胆汁CA19-9、CEA检测对胆管癌的诊断价值

[目的]探讨胆汁CA19-9、CEA对胆管癌的诊断价值。[方法]选择胆管癌30例，胆道良性病变25例作为对照组。采用化学发光法检测其血清和胆汁中CA19-9、CEA的水平，比较血清与胆汁中CA19-9、CEA的水平以及与肿瘤分期的关系。[结果]胆汁CA19-9、CEA均明显高于血清检测结果（P〈0．01）。不同临床分期胆管癌患者胆汁CA19-9、CEA的彰、蔓比较未发现统计学差异，但各期胆汁CA19-9、CEA的浓度显著高于血清CA19-9、CEA的浓度，且有统计学差异，尤其在Ⅰ期胆管癌其胆汁CA19-9、CEA的水平明显高于血清。[结论]胆汁CA19-9、CEA的测定对胆管癌，尤其早期胆管癌的诊断具有重要价值，优于血清CA1909、CEA的测定。     

血清胆汁CA19-9、CEA、CA242联合检测诊断胆道良恶性肿瘤的可行性分析

目的:探讨血清、胆汁CA19-9、CEA、CA242联合诊断胆道良恶性肿瘤的临床价值。方法:对象为2013年10月-2015年2月来我院诊治的疑似恶性胆道肿瘤的患者202例,均行手术探查。所有患者均通过穿刺的方式取胆汁进行CA19-9、CEA、CA242检测,比较不同疾病类型患者血清、胆汁中的CA19-9、CEA、CA242检测水平,分析血清胆汁联合检测在胆道良恶性肿瘤中的诊断价值。结果:202例手术探查患者中,98例经病理证实为恶性胆道肿瘤患者、22例为良性胆道肿瘤患者,82例为其他胆道疾病。恶性胆道肿瘤与良性胆道肿瘤患者胆汁中CA242、CA19-9和CEA的表达水平要显著性的高于在血清中的表达水平（P＜0.05）;恶性肿瘤组患者的胆汁中CA242、CA19-9和CEA检测水平均显著性高于良性肿瘤患者（P＜0.05);胆汁CA242、CA19-9和CEA联合诊断胆道恶性肿瘤的敏感率为33.66%,准确率为88.98%,特异性为91.16%,阳性率为35.24%。结论:利用胆汁中肿瘤标记物对胆道肿瘤的检测水平要高于血清中的水平,采用CA19-9、CEA、CA242的联合检测是诊断胆道肿瘤比较理想的组合。上述肿瘤标志物的组合能够提高胆道肿瘤良恶性的预判准确度,对于早期胆道良恶性肿瘤的发现、治疗具有十分重要的意义。     

血清和腹水肿瘤标志物对良、恶性腹水的鉴别诊断价值

目的 探讨血清和腹水AFP、CEA、CA125、CA19-9对良、恶性腹水鉴别诊断的价值.方法 70例腹水患者根据病因分为良性组和恶性组,比较2组患者血清和腹水肿瘤标志物的水平.结果 恶性组血清和腹水中AFP、CEA、CA19-9水平均高于良性组(P均＜0.05).血清AFP、CEA、CA19-9联合检测的敏感性、特异性和准确性分别为61.90％、82.14％和70.00％,腹水AFP、CEA、CA19-9联合检测的敏感性、特异性和准确性分别为57.14％、88.46％和67.14％.结论 血清和腹水AFP、CEA、CA19-9的检测有助于良、恶性腹水的鉴别,血清或腹水AFP、CEA、CA19-9联合检测可提高恶性腹水诊断的敏感性和准确性.     

