼痛的护理显得尤为重要。癌痛护理的目标是要解除患者的疼痛 ,下面就癌性疼痛的护理谈谈自己的粗浅体会。1　缓解疼痛 ,减轻躯体症状疼痛与躯体症状的产生互为因果 ,疼痛严重地影响了患者的生活质量 ,必须及时给予止痛治疗 ,以减少躯体症状的产生。1.1　正确评估疼痛　疼痛评估的目的是为了解患者疼痛的程度 ,以便采取相应的措施。不同患者对疼痛的承受力有所差异 ,患者…     

初诊鼻咽癌患者血清C反应蛋白检测临床意义分析

目的 C反应蛋白(C reactive protein,CRP)可能是肿瘤和炎症之间的桥梁,有研究证实CRP水平和鼻咽癌分期相关.本研究旨在探讨放疗前血清中CRP水平与临床特征之间的关系,并判断其在预测鼻咽癌患者疗效和预后的价值.方法 随访2006-12-27-2011-07-27中山大学肿瘤防治中心治疗的初诊鼻咽癌患者227例.227例患者全部入组了国家863计划项目资助的课题“以生物学行为和分子特征为基础的鼻咽癌个性化治疗新方案的研究”.临床分期依据2002 AJCC/UICC分期标准.所有患者接受直线加速器6～8 MV高能X射线放疗,216例患者均接受同期化疗.采用x2检验,分析CRP表达情况与患者一般临床特征的相关性;采用Kaplan-Meier法,分析治疗前CRP对鼻咽癌患者近期疗效以及总生存率、局部无复发率和无远处转移率等远期疗效的影响.结果 在227例鼻咽癌患者血清中,CRP在不同的N分期(P=0.017)、M分期(P=0.010)及病理分型(P＜0.001)之间差异有统计学意义.227例鼻咽癌患者治疗前,CRP正常195例,异常32例.血清CRP正常患者的总生存率(88.2％)高于异常患者(71.8％),P=0.022;无远处转移率(86.7％)也高于异常患者(68.7％),P=0.027.结论 鼻咽癌患者治疗前CRP表达升高,会显著降低鼻咽癌患者的总生存率及无远处转移生存率,是影响预后的不利因素.     

癌性疼痛的麻醉处理

本文重点介绍癌性疼痛病人应用麻醉技术的适应症、麻醉技术的类型以及止痛药物的选择。如何决定使用麻醉技术为了全面理解麻醉技术在癌性疼痛综合处理中的作用,有必要讨论一下目前其它一些理论:药物学调治(pharmacologic tailoring)、刺激诱导止疼和神经外科技术。从少侵入性/低危险性逐步到高侵入性/高危险性的步骤,被一致认为是可取的方法。     

C反应蛋白与白蛋白比值对原发性肝癌患者预后的判断价值

目的 探讨C反应蛋白（CRP）与白蛋白（Alb）比值对原发性肝癌患者预后的判断价值。方法 纳入首次行手术治疗的原发性肝癌患者178例,计算术前CRP/Alb,运用受试者工作特征曲线、生存分析和Cox多元回归分析评价CRP/Alb与预后的关系。结果 CRP/Alb比值的最佳界点为0.46,敏感度为70.45%,特异度为73.97%。与低CRP/Alb组相比,高CRP/Alb组的CRP水平较高、Alb水平较低、Child-Pugh分级较高、肿瘤最长径较大、血管浸润比例较多,差异均有统计学意义（P<0.001）。Kaplan-Meier曲线显示高CRP/Alb组的生存率较低（26.8% vs. 56.8%, P<0.001）。Cox多元回归分析显示CRP/Alb、Child-Pugh分级、血管浸润是预后的独立危险因素。结论 术前CRP/Alb比值升高提示原发性肝癌患者预后不良,是影响患者预后的独立危险因素。     

血清超敏C反应蛋白、降钙素原与血小板参数与白血病患者病情的相关性

目的 探讨血清超敏C反应蛋白、降钙素原与血小板参数在白血病患者血清中的表达水平,并分析其与白血病患者病情的相关性.方法 选取100例白血病患者作为研究对象进行回顾性分析,依照患者病情严重程度,将其分为A组、B组和C组.A组患者为白血病未感染患者,共28例;B组患者为白血病轻微感染患者,共51例;C组为白血病脓毒症患者,...     

