GPC3/MXR7基因在肾细胞癌及癌旁肾组织中的表达

目的 探讨肾癌、癌旁肾组织中多种相关基因的表达水平及差异,以及与临床分期的关系.方法 应用实时荧光定量PCR方法 检测GPC3/MXR7基因在肾细胞癌组织及癌旁肾组织中的表达,并比较不同临床阶段其表达的差异.结果 GPC3/MXR7在肾癌组织中平均表达(GPC3/MXR7和18 S的比值)是(0.07±0.14)×10-3,而癌旁肾组织中是(0.16±0.14)×10-3,差异有统计学意义(P＜0.05),表明GPC3/MXR7基因在肾癌组织中平均表达均明显低于在癌旁肾组织中的平均表达.GPC3/MXR7在癌旁与肾癌的表达比值在临床分期(I+Ⅱ)期中平均为32.05±48.87,而在(Ⅲ+Ⅳ)期中为22.95±49.58,差异无统计学意义(P＞0.05),表明GPC3/MXR7基因在癌旁与肾癌组织中的表达降低或增高均与临床分期无关.结论 肾癌的发生、发展可能与GPC3/MXR7基因有关,是多种基因共同作用的结果 .     

ASPM基因在肾透明细胞癌中的表达及其诊断预后的价值

目的:探讨人类异常纺锤体样小头畸形相关蛋白(abnormal spindle-like microcephaly-associated protein,ASPM)在肾透明细胞癌中的表达情况以及其诊断预后的价值。方法:利用癌症基因组图谱(The Cancer Genome Atlas,TCGA)数据库的RNA-Seq数据和临床数据,分析ASPM基因与肾透明细胞癌患者临床病理特征以及生存预后的关系。结果:总体534例肾透明细胞癌样本的癌和癌旁组织中的ASPM的表达水平分别为6.62±1.34和3.59±1.41,差异有统计学意义(P0.001)。72例配对的肾透明细胞癌和癌旁组织中的ASPM表达水平分别为6.89±1.14和3.59±1.41,差异有统计学意义(P0.001)。ROC曲线分析结果表明,ASPM基因可作为一个灵敏度和特异度较高的肾透明细胞癌诊断指标(敏感性为94.2%,特异性为90.3%,AUC=0.935)。ASPM基因表达与肾透明细胞癌患者临床病理特征的关系显示,ASPM表达与性别、肿瘤分级、T分期、M分期、临床分期均有显著性差异(P0.001)。生存分析发现总体534例样本中ASPM低表达者和高表达者的总体生存时间分别为(1 421.85±984.72) d和(1 279.89±976.68) d,比较差异有统计学意义(Log-rank=14.69,P0.001)。结论:ASPM在肾透明细胞癌中高表达,且临床特征密切相关,其高表达对判断肾透明细胞癌的生存预后及其诊断具有参考价值。     

肿瘤-睾丸抗原基因在肾透明细胞癌中的表达

目的 研究6种肿瘤.睾丸抗原(CT)基因在肾透明细胞癌中的表达及其临床意义.方法 采用逆转录-聚合酶链反应(RT-PCR)技术检测42例肾透明细胞癌患者癌组织(新鲜标本,T1期16例,12期12例,T3期10例,T4期4例;G1 10例,G2 18例,G3 14例)及其中14例患者癌旁组织的cTAGE-1、cTAGE-2、MAGE-A1、MAGE-A3、MAGE-A12及NY-ESO-1基因mRNA的表达.结果 42例肾透明细胞癌组织中100%(42/42)至少表达6种CT基因中一种,14例癌旁组织表达均阴性.肾透明细胞癌组织中MAGE-A12表达最高,其次为MAGE-A3,MAGE-A1,cTAGE-1,cTAGE-2及NY-ESO-1,分别为71%(30/42),69%(29/42),67%(28/42),64%(27/42),60%(25/42)及48%(20/42).肿瘤不同分期、不同分级之间6种CT基因表达的差异均无统计学意义(Pearson x2检验法,P＞0.05).结论 CT基因在肾透明细胞癌中有较高表达,可望成为肾透明细胞癌特异性免疫治疗的靶基因.     

