血清及胆汁CEA、CA19-9、CA24-2在胆道良恶性梗阻性疾病中的诊断价值

目的探讨血清及胆汁CEA、CA19-9、CA24-2检测对胆道良恶性梗阻性疾病的诊断价值。方法选择2015年6月-2016年12月来恩施土家族苗族自治州中心医院诊治的良性和恶性胆道梗阻患者各40例,收集入院时的血清和手术中的胆汁标本进行肿瘤标志物(CEA、CA19-9及CA24-2)检测。2组间比较采用t检验,并对各肿瘤标志物诊断胆道良恶性梗阻性疾病进行受试者工作特征曲线分析。结果胆道恶性梗阻性疾病组血清CA19-9、CA24-2水平均明显高于胆道良性梗阻性疾病组,差异均有统计学意义(t值分别为5.899、3.223,P值均<0.05)。胆道恶性梗阻性疾病组胆汁CEA、CA19-9及CA24-2水平均明显高于胆道良性梗阻性疾病组,差异均有统计学意义(t值分别为3.304、7.615、7.279,P值均<0.05)。胆道恶性梗阻性疾病组胆汁中肿瘤标志物CEA、CA19-9及CA24-2水平均明显高于血清,差异均有统计学意义(t值分别为3.297、4.975、3.993,P值均<0.05);其中胆汁CA24-2的约登指数和受试者工作特征曲线下面积(AUC)最高,分别为0.75和0.946,而胆汁CA19-9和血清CA19-9的约登指数和AUC也较高,分别为0.74和0.937以及0.68和0.898,三者的诊断价值较大。将胆汁CA24-2、血清CA19-9及胆汁CA19-9三者联合检测,其诊断恶性胆道梗阻性疾病的灵敏度为94.75%、阴性预测值为93.50%、约登指数为0.82。结论胆汁肿瘤标志物检测对胆道恶性梗阻性疾病的诊断价值重大,而胆汁CA24-2、血清CA19-9及胆汁CA19-9三者联合检测对胆道良恶性梗阻性疾病的鉴别诊断价值最大。     

胆管癌患者血清、胆汁中的CA19-9水平ROC曲线分析及临床参考价值评估

目的 探讨血清、胆汁CA19-9水平对胆管癌的早期诊断和鉴别诊断的价值.方法 对82例胆道恶性病变患者和85例胆道良性疾病者测定血清和胆汁的CA19-9水平,进行对比分析和评价.结果 恶性组患者血清、胆汁CA19-9水平均明显高于良性组患者(P＜0.001);胆汁CA19-9诊断胆管癌的ROC曲线下面积为0.764,诊断价值高于血清的0.701;根据诊断评价指标,胆汁CA19-9灵敏度、特异度、符合率、阳性预测值和阴性预测值(57.90％、95.50％、77.25％、92.30％、70.43％)均高于血液CA19-9(50.90％,89.10％,70.66％,82.35％,65.62％),两项联合检测灵敏度、符合率及阴性预测值均有不同程度提高.结论 选择血清、胆汁CA19-9进行联合检测,在胆管癌的早期筛检中具有重要参考价值.     

胆管癌患者血清肿瘤标记物糖类抗原19-9的动态变化及其临床意义

目的 探讨胆管癌患者血清中肿瘤标记物糖类抗原(CA)19-9动态变化及其临床意义.方法 选择2010年8月至2011年11在该院经手术和病理证实胆管癌的患者79例作为胆管癌组,另选同期该院收治的胆道良性疾病患者82例作为胆道良性疾病组.采用化学发光法,分别检测肿瘤标记物CA19-9和癌胚抗原(CEA)的含量.比较两组患者CA19-9和CEA含量以及阳性率,以及CA19-9与CEA对胆管癌的效能评价.结果 与胆道良性疾病组患者相比,胆管癌组患者CA19-9和CEA的含量均明显提高,且胆管癌患者CA19-9和CEA的阳性率均明显增高,差异具有统计学意义(P＜0.05).与此同时,与CEA相比,CA19-9的敏感性、特异性以及准确性均明显提高,差异具有统计学意义(P＜0.05).结论 肿瘤标记物CA19-9含量的变化,对于胆管癌患者的治疗具有一定的指导作用,且对于胆管癌患者的早期诊断具有较为明显的特异性.     