晚期实体瘤患者C反应蛋白与糖代谢的关系

目的研究晚期实体瘤患者C反应蛋白(CRP)与糖代谢的关系。方法对32例病情稳定的晚期肿瘤患者,给予塞来西布200m/gd,比较服药前和服药5d后的空腹血糖(FBS)、胰岛素(FINS)、餐后血糖、CRP、皮质醇水平。结果晚期肿瘤患者CRP与皮质醇、FINS和胰岛素抵抗指数(IR)也有很好的相关性,服用塞来西布后,CRP下降明显([8.17±1.76)m/gLv(s4.37±0.65)m/gL)],同时皮质醇([876±123)pmo/lLv(s621±145)pmo/lL],FINS([14.23±7.21)μU/Lv(s9.83±3.37)μU/L]和IR([3.20±1.01)v(s1.90±0.78)]也明显好转。结论CRP水平与晚期肿瘤患者的异常糖代谢有关,塞来西布可以改善这种异常的代谢状态。     

血清C反应蛋白水平与非小细胞肺癌患者近期疗效及预后的关系

[目的]探讨非小细胞肺癌(NSCLC)患者治疗前后血清C反应蛋白(CRP)的水平及其与肿瘤近期疗效及预后的关系.[方法]用免疫比浊法分别检测215例NSCLC患者(其中105例患者行手术治疗,110例患者行化疗)和102名健康对照者血清中的CRP表达水平,并进行24个月的随访.[结果] NSCLC患者手术后血清CRP浓度(12.52±4.37)mg/L与术前(18.13±5.78)mg/L相比,差异有统计学意义(P＜0 05).经化疗后,30例缓解组患者血清CRP浓度(10.49±3.85)mg/L与治疗前(18.64±4.63)mg/L相比显著下降(P＜0.05);44例进展组患者血清CRP浓度(20.14±7.68)mg/L与治疗前(14.53±4.56)mg/L相比显著升高(P＜0.05); 36例稳定组患者血清CRP浓度治疗前后差异无统计学意义(P＞0.05).手术后CRP阳性率显著下降,而化疗后阳性率下降不明显.手术前CRP阳性患者肿瘤复发或转移率(26.7％)高于术前阴性患者(7.5％).[结论]检测NSCLC患者血清CRP水平对预测肿瘤转移有一定的临床意义,有助于疗效的评估以及预后的预测.     

胃癌患者血清瘦素与营养状况的关系

目的:探讨肥胖基因表达产物瘦素与胃癌病人营养状况的关系。方法:采用放射免疫分析法测定147例胃癌病人血清瘦素含量,同时测定身高、体重、疾病分期、ECOG法一般状况分级。体质指数(BMI)=体重(kg)/犤身高(m)犦2。营养正常的BMI范围为18.5～25;BMI<18.5为营养不良;BMI>25为肥胖。结果:胃癌病人合并营养不良组的血清瘦素平均含量明显低于营养正常组或肥胖组。男性胃癌病人合并营养不良、营养正常及肥胖组血清瘦素水平分别为(2.41±1.59)μg/L、(4.80±3.21)μg/L、(9.16±2.81)μg/L;女性则分别为(5.53±3.06)μg/L、(8.94±4.78)μg/L、(20.58±9.48)μg/L。全组男性、女性胃癌病人的血清瘦素水平分别为(4.39±3.42)μg/L、(8.97±6.56)μg/L;女性均值高于男性1倍。胃癌病人的血清瘦素水平与BMI显著相关(男性r=0.538,P<0.05;女性r=0.785,P<0.05)。BMI正常的胃癌病人的血清瘦素与健康人无差异。结论:血清瘦素含量可以反映胃癌病人的BMI变化和营养状况,且可作为判断胃癌病人营养状况的指标。     

肝细胞癌术前血清C-反应蛋白水平与术后早期复发的关系

目的：研究肝细胞癌术前检测血清C-反应蛋白（CRP）水平与术后早期复发的关系。方法：2000年1月至2004年1月，72例肝细胞癌行肝切除术，术前30min采静脉血，采用散射免疫比浊法检测血清CRP水平血清CRP≥8mtg／L为CRP阳性，血清CRP〈8mg／L为CRP阴性。分析血清CRP水平与肝细胞癌I临床病理的关系、结果：肝细胞癌血清CRP表达阳性率为72．2％（52／72）。肝细胞癌术前血清CRP水平与术后早期复发、血清AFP滴度水平及包膜浸润、门静脉侵犯、肝内转移、肿瘤大小等肿瘤恶性生物学行为明显相关．术前血清CRP阳性及阴性患者术后早期复发率分别为44．2％（23／52）及10％（2／20）。结论：肝细胞癌术前血清CRP水平可能是术后早期复发的良好的预后指标     