内皮细胞特异性分子在肾透明细胞癌组织中的表达及意义

目的观察不同临床分期肾透明细胞癌的内皮细胞特异性分子(ESM-1)的表达差异,以探讨ESM-1与肿瘤发生及恶性程度的相关性。方法收集肾透明细胞癌组织、正常肾组织以及癌旁组织标本,进行免疫印迹和免疫组化染色,并根据蛋白条带的灰度值和免疫组化结果进行定量评分,同时监测患者血清中ESM-1的表达水平。结果免疫印迹显示肾透明细胞癌标本中ESM-1表达灰度为2.12±0.23,免疫组化显示肾透明细胞癌中ESM-1阳性染色评分为2.1±0.94,相比癌旁组织组和正常肾组织组,差异均有统计学意义(P0.05);且ESM-1血清中表达量较正常组升高。结论检测ESM-1的表达有助于判断肾透明细胞癌的预后。     

RASL11B基因在肾透明细胞癌组织中的表达特征及其临床意义

目的 研究RAS样家族成员11B(RASL11B)在肾透明细胞癌中的表达特征及意义.方法 收集36例肾透明细胞癌患者的癌组织和对应癌旁组织,采用实时荧光定量PCR方法,检测RASL11BmRNA的表达差异,并分析RASL11B mRNA的表达水平与临床病理参数的关系;分别采用Western-blot和免疫组化的方法,确定RASL11B蛋白在癌组织和癌旁组织的表达差异及定位.结果 实时荧光定量PCR结果显示,肾透明细胞癌组织和癌旁组织均表达RASL11B mRNA,与癌旁组织(1.93±0.43)比较,其表达量在癌组织(0.28±0.08)中显著降低,两组比较有显著性差异(P＜0.001);RASL11B mRNA的表达水平下调与肿瘤直径大小、T分期、组织学分级、临床分级及有无大血管浸润呈显著负相关性;而与年龄和性别无显著相关性.Western-blot结果显示,癌组织和癌旁组织均表达RASL11B蛋白,癌组织表达量明显低于癌旁组织,Western-blot条带半定量分析结果分别为0.98±0.06、1.43±0.15,有显著性差异(P＜0.05);免疫组化染色结果显示RASL11B蛋白主要定位于正常肾组织肾小管上皮细胞胞浆;癌组织和癌旁组织的免疫组化染色评分结果分别为0.81±0.16、3.00±0.31,两组比较有显著性差异(P＜0.001).结论 RASL11B在肾透明细胞癌组织中的表达较癌旁组织显著降低,提示该基因的低表达在肾透明细胞癌的发生发展过程中具有一定的促进作用.     

G250、Ki-67和Bax在肾细胞癌组织中的表达与术后生存率的关系

目的 检测G250/MN/CA(简称G250)、Ki-67和Bax在肾细胞癌及癌旁组织中的表达,探讨G250在肿瘤发展过程中的作用,以及G250、Ki-67和Bax表达对肾细胞癌患者术后生存率的影响. 方法 采用免疫组化SP法检测54例肾癌组织和18例癌旁组织中G250、Ki-67和Bax的表达. 结果 G250、Ki-67和Bax免疫染色位于肾癌细胞的细胞膜、细胞核和细胞质,三者在肾细胞癌与癌旁组织中的阳性表达差异均有统计学意义;Ki-67和Bax在肾细胞癌不同病理分级和临床分期中的阳性表达差异有统计学意义,而G250的阳性表达差异无统计学意义.随访的47例患者中,G250阳性组患者术后远期无瘤生存率低于G250阴性组,但二者间的差异无统计学意义;进一步研究表明G250阳性高表达的患者术后无瘤生存率明显高于低表达者,经Log-rank检验差异有统计学意义.Ki-67阳性组患者术后远期无瘤生存率低于Ki-67阴性组,二者间的差异无统计学意义.Bax阳性组患者术后远期无瘤生存率高于Bax阴性组,二者间的差异有统计学意义. 结论 G250作为一种新的肾细胞癌特异性标志物,在肾细胞癌尤其是肾透明细胞癌的诊断、筛选方面具有良好的前景,并可能影响患者的术后无瘤生存率,但其表达与肾细胞癌临床分期及病理分级无明显相关;肾细胞癌中Ki-67和Bax的表达与肾细胞癌临床分期及病理分级有明显相关性,后者的表达同时也会影响患者术后的无瘤生存率.联合检测肾细胞癌组织中G250、Ki-67和Bax的表达有利于早期诊断肾细胞癌,并有利于判断患者的预后情况,对临床工作有指导意义.     