胆汁端粒酶活性联合血清CEA、CA19-9检测在胆道恶性梗阻诊断中的价值

目的 探讨胆汁端粒酶活性联合血清CEA、CA19-9检测对胆道恶性梗阻的诊断价值.方法 应用TRAP-ELISA法检测66例胆道恶性梗阻患者(恶性组)和28例胆管结石引起胆道梗阻患者(良性组)胆汁脱落细胞端粒酶活性,并检测血清CEA、CA19-9水平.结果 恶性组端粒酶活性、CEA、CA19-9阳性率均高于良性组(P均<0.05),端粒酶阳性率与病灶转移无相关性;胆汁端粒酶活性联合血清CEA、CA19-9检测的敏感性、特异性均高于单独检测,但无统计学意义.结论 胆汁端粒酶活性联合血清CEA、CA19-9检测可提高恶性胆道疾病的诊断率.     

胆汁CA19—9检测在胆管癌诊断中的价值

目的探讨胆汁糖链抗原19-9（CA19-9）检测对胆管癌的诊断价值。方法选择30例胆管癌患者（胆管癌组）、25例胆管良性病变患者（胆管良性病变组）及25例ERCP检查示胰胆管正常者（正常对照组）。采用化学发光法检测其血清和胆汁中的CA19—9。结果胆管癌组胆汁CA19-9水平明显高于血清水平（P〈0．01）,胆汁和血清CA19—9水平均高于胆管良性病变组及正常对照组（P〈0．05）。胆汁不同临床分期胆管癌患者胆汁CA19．9水平比较,P〉0．05;各期胆汁CA19-9水平显著高于血清（P〈0．05）。以35U／ml为界值,胆汁CA19-9诊断胆管癌的灵敏度为93．3％（28／30）。结论胆汁CA19-9对胆管癌的定性诊断有一定价值。     

血清糖链抗原19-9对梗阻性黄疸患者发生急性胆管炎的预测价值

目的探讨梗阻性黄疸患者发生急性胆管炎的预测因子。方法回顾性分析海口市第四人民医院2010年10月-2015年10月收治的358例胆总管结石合并梗阻性黄疸患者的临床资料。根据患者是否发生急性胆管炎,分为急性胆管炎组(n=223)和梗阻性黄疸组(n=135)。比较两组患者的年龄、性别和合并症,评估血清肿瘤标志物及肝功能指标的异常与急性胆管炎发生的关系。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。选取有统计学意义的指标构建受试者工作特征曲线(ROC),评价其对急性胆管炎诊断的敏感度和特异度。结果急性胆管炎组血清糖链抗原(CA)19-9、CA12-5水平明显高于梗阻性黄疸组[(82.33±23.01)k U/L vs(36.75±12.58)k U/L,(30.21±9.59)k U/L vs(18.62±5.27)k U/L],差异均有统计学意义(t值分别为11.028、8.597,P值均0.001)。ROC曲线分析显示,血清CA19-9、CA12-5曲线下面积分别为0.891、0.705,对应诊断准确度最高的临界值分别为61.01 k U/L、22.56 k U/L,敏感度分别为82.1%、77.6%,特异度分别为79.8%、69.5%。结论血清CA19-9升高对胆总管结石合并梗阻性黄疸发生急性胆管炎有较大的预测价值。     