食管癌患者营养状况与治疗相关性的研究进展

食管癌是我国常见的消化道恶性肿瘤,其发病率位于我国恶性肿瘤第5位。食管癌患者由于梗阻引起摄入不足、肿瘤消耗等因素易发生营养不良,约50%～80%的患者在就诊时已经发生营养不良。而手术创伤和应激所引起的高分解代谢又加剧营养不良;同时,放化疗的毒副反应,特别是同步放化疗的毒副反应会增加患者营养不良风险。近年来的研究显示,食管癌营养不良是影响患者预后及生活质量的重要因素,治疗期间积极的营养支持可提高治疗疗效和降低并发症的发生。目前采用的营养支持方式较多,以肠内营养支持为首选,可适当给予免疫营养制剂。     

癌痛治疗不足的现状与原因

本文旨在以综述的方式对于癌痛治疗不足的现状、原因以及应对措施进行汇总,进而为改善临床癌痛治疗提供参考。对于癌痛治疗以及治疗不足的现状进行了汇总和总结,对于癌痛治疗不足的原因和应对措施进行了归纳和分析。今后癌痛治疗的规范化、癌痛的正确评估以及加强癌痛治疗的宣教仍然是癌痛治疗研究的重点方向。     

The Diversity of Nutritional Status in Cancer: New Insights

Objective.

Nutritional status in cancer has been mostly biased toward undernutrition, an issue now in dispute. We aimed to characterize nutrition status, to analyze associations between nutritional and clinical/cancer-related variables, and to quantify the relative weights of nutritional and cancer-related features.

Methods.

The cross-sectional study included 450 nonselected cancer patients (ages 18–95 years) at referral for radiotherapy. Nutritional status assessment included recent weight changes, body mass index (BMI) categorized by World Health Organization''s age/sex criteria, and Patient-Generated Subjective Global Assessment (PG-SGA; validated/specific for oncology).

Results.

BMI identified 63% as ≥25 kg/m² (43% overweight, 20% obese) and 4% as undernourished. PG-SGA identified 29% as undernourished and 71% as well nourished. Crossing both methods, among the 319 (71%) well-nourished patients according to PG-SGA, 75% were overweight/obese and only 25% were well nourished according to BMI. Concordance between BMI and PG-SGA was evaluated and consistency was confirmed. More aggressive/advanced stage cancers were more prevalent in deficient and excessive nutritional status: in 83% (n = 235/282) of overweight/obese patients by BMI and in 85% (n = 111/131) of undernourished patients by PG-SGA. Results required adjustment for diagnoses: greater histological aggressiveness was found in overweight/obese prostate and breast cancer; undernutrition was associated with aggressive lung, colorectal, head-neck, stomach, and esophageal cancers (p < .005). Estimates of effect size revealed that overweight/obesity was associated with advanced stage (24%), aggressive breast (10%), and prostate (9%) cancers, whereas undernutrition was associated with more aggressive lung (6%), colorectal (6%), and head-neck (6%) cancers; in both instances, age and longer disease duration were of significance.

Conclusion.

Undernutrition and overweight/obesity have distinct implications and bear a negative prognosis in cancer. This study provides novel data on the prevalence of overweight/obesity and undernutrition in cancer patients and their potential role in cancer histological behavior.     

术前血清C-反应蛋白水平在卵巢癌患者预后判断中的价值

[目的]探讨术前卵巢癌血清中C-反应蛋白(C-reactive protein,CRP)与临床病理参数及预后的关系.[方法]回顾性分析2008年1月至2014年4月手术的187例初治卵巢癌患者的病例资料,分析术前CRP值与年龄、国际妇产科联盟(International Federation of Gynecologists and Obstetricians,FIGO)分期、组织分级、腹水量及术后残余病灶大小的关系.[结果] 82例(44.09％)卵巢癌患者术前血清CRP值为阳性,平均值为26.41 mg/L.CRP值与FIGO分期(P＜0.05),残余肿瘤大小(P＜0.01)和腹水量(P＜0.01)显著性相关.术前血清CRP阳性率与腹水量相关(P＜0.01),与年龄、组织分级和FIGO分期无关.CRP阳性的卵巢癌患者5年生存率(62.3％)低于CRP阴性的患者(79.6％)(P＜0.01).[结论]检测术前血清CRP值对卵巢癌病情严重程度及预后有重要临床意义.     