α-FR在肾细胞癌及膀胱癌患者血清中的表达水平及其临床意义

目的 探讨α-FR(α型叶酸受体)在肾细胞癌及膀胱癌患者血清中的表达水平及其临床意义.方法 选取在本院经组织病理学确诊的肾细胞癌患者58例和膀胱癌患者42例,选取同期在本院健康体检的志愿者40例作为对照组,比较3组研究对象血清中的α-FR表达水平的差异.比较肾细胞癌和膀胱癌患者不同病理参数间血清中α-FR表达水平的差异.结果 肾细胞癌患者血清中的α-FR表达水平(87.39±47.15) pg/mL和膀胱癌患者血清中的α-FR表达水平(84.52±45.68) pg/mL均高于正常对照组(1.45±0.73) pg/mL,且差异具有统计学意义(P＜0.05).肾细胞癌和膀胱癌患者血清中的α-FR表达水平无统计学差异(P＞0.05).肾细胞癌TNM分期为Ⅰ期和Ⅱ期的患者血清中的α-FR表达水平(67.39±39.63)pg/mL低于TNM分期为Ⅲ期和Ⅵ期的患者(125.32±68.22) pg/mL,肾细胞癌高分化的患者血清中的α-FR表达水平(155.29 ±75.31) pg/mL高于中低分化的患者(78.85±42.68)pg/mL,且差异具有统计学意义(P＜0.05);膀胱癌TNM分期为Ⅰ期和Ⅱ期的患者血清中的α-FR表达水平(84.71±53.64) pg/mL低于TNM分期为Ⅲ期和Ⅵ期的患者(157.92±88.34) pg/mL,膀胱癌高分化的患者血清中的α-FR表达水平(145.31±65.87) pg/mL高于中低分化的患者(79.64±48.22) pg/mL,且差异具有统计学意义(P＜0.05).结论 血清中α-FR表达水平可作为肾细胞癌和膀胱癌诊断的肿瘤标志物.     

APEH基因在肾透明细胞癌中的表达研究

目的 研究APEH基因在肾透明细胞癌中的表达,以探索其意义.方法 应用半定量RT-PCR、实时定量PCR、免疫组化(IPH)检测30例配对肾透明细胞癌组织/癌旁正常肾组织标本中APEH基因mRNA和蛋白的表达,并对其中16例配对标本进行Western blot蛋白检测,予以统计分析.结果 相较正常对照组,RT-PCR 、实时定量PCR 及IPH均显示肾细胞癌组织中APEH基因表达下调,其比例分别达到60.0%(18/30)、73.3%(22/30)和80.0%(24/30),另外,Western blot示62.5%(10/16)的癌组织标本APEH蛋白表达下调.4种方法检验P值均<0.05,差异有统计学意义,且针对同一批配对标本各检测方法结果之间一致性显著.结论 APEH可能为一新的肾透明细胞癌分子标志物.     