糖链抗原19-9对可切除肝门部胆管癌患者预后及早期复发的预测价值

目的探讨手术前后肿瘤标志物糖链抗原19-9(CA19-9)水平对可切除肝门部胆管癌(HCCA)患者生存预后及早期复发的预测作用。方法选择2001年1月-2013年12月于陕西中医药大学第二附属医院接受根治性切除术治疗的HCCA患者80例。根据患者病历信息及检查资料,记录HCCA患者年龄、性别等临床资料。应用电化学发光法测定血清CA19-9水平。术前、术后CA19-9截断点预测HCCA患者生存率的截断点分为≤100 U/ml、100 U/ml组,≤150 U/ml、150 U/ml组,≤200 U/ml、200 U/ml组,≤400 U/ml、400 U/ml组。采用Kaplan-Meier法比较CA19-9≤150 U/ml和CA19-9150 U/ml组,CA19-9升高、CA19-9降低≤50%和CA19-9降低50%组生存率差异。应用单因素、多因素非条件logistic回归分析手术前后CA19-9水平与临床资料的关系。计量资料2组间比较采用t检验;计数资料组间比较采用χ2检验。结果术前不同CA19-9截断点100 U/ml、150 U/ml、200 U/ml、400 U/ml预测HCCA根治性切除术患者生存时间的差异均有统计学意义(t值分别为2.85、3.66、2.84、2.55,P值均0.05);术后不同CA19-9截断点100 U/ml、150 U/ml、200 U/ml、400 U/ml预测HCCA根治性切除术患者生存时间的差异均有统计学意义(t值分别为3.06、4.55、3.08、5.15,P值均0.05)。Kaplan-Meier生存分析结果显示,术前CA19-9≤150 U/ml的HCCA根治性切除术患者生存率显著高于术前CA19-9150 U/ml患者(P0.05);术后CA19-9≤150 U/ml的HCCA根治性切除术患者生存率显著高于术后CA19-9150 U/ml患者(P0.05)。手术前后CA19-9升高的HCCA根治性切除术患者生存率显著高于手术前后CA19-9降低≤50%和CA19-9降低50%患者(P值均0.05)。单因素、多因素分析结果显示,HCCA根治性切除术患者术前CA19-9水平与淋巴结转移、早期复发有关(P值均0.05);术后CA19-9水平与早期复发有关(P0.05)。结论手术前后CA19-9水平可预测可切除HCCA患者生存及早期复发。手术前后CA19-9水平升高提示HCCA患者易早期复发及较差的生存结局。     

血清CA19-9对肝胆胰疾病的临床诊断价值

目的 观察血清CA19-9在肝胆胰良恶性疾病中的诊断和鉴别诊断价值.方法 回顾性调查2007年7月-2009年12月福建医科大学附属第一医院收治的180例伴有不同程度肝功能异常或胆管梗阻的肝胆胰良恶性疾病患者中血清CA19-9水平,并结合血清胆红素、肝转氨酶进行分析.结果 胰腺癌组和胆管癌组血清CA19-9水平较良性疾病组明显升高,差异有统计学意义（P＜0.05）,而肝细胞癌组与良性疾病组血清CA19-9水平比较,差异无统计学意义（P =0.143）;在恶性疾病中,胰腺癌组血清CA19-9水平明显高于胆管癌组和肝细胞癌组,差异有统计学意义（P ＜0.001）,胆管癌组则明显高于肝细胞癌组,差异有统计学意义（P=0.003）;血清CA19-9对胰腺癌、胆管癌、肝细胞癌的灵敏度分别为73.5％、53.8％、23.5％,胰腺癌和胆管癌灵敏度比较,差异无统计学意义（P =0.171）,但二者与肝细胞癌相比,灵敏度差异有统计学意义（P ＜0.0125）;良性疾病组血清CA19-9水平与胆红素水平呈明显正相关性（0.8＜r＜0.9,P ＜0.001）,与肝转氨酶相关性较弱（0.16 ＜r＜0.18,P＞0.10）,但恶性疾病组血清CA19-9与血清胆红素、肝转氨酶均无明显相关性（P＞0.10）;通过绘制ROC曲线确定血清CA19-9诊断胆胰癌的最佳阳性参考值为55.2 U/ml.结论 伴有不同程度的肝功能异常或胆管梗阻的肝胆胰疾病中,血清CA19-9对胆胰恶性肿瘤有一定的诊断和鉴别诊断价值,而对肝细胞癌的诊断价值不大;良性疾病中,不同程度的肝功能异常或者胆管梗阻可相应使血清CA19-9水平不同程度升高,但恶性疾病中血清CA19-9水平的高低主要与肿瘤本身表达强弱有关;使用CA19-9的最佳阳性参考值并联合检测其他肿瘤标志物可以明显提高其对胆胰癌的诊断效率.     