肿瘤标志物在胰腺囊性肿瘤良恶性鉴别诊断中的价值

目的探讨糖类抗原19-9(CA19-9)、癌胚抗原(CEA)和总胆红素(TB)联合检测在胰腺囊性肿瘤良恶性鉴别中的临床诊断与应用价值。方法选取2015年1月至2017年1月间陕西省宝鸡市人民医院收治的116例胰腺囊性肿瘤患者,分别行血清CA19-9、CEA和TB检测,以病理学检查结果进行分组,将106例恶性胰腺囊性肿瘤患者纳入恶性胰腺囊性肿瘤组; 10例良性胰腺囊性肿瘤患者纳入良性胰腺囊性肿瘤组。比较两组患者的肿瘤标志物水平,并计算CA19-9、CEA和TB单独检测与CA19-9、CEA和TB联合检测恶性胰腺囊性肿瘤的阳性率、敏感性、准确性和特异性。结果恶性囊胰腺囊性肿瘤患者血清CA19-9、CEA和TB水平均显著高于良性胰腺囊性肿瘤患者; CA19-9、CEA和TB单独检测恶性胰腺囊性肿瘤阳性率均显著低于三组联合检测的阳性率,差异均有统计学意义(均P <0. 05)。CA19-9、CEA和TB联合检测恶性胰腺囊性肿瘤的灵敏度与准确度均显著高于CA19-9、CEA和TB单独检测,差异均有统计学意义(均P <0. 05)。CA19-9、CEA和TB联合检测恶性胰腺囊性肿瘤的特异性与CA19-9、CEA和TB单独检测的特异性无显著差异,差异无统计学意义(P> 0. 05)。结论 CA19-9、CEA和TB联合诊断可显著提升恶性胰腺囊性肿瘤的确诊率,值得在胰腺囊性肿瘤良恶性的鉴别诊断中应用推广。     

血清CA19-9和CA242检测在胆管癌中的诊断价值

目的：研究多肿瘤标志物蛋白质芯片联合检测CA19—9和CA242在诊断胆管癌中的价值。方法：应用多肿瘤标志物蛋白质芯片诊断系统检测75例胆管疾病患者血清中两种肿瘤标志物糖类抗原19—9（CA19—9）和糖类抗原242（CA242）的改变。所有疾病均经术中和／或术后病理学证实，其中胆管癌40例、胆管良性病变35例。结果：40例胆管癌中，CA19—9阳性者35例（87．5％），CA242阳性者33例（82．5％）；35例胆管良性病变中CA19—9阳性者22例（62．9％），CA242阳性者10例（28．6％）。75例患者中CA19—9和CA242同时阳性者37例，其中胆管癌患者同时阳性者31例（77．5％），CA19—9〉500U／ml者28例；胆管良性病变同时阳性者6例（17．1％），CA19-9〉500U／ml者1例，两者相比较有统计学差异（P〈0．01）。结论：应用多肿瘤标志物蛋白质芯片诊断系统联合检测CA19-9和CA242，对胆管疾病良恶性的鉴别具有重要临床价值。     

肠镜联合血清肿瘤标志物检测对结直肠癌的诊断价值分析

目的 分析肠镜联合血清肿瘤标志物检测对结直肠癌的诊断价值.方法 将103例结直肠癌患者纳入恶性组,以同期收治的103例结直肠良性病变患者作为良性组,比较两组患者血清肿瘤标志物[糖类抗原72-4(CA72-4)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)]水平,全部患者均接受肠镜检查;以病理检查结果为金标准,采用受试者工作特征(ROC)曲线分析肠镜、血清肿瘤标志物单独及联合检测对结直肠癌的诊断价值,分析各项检测方法诊断结果与金标准的一致性,计算诊断效能.结果 恶性组患者血清CA19-9、CEA、CA72-4水平均明显高于良性组,差异均有统计学意义(P﹤0.01).肠镜与血清肿瘤标志物联合诊断结直肠癌的各项诊断效能均高于各项单独应用,灵敏度为89.32％,特异度为99.03％,准确度为94.17％;各项诊断结果与金标准的一致性均为良(0.6﹤Kappa值≤0.8,P﹤0.01).肠镜具有中等诊断价值[曲线下面积(AUC)=0.883,P﹤0.01];3项血清肿瘤标志物均具有中等诊断价值,其中CA19-9最高(AUC=0.854,P﹤0.01);肠镜与血清肿瘤标志物联合应用具有较高的诊断价值(AUC=0.942,P﹤0.01).结论 肠镜联合血清肿瘤标志物检测对结直肠癌具有较高的诊断价值.     