427例恶性肿瘤患者营养状况调查

目的 调查恶性肿瘤患者营养状况,探讨其是否存在性别和年龄差异及PG-SGA在肿瘤患者营养评估中的价值。方法 采用PG-SGA对427名恶性肿瘤患者进行营养状况评估,同时测定传统营养指标。结果 营养不良发生率在非老年与老年患者中差异有统计学意义,而在不同性别患者中差异无统计学意义。不同PG-SGA分级（A、B、C）患者BMI、TSF、MAC等营养指标差异均存在统计学意义。PG-SGA评分与各个指标呈负相关,进一步就性别进行分层分析,表明除Hb、MAMC两个指标外,女性PG-SGA评分与其他营养指标显著负相关,而男性PG-SGA评分与各个营养指标均呈负相关。结论 肿瘤患者营养不良发生率存在年龄差异。PG-SGA与传统营养指标之间具有良好关联性,但存在性别差异。     

Association Between C-reactive Protein and Risk of Cancer: A Meta-analysis of Prospective Cohort Studies

Background: Associations between elevated C-reactive protein (CRP) and cancer risk have been reported formany years, but the results from prospective cohort studies remains controversial. A meta-analysis of prospectivecohort studies was therefore conducted to address this issue. Methods: Eligible studies were identified bysearching the PubMed and EMBASE up to October 2012. Pooled hazard ratios (HR) was calculated by usingrandom effects model. Results: Eleven prospective cohort studies involving a total of 194,796 participants and11,459 cancer cases were included in this meta-analysis. The pooled HR per natural log unit change in CRP was1.105 (95% confidence interval (CI): 1.033-1.178) for all-cancer, 1.308 (95% CI: 1.097-1.519) for lung cancer,1.040 (95% CI: 0.910-1.170) for breast cancer, 1.063 (95% CI: 0.965-1.161) for prostate cancer, and 1.055 (95%CI: 0.925-1.184) for colorectal cancer. Dose-response analysis showed that the exponentiated linear trend for achange of one natural log unit in CRP was 1.012 (95% CI: 1.006-1.018) for all-cancer. No evidence of publicationbias was observed. Conclusions: The results of this meta-analysis showed that the elevated levels of CRP areassociated with an increased risk of all-cancer, lung cancer, and possibly breast, prostate and colorectal cancer.The result supports a role of chronic inflammation in carcinogenesis. Further research effort should be performedto identify whether CRP, as a marker of inflammation, has a direct role in carcinogenesis.     

Nutritional Status in Patients with Esophageal Cancer Receiving Chemoradiation and Assessing the Efficacy of Usual Care for Nutritional Managements

Background: Malnutrition is prevalent in esophageal cancer patients which affects cancer prognosis. The purpose of this study was a comprehensive assessment of nutritional status during Chemoradiation (CRT). Methods: Newly diagnosed adults with esophageal cancer were recruited for this study. Patient-Generated- Subjective Global Assessment (PG-SGA), anthropometric indices, body composition, dietary intake, laboratory tests, and nutritional-related complications were assessed before, after, and 4 to 6 weeks after CRT. Results: Seventy-one cases were enrolled. The mean age was 66.8±12 years. Patients’ mean weight loss was 2.42±2.4 kilograms during treatment. A significant reduction observed in mean MUAC (26.68±4.9 vs. 25.42±5.1 cm), fat mass percentage (24.11±11.8 vs. 22.8±12.5), fat free mass index (16.87±2.4 vs. 16.47±2.6 kg/m2) and hand grip strength (43.2±19 vs. 36.1±20 kg) during CRT (all p-values <0.0001). We had also a non-significant change in mean energy intake (19.5±11 vs. 18.3±11 kcal/kgw. day) and protein intake (0.56±0.4 vs. 0.66±0.5 g/kgw.day) during CRT.  In our assessment before, immediately after and 4-6 weeks following CRT, we recorded energy intake insufficiency in 55.7%, 58.7% and 27.3% and protein intake inadequacy in 89.8%, 89.1% and 72.7% of cases, respectively. The most common complications were dysphagia (56.7%), anorexia (25%), and constipation (47.9%) at admission. Dysphagia improved in some cases (42%), but anorexia (35%), early satiety (25%), Esophagitis (25%), dysosmia (21%) and dysgeusia (17%) were increased as CRT complication. yet, 25% of patients had dysphagia and 34.4% had constipation 4-6 weeks after CRT. The twelve-months mortality was significantly associated with lower BMI after CRT, primary PG-SGA score, weight loss, BMI<18.5, MUAC, physical performance, living in rural or urban areas, addiction. Conclusion: Our study demonstrated a high prevalence of malnutrition among esophageal cancer patients which worsened during Chemoradiotherapy. Our findings warrant early screening and monitoring of nutritional status and effective nutritional interventions with symptoms management during treatment in these patients.