老年胆管细胞癌患者外周血糖蛋白抗原19-9与24-2水平变化及其临床意义

目的探讨血清糖蛋白抗原(CA)19-9与CA24-2水平动态表达在老年胆管细胞癌患者诊断、预后及复发中的临床意义。方法采用电化学发光免疫分析法,分别以年龄匹配的20例胆系良性疾病及20例正常人作对照,对26例老年胆管细胞癌患者外周血CA19-9与CA24-2水平进行检测。结果胆管细胞癌组外周血CA19-9与CA24-2表达阳性率分别为76.9%,69.2%,明显高于胆系良性疾病组(5.0%,10.0%)及正常对照组(0.0%,5.0%)(均P<0.01);CA19-9、CA24-2的均值分别[(1 571.82±291.75)、(181.69±71.80)U/ml]明显高于胆系良性疾病组[(28.52±10.61)、(16.26±11.50)U/ml]及正常对照组[(22.53±6.42)、(10.68±5.87)U/ml](P<0.01)。CA19-9与CA24-2联合检测阳性率(88.5%)明显高于单一检测(P<0.05)。临床影像学检查提示胆管细胞癌占位性病变的,同时CA19-9、CA24-2联合检测明显升高的患者术后经病理证实均为胆管细胞癌。未复发胆管细胞癌组术后1 w CA19-9、CA24-2水平较术前均明显下降(P<0.05);而术后复发组术后1 w血清CA19-9、CA24-2较术前亦明显下降(P<0.05);术后4 w下降最明显,术后12 w水平回升;姑息手术组手术前后CA19-9、CA24-2水平无显著变化(P<0.05)。结论动态监测血清CA19-9、CA24-2水平变化对于老年胆管细胞癌的临床诊断及术后复发的判断均有重要价值。     

CA19-9和CEA在肝胆管结石合并胆管癌诊断与预防评估中的价值

目的探讨行内镜下逆行胰胆管造影(ERCP)检测胆汁中一种糖蛋白类的单克隆抗体糖类抗体CA19-9和癌胚抗原(CEA)在肝胆管结石合并胆管癌诊断与预防评估中的价值。方法收集肝胆管结石合并胆管癌患者50例,胆道良性病变150例作为对照组,采用化学发光法检测胆汁中CA19-9、CEA的水平。结果胆管癌组术前胆汁CA19-9和CEA明显高于对照组(P0.05)。结论胆汁中CEA、CA19-9的水平可以作为诊断肝胆管结石合并胆管癌疾病的定性方法。肝胆管结石合并胆管癌的临床表现缺乏特异性,胆汁中CA19-9和CEA显著升高者应行病理活检确诊,并积极行根治性手术治疗,有助于提高患者的生存期。     

Comparison of sequential and 7-, 10-, 14-d triple therapy for Helicobacter pylori infection