Fibulin-1基因表达与肾细胞癌的关系研究

目的 检测肾细胞癌组织中Fibulin-1基因表达的改变,探讨其相关的临床意义.方法 选取2014年1月至2016年5月本院收治的肾细胞癌患者手术切除种癌组织83例,以及相应的癌旁正常非瘤肾脏组织.SYBR Green 荧光定量-PCR检测癌组织和非癌组织Fibulin-1基因表达量.结果 肾细胞癌肿瘤组织中Fibulin-1基因表达量为(0.176±0.028),显著低于对照非肿瘤肾组织的(0.384±0.052,P<0.01).肾细胞癌肿瘤组织中Fibulin-1基因表达量在不同性别、不同年龄和组织病理类型间差异无统计学意义(P>0.05).有淋巴结转移肿瘤组织Fibulin-1基因表达量为(0.152±0.022),显著低于无淋巴结转移肿瘤组织(0.204±0.035,P<0.05).中、低分化肿瘤组织Fibulin-1基因表达量为(0.160±0.021),显著低于高分化肿瘤组织(0.207±0.036,P<0.05).Ⅲ、Ⅳ期肿瘤组织中的Fibulin-1基因表达量为(0.148±0.019),显著低于Ⅰ、Ⅱ期肿瘤组织(0.199±0.034,P<0.05).结论 肾细胞癌患者fibulin-1基因表达下调,fibulin-1基因表达下调与肾细胞癌有无淋巴结转移、分化程度以及临床分期密切相关.     

VEGF和PCNA在肾细胞癌中的表达及意义

目的 研究肾细胞癌中血管内皮生长因子(VEGF)和增殖细胞核抗原(PCNA)表达与肾癌临床分期、病理分级、组织学类型、预后之间的关系. 方法 采用免疫组织化学技术检测40例肾细胞癌和10例正常肾组织标本中VEGF和PCNA的表达. 结果 正常肾组织与肾细胞癌组织中VEGF和PCNA阳性表达率比较差异均有统计学意义(P＜0.01,P＜0.05).在不同病理分级肾细胞癌中,高分化组、中分化组的VEGF和PCNA阳性表达率分别与低分化组比较差异有统计学意义(P＜0.01,P＜0.05).在不同临床分期肾细胞癌中,VEGF阳性表达率随临床分期的升高而逐渐升高;PCNA阳性表达率随临床分期的升高有升高的趋势.在不同组织类型肾细胞癌中,VEGF和PCNA阳性表达率差异均无统计学意义(P>0.05). 结论 VEGF在肾细胞癌组织中的表达与肾癌的病理分级及临床分期有相关性,其高表达与肾细胞癌的浸润转移密切相关.PCNA的表达与肾癌的病理分级具有相关性,能较为客观、准确地反映肾癌的恶性程度.     

Continuous renal replacement therapy improves renal recovery from acute renal failure

BACKGROUND: Acute renal failure (ARF) occurs in up to 10% of critically ill patients, with significant associated morbidity and mortality. The optimal mode of renal replacement therapy (RRT) remains controversial. This retrospective study compared continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) for RRT in terms of intensive care unit (ICU) and hospital mortality, and renal recovery. METHODS: We reviewed the records of all patients undergoing RRT for the treatment of ARF over a 12-month period. Patients were compared according to mode of RRT, demographics, physiologic characteristics, and outcomes of ICU and hospital mortality and renal recovery using the Chi square, Student's t test, and multiple logistic regression as appropriate. RESULTS: 116 patients with renal insufficiency underwent RRT during the study period. Of these, 93 had ARF. The severity of illness of CRRT patients was similar to that of IHD patients using APACHE II (25.1 vs 23.5, P = 0.37), but they required significantly more intensive nursing (therapeutic intervention scale 47.8 vs 37.6, P = 0.0001). Mortality was associated with lower pH at presentation (P = 0.003) and increasing age (P = 0.03). Renal recovery was significantly more frequent among patients initially treated with CRRT (21/24 vs 5/14, P = 0.0003). Further investigation to define optimal timing, dose, and duration of RRT may be beneficial. CONCLUSIONS: Although further study is needed, this study suggests that renal recovery may be better after CRRT than IHD for ARF. Mortality was not affected significantly by RRT mode.     