血清癌胚抗原联合糖类抗原19-9检测对胰腺癌筛查的临床价值评估

目的 研究血清癌胚抗原(CEA)联合糖类抗原19-9(CA19-9)检测对胰腺癌筛查的临床价值.方法 将103例胰腺癌患者作为胰腺癌组,选取同期收治的105例胰腺炎患者以及健康体检的97例健康人群作为胰腺炎组及健康对照组.对比治疗前3组血清CEA、CA19-9水平,以及手术前后胰腺癌患者血清CEA、CA19-9水平;对比血清CEA、CA19-9单独及联合检测诊断胰腺癌的灵敏度、准确度、特异度.结果 胰腺癌组与胰腺炎组患者血清CEA、CA19-9水平均高于健康对照组,胰腺癌组患者血清CEA、CA19-9水平均高于胰腺炎组,差异均有统计学意义(P﹤0.05).血清CEA联合CA19-9检测诊断胰腺癌的灵敏度明显优于CEA、CA19-9单一检测.术后3个月,胰腺癌患者血清CEA、CA19-9水平均明显低于手术前,差异均有统计学意义(P﹤0.01).结论 在胰腺癌的筛查过程中,采用血清CEA联合CA19-9检测效果显著,两者联合检测对胰腺癌诊断有较高的灵敏度、准确度,有助于提高疾病诊断率.     

外周血内CA19-9、CA242及CEA对胰腺癌诊断及病理分期评估的价值

目的：分析糖类抗原19-9（carbohydrate antigen 19-9,CA19-9）、CA242、癌胚抗原（carcino-embryonic anti-gen,CEA）联合检测诊断胰腺癌的临床价值及其对临床分期判断的指导作用。方法选取95例胰腺癌患者为患者组,及同期60例健康体检者为对照组,比较两组受试者血清CA19-9、CA242和CEA的表达水平,计算血清CA19-9、CA242、CEA单独检测及联合检测诊断胰腺癌的敏感度、特异度和准确性,并比较不同临床分期胰腺癌患者血清CA19-9、CA242、CEA的差异,评价上述指标对胰腺癌临床分期判断的指导作用。结果患者组血清 CA19-9、CA242、CEA水平均高于对照组,差异均具有统计学意义（均P＜0．05）。联合检测诊断胰腺癌的敏感度、特异度和准确性分别为96．8％、66．7％、85．2％,其敏感度、准确性均优于单项检测。随着患者病理分期的增加,其血清CA19-9、CA242、CEA水平均升高,差异均具有统计学意义（均P＜0．05）。患者组治疗后6个月血清CA19-9、CA242、CEA水平均较术前降低,差异均具有统计学意义（均P＜0．05）。肿瘤直径≥5 cm者、肿瘤位于胰腺体／尾部者,其血清CA19-9、CA242、CEA水平均高于肿瘤直径＜5 cm 者及肿瘤位于胰腺头部或全胰腺者,差异均具有统计学意义（均 P＜0.05）。结论联合检测血清CA19-9、CA242和CEA有助于胰腺癌的早期诊断及分期判断,具有较高的临床价值。     

血清癌胚抗原、糖类抗原125、糖类抗原153联合检测对乳腺癌的诊断价值

目的 探讨血清癌胚抗原（CEA）、糖类抗原125(CA125)、糖类抗原153(CA153)联合检测对乳腺癌的诊断价值。方法 选取106例乳腺癌患者和72例乳腺良性疾病患者,分别作为恶性组和良性组。比较两组患者的血清CEA、CA125、CA153水平,绘制受试者工作特征（ROC）曲线,分析血清CEA、CA125、CA153单独及三者联合检测对乳腺癌的诊断价值。结果 恶性组患者的血清CEA、CA125、CA153水平均明显高于良性组,差异均有统计学意义（P<0.01）。CA153对乳腺癌具有较高诊断价值,CEA、CA125对乳腺癌具有中等诊断价值,三者联合检测对乳腺癌具有较高诊断价值,且诊断价值高于各指标单独检测。结论 血清CEA、CA125、CA153联合检测对乳腺癌具有较高诊断价值,可用于乳腺癌筛查。     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.