AIM: To compare the effectiveness of sequential therapy for Helicobacter pylori (H. pylori) infection with that of triple therapy of varying durations.METHODS: The 460 patients enrolled in this study had H. pylori-associated gastritis or a gastric or duodenal ulcer. After screening, H. pylori-infected patients were randomly assigned to receive either conventional triple therapy for 7, 10 or 14 d, or a new 10-d sequential therapy. Each of the 4 treatment groups included 115 patients. The outcomes of eradication therapy were assessed 4 wk after treatment by the urea breath test and histology.RESULTS: The overall eradication rate was 81.0%, and eradication rates were 75.7% for 7-d conventional triple therapy, 81.9% for 10-d conventional triple therapy, 84.4% for 14-d conventional triple therapy, and 82.0% for 10-d sequential therapy. Neither intention-to-treat analysis nor per protocol analysis showed significant differences in eradication rates using sequential therapy or the standard triple therapy (P = 0.416 and P = 0.405, respectively).CONCLUSION: There are no significant differences between 10-d sequential eradication therapy for H. pylori and any duration of standard triple treatment in Korean patients.     

Analytical Assessment of Interleukin - 23 and -27 Cytokines in Healthy People and Patients With Hepatitis C Virus Infection (Genotypes 1 and 3a)

Background:

The immune system plays important roles in determining the outcomes of hepatitis C virus (HCV) infection. Interleukin-23 and -27 (IL-23 and IL-27) are two novel IL-12 cytokine family members known to enhance the T-lymphocyte response, but their precise involvement in HCV infection is not well known.

Objectives:

We investigated the serum IL-27 and IL-23 levels in patients with HCV infection and in healthy individuals.

Patients and Methods:

In this case-control study, we assessed IL-23 and IL-27 levels in serum of 37 healthy individuals and 64 patients with chronic HCV using Enzyme-linked immunosorbent assay (ELISA). The relationship of cytokines level with liver enzymes (ALT, AST, and ALP), HCV genotype and viral load were analyzed. The differences of these cytokine levels in the groups of treatment and no treatment was compared. HCV genotypes were classified by HCV-specific primers methods. HCV RNA loads were determined by fluorescence quantitative PCR.

Results:

Serum level of IL-23 was higher in HCV infected patients compared to control group (P = 0.005). However, no significant difference was seen in IL-27 serum level between patients compared to the control group (P = 0.65). There was no significant difference in IL-23 and IL-27 level between genotype 1 HCV-infected- and 3a HCV-infected- patients. Positive moderate correlation between IL-23 and IL-27 with viral load was found in type 3a and 1 HCV-infected patient. Positive relative correlation was seen between ALT and IL-23 in 1a HCV-infected patients, which was higher than 3a HCV-infected patients; but there were no significant difference between serums liver enzymes with IL-23 and IL-27 in respect to genotype 3a and 1a HCV-infected patients

Conclusions:

These findings may reflect a vigorous pro-inflammatory reaction orchestrated by the host immune system against chronic HCV. Also, a better understanding of the involvement mechanism considering the correlation between other genotypes with inflammatory cytokines in various stages of disease can be obtained.     

Efficient and accurate bypass of N2-(1-carboxyethyl)-2'-deoxyguanosine by DinB DNA polymerase in vitro and in vivo

DinB, a Y-family DNA polymerase, is conserved among all domains of life; however, its endogenous substrates have not been identified. DinB is known to synthesize accurately across a number of N(2)-dG lesions. Methylglyoxal (MG) is a common byproduct of the ubiquitous glycolysis pathway and induces the formation of N(2)-(1-carboxyethyl)-2'-deoxyguanosine (N(2)-CEdG) as the major stable DNA adduct. Here, we found that N(2)-CEdG could be detected at a frequency of one lesion per 10(7) nucleosides in WM-266-4 human melanoma cells, and treatment of these cells with MG or glucose led to a dose-responsive increase in N(2)-CEdG formation. We further constructed single-stranded M13 shuttle vectors harboring individual diastereomers of N(2)-CEdG at a specific site and assessed the cytotoxic and mutagenic properties of the lesion in wild-type and bypass polymerase-deficient Escherichia coli cells. Our results revealed that N(2)-CEdG is weakly mutagenic, and DinB (i.e., polymerase IV) is the major DNA polymerase responsible for bypassing the lesion in vivo. Moreover, steady-state kinetic measurements showed that nucleotide insertion, catalyzed by E. coli pol IV or its human counterpart (i.e., polymerase kappa), opposite the N(2)-CEdG is both accurate and efficient. Taken together, our data support that N(2)-CEdG, a minor-groove DNA adduct arising from MG, is an important endogenous substrate for DinB DNA polymerase.     

Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options

Fournier’s gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects.     

Etiopathogenesis, clinical diagnosis and treatment of thromboangiitis obliterans - current practices

Thromboangiitis obliterans (TAO) is a segmental inflammatory occlusive disorder that affects small- and medium-sized arteries, and arm and leg veins of young smokers. Several different diagnostic criteria have been offered for the diagnosis of TAO. Clinically, it manifests as migratory thrombophlebitis or signs of arterial insufficiency in the extremities. It is characterized by highly cellular and inflammatory occlusive thrombi, primarily of the distal extremities. Thromboses are often occlusive and sometimes display moderate, nonspecific inflammatory infiltrate, consisting mostly of polymorphonuclear leukocytes, mononuclear cells and rare multinuclear giant cells. The immune system appears to play a critical role in the etiology of TAO. However, knowledge about immunological aspects involved in the progression of vascular tissue inflammation, and consequently, the evolution of this disease, is still limited. There are several studies that suggest the involvement of genetic factors and results have shown increasing levels of antiendothelial cell antibodies in patients with active disease. Vasodilation is impaired in patients with TAO. TAO disorder may actually be an autoimmune disorder, probably initiated by an unknown antigen in the vascular endothelium, possibly a component of nicotine. There are various therapies available for treatment of TAO, but the major and indispensable measure is smoking cessation. Except for discontinuation of tobacco use, no forms of therapy are definitive. Sympathectomy, cilostazol and prostaglandin analogues (prostacyclin or prostaglandin E) have been used in specific conditions. Recently, therapeutic angiogenesis with autologous transplantation of bone marrow mononuclear cells has been studied in patients with critical limb ischemia.     

Analytical Study of Porous Organosilicate Glass Films Prepared from Mixtures of 1,3,5- and 1,3-Alkoxysilylbenzenes

Organosilicate glass (OSG)-based porous low dielectric constant (low-k) films with different molar ratios of 1,3,5-tris(triethoxysilyl)benzene to 1,3-bis(triethoxysilyl)benzene bridging organic groups (1:3 and 1:7) were spin-on deposited, followed by a soft bake in air and N₂ at 150 °C and hard bake in air and N₂ at 400 °C. Non-ionic template (Brij^®30) concentrations were varied from 0 to 41 wt% to control the porosity of the films. The chemical composition of the matrix of the films was evaluated and discussed with the shrinkage of the film during the curing, refractive indices, mechanical properties, k-values, porosity and pore structure. The chemical composition of the film cured in both air and N₂-containing ambient were evaluated and compared. The benzene bridging groups containing films change their porosity (0 to 43%) but keep the pore size constant and equal to 0.81 nm when porosity is lower than 30%. The k-value decreases with increasing porosity, as expected. The films containing benzene bridge have higher a Young’s modulus than plasma-enhanced chemical vapor deposition (PECVD) methyl-terminated low-k films with the same porosity and show good hydrophobic properties after a hard bake and close to the values reported for 1,4-benzene-bridged films. The fabricated films show good stability after a long time of storage. However, the improvement of mechanical properties was lower than the values predicted by the published literature data. It was concluded that the concentration of 1,3,5-benzene bridges was below the stiffness threshold required for significant improvement of the mechanical properties. The films show UV-induced luminescence with a photon energy of 3.6 to 4.3 eV. The luminescence is related to the presence of oxygen-deficient-type defects or their combination with organic residues. The most intensive luminescence is observed in as-deposited and soft bake samples, then the intensity is reduced after a hard bake. It is assumed that the oxygen-deficient centers form because of the presence of Si–OC₂H₅ groups in the films and the concentration of these centers reduces when all these groups completely transformed into siloxane (Si–O–Si).