Influences of renal stone surgeries on renal function--evaluation of renal function with 99mTc-DMSA renal scintigraphy]

From 1984 to 1990, 99mTc-DMSA renal scintigraphy was performed before and after nephrolithotomy (15 cases), pyelolithotomy (15 cases), percutaneous nephrolithotripsy (PNL: 15 cases) and extracorporeal shock wave lithotripsy (ESWL: 16 cases, 17 kidneys) in order to evaluate of influences of renal stone surgeries on split renal function. DMSA renal uptake change ratio of treated kidneys of nephrolithotomy (-24.94 +/- 5.60%) was significantly lower than that of PNL (-0.06 +/- 3.92%), pyelolithotomy (-4.08 +/- 4.79%) (p less than 0.01) and ESWL (-7.72 +/- 3.87%) (p less than 0.05). The average change ratios of contralateral kidneys were as follows: PNL 4.80 +/- 4.21% nephrolithotomy 4.67 +/- 4.73%, pyelolithotomy -1.46 +/- 5.39% and ESWL -2.02 +/- 4.44%. One to 3 weeks after PNL, the cold area on the renal image was found in 10 (66.7%) of 15 cases. In cases of ESWL, DMSA renal uptake decreased even 4-10 weeks (mean 7 weeks) after treatment. In conclusion, possivility of deterioration of renal function after ESWL was suggested.     

Transplantation of renal primordia: renal organogenesis

Dialysis and allotransplantation of human kidneys represent effective therapies to replace kidney function, but the former replaces only a small component of renal function, and the latter is limited by lack of organ availability. Xenotransplantation of whole kidneys from nonprimate donors is complicated by humoral and severe cellular rejection. The use of individual cells or groups of cells to repair damaged tissue (cellular therapies) offers an alternative for renal tissue replacement. However, recapitulation of complex functions such glomerular filtration and reabsorption and secretion of solutes that are dependent on a three-dimensionally integrated kidney structure are beyond the scope of most cellular replacement therapies. The use of nonvascularized embryonic renal primordia for transplantation circumvents humoral rejection of xenogeneic tissue and ameliorates cellular rejection. Renal primordia are preprogrammed to attract a vasculature and differentiate into a kidney and in this manner undergo organogenesis after transplantation into the mesentery of hosts. Here we review a decade’s progress in renal organogenesis.     

The renal medulla in acute renal allograft rejection: comparison with renal cortex

A retrospective cohort study was undertaken to evaluate thediagnostic value of the renal medulla in acute renal allograftrejection (ARAR). One hundred and ninety-five biopsies from98 patients were randomly selected out of 565 transplant biopsies.Biopsies were graded blindly from Grade 0 (no rejection) toGrade 3 (severe rejection) using standard criteria; ARAR wasconfirmed by a fall in all cases of mean serum creatinine concentrationfrom 0.331 ± 0.182 to 0.184 ± 0.079 mmol/l, withanti-rejection therapy. In the 43 biopsies which contained bothcortex and medulla, the ARAR grades and the intensities of mononuclearcell, plasma cell, polymorphonuclear cell and eosinophil infiltrates,and of interstitial oedema and haemorrhage, were similar incortex and medulla (Spearman's Rank Correlation r=0.55–0.81,P < 0.001 ). The sensitivity, specificity and overall accuracyof medullary changes in predicting ARAR changes in the cortexwere 77%, 100% and 38%, respectively. Acute vascular rejectionchanges could not be compared between renal cortex and renalmedulla because of the anatomical differences between cortexand medulla. Further evaluation of ARAR in the all 195 biopsies,of which 188 had cortical tissue and 50 had medullary tissue,showed no significant differences in histological features (P> 0.05), except for more cortical biopsies with plasma cells(29%) than medullary biopsies with plasma cells (10%; P <0.02). It is concluded that: (1) ARAR histological changes aresimilar in cortex and medulla; (2) the predictive value of ARARmedullary changes for cortical rejection changes has low sensitivity(77%) and high specificity (100%). It is suggested that a predominantlynormal medullary renal biopsy in suspected rejection shouldbe repeated to obtain cortical tissue.     

Abnormal renal arteriography after renal trauma.

Angiograms following renal trauma in a ten-year-old girl were highly suggestive of renal neoplasm, especially Wilms' tumor. There are striking similarities between arteriograms after renal trauma and those showing neovascularity.     

Extensive renal involvement by renal cell carcinoma

Experience with the management of 3 cases of bilateral renal adenocarcinoma and 1 case of unilateral carcinoma in the solitary kidney is presented. Two patients died of metastases six and thirteen months postoperatively, while one is alive with metastases at fourteen months and another is alive without metastases at four months. The literature is reviewed, and the various treatments are discussed.