直肠癌新辅助放化疗的近期疗效研究

目的 探讨局部晚期直肠癌行新辅助放化疗的近期疗效.方法 对收治的30例经病理证实的局部晚期直肠癌患者行放射治疗:盆腔淋巴引流区放疗剂量45 Gy/25次之后缩野至肿瘤区加量至总剂量为50.4 Gy/28次.同步化疗方案为奥沙利铂联合卡培他滨(希罗达),同步放化疗结束后4-6周进行手术,术后完成围手术期6月的FOLFOX6方案全身化疗.结果 经治疗后肿瘤降期率60.0％(18/30).术后完全缓解率(CR)23.3％ (7/30),部分缓解率(PR)60.0％ (18/30);稳定(SD) 16.7％ (5/30);总有效率(CR+PR)83.3％(25/30).不良反应主要为恶心呕吐、畏食、乏力、白细胞和血小板减少、腹泻、口腔炎等,无4度不良反应发生,无放化疗相关死亡.总体保肛率26.7％(8/30),本组无手术死亡.结论 直肠癌术前放化疗能提高肿瘤病理完全缓解率,降低肿瘤分期,提高手术切除率,且不良反应较轻,临床实施安全.     

食管癌分次放疗期间靶区不确定性初步研究

Objective To investigate the changes of target during fractionated radiotherapy for e-sophageal cancer, and to assess their impact on the implementation of radiotherapy. Methods Fourteen pa-tients with unresectable esophageal cancer were enrolled to receive full course conformal radiotherapy. CT scans were performed after every ten fractions. New targets (GTV) were delineated on repeated CT scans. Then the pretreatment radiotherapy plans were copied to the new targets to investigate the conformity between the new GTV and the plans. Results The majority of the GTVs decreased with the increasing fractions dur-ing radiotherapy. However, GTVs of 35.7% (5/14) patients increased by 2.0%-37.7% at the tenth frac-tion. The PTVs covered by 95% isodose curve at the time of pretreatment,tenth fraction,twentieth fraction and thirtieth fraction were 97.81%±1.53%, 91.95%±5.25%, 94.27%±4.23% and 94.03%±6.45%, respectively. Moreover, at tenth, twentieth and thirtieth fraction, there were 6,5, and 4 patients whose PTVs covered by 95% isodose curve were below 95%, respectively. Conclusions There are signifi-cant target changes during fractionated radiotherapy for esophageal cancer, which may result in uncertainties of radiotherapy implementation.     

个性化发泡剂定位在直肠癌放射治疗体位固定中的应用

[目的]探讨直肠癌放疗摆位装置在直肠癌放疗体位固定中的作用。[方法]将60例直肠癌患者分为两组,每组30例。对照组患者用真空垫固定体位,试验组患者利用直肠癌放疗摆位装置固定体位。在治疗前以及每周一次的分次治疗前、后拍摄锥形束计算机断层扫描（CBCT）,比较两组患者分次治疗前、后的摆位误差得到误差幅度。采用独立样本t检验分析组间摆位误差差异。[结果]对照组患者与试验组患者治疗前在左右方向摆位误差分别为(2.07±1.09) mm和(1.22±1.41) mm(P=0.011),头脚方向摆位误差分别为(1.55±0.94) mm和(1.13±1.13) mm(P=0.126),腹背方向摆位误差分别为(2.33±1.69) mm和(0.98±1.39) mm(P=0.001)。两组误差幅度值在左右方向分别为（1.99±0.63） mm和（0.75±0.61） mm,头脚方向分别为（1.63±0.61） mm和（0.79±0.66） mm,腹背方向分别为（1.99±0.74） mm和（0.92±0.68） mm,误差幅度值在左右、头脚、腹背三个方向的差异均有统计学意义（P均<0.001）...     

上海地区人群血清骨转换标志物参考区间的建立

Objective To establish the reference intervals of serum osteocalcin (OCN), C-terminal cross-linking telopeptide of type Ⅰ collagen (β-CTx) and total type Ⅰ procollagen N-terminal peptide (P1NP) by electrochemiluminescence assay. Methods According to the Clinical and Laboratory Standards Institute (CLSI) "CA8-A" document the appropriately healthy people, who were divided into three groups (men, premenopausal women, and postmenopausal women) by sex and pre- or postmenopausal status were screened. The levels of fasting serum of OCN,β-CTx, tPINP were detected by Roche Modular E170 electrochemical immunoassay. Results 393 appropriately healthy people consists of 112 men between the ages of 29 and 69 years, 148 premenopausal women between the ages of 29 and 69 years, 133 postmenopausal women between the ages of 29 and 69 years. The levels of serum OCN, β-CTx, tP1NP in men group were (15.33±4.76) μg/L, (413±189) ng/L, (42.15±17.14) μg/L, respectively. The levels of serum OCN, β-CTx, tP1NP in premenopausal women group were (12.99±4.53) μg/L, 265(30-820) ng/L, (36.43±14.23) μg/L, respectively. The levels of serum OCN, β-CTx, tP1NP in postmenopausal women group were (18.96±5.15) μg/L, (513±195) ng/L, 51.40 (8.98 -118.6)μg/L, respectively. Logarithmic transformation produced normal distributions for all markers but serum β-CTx of premenopausal women group and serum tPINP of postmenopausal women group. The 95% of the distribution intervals for serum OCN, β-CTx, tP1NP in men group was 6.00-24.66 μg/L, 43-783 ng/L, 9.06-76.24 μg/L, respectively. The 95% of the distribution intervals for serum OCN, β-CTx, tP1NP in premenopausal women group was 4.11-21.87 μg/L, 68-680 ng/L, 8.53-64.32 μg/L respectively. The 95% of the distribution intervals for serum OCN, β-CTx, tPl NP in postmenopausal women group were 8.87-29.05 βg/L, 131-900 ng/L, 21.32-112. 80 μg/L, respectively. Conclusions Compared with the reference intervals provided by manufacture, the reference intervals of three serum bone turnover markers established by our laboratory have great difference. Laboratory should pay attention to the reference intervals was cited.     

食管癌分次放疗期间靶区不确定性初步研究

Objective To investigate the changes of target during fractionated radiotherapy for e-sophageal cancer, and to assess their impact on the implementation of radiotherapy. Methods Fourteen pa-tients with unresectable esophageal cancer were enrolled to receive full course conformal radiotherapy. CT scans were performed after every ten fractions. New targets (GTV) were delineated on repeated CT scans. Then the pretreatment radiotherapy plans were copied to the new targets to investigate the conformity between the new GTV and the plans. Results The majority of the GTVs decreased with the increasing fractions dur-ing radiotherapy. However, GTVs of 35.7% (5/14) patients increased by 2.0%-37.7% at the tenth frac-tion. The PTVs covered by 95% isodose curve at the time of pretreatment,tenth fraction,twentieth fraction and thirtieth fraction were 97.81%±1.53%, 91.95%±5.25%, 94.27%±4.23% and 94.03%±6.45%, respectively. Moreover, at tenth, twentieth and thirtieth fraction, there were 6,5, and 4 patients whose PTVs covered by 95% isodose curve were below 95%, respectively. Conclusions There are signifi-cant target changes during fractionated radiotherapy for esophageal cancer, which may result in uncertainties of radiotherapy implementation.     

心肌标志物在心脏手术后的应用价值

目的　观察两组心脏外科手术患者术后 4 8h内各心肌标志物测定值的变化 ,评价其对判断心肌损伤程度的应用价值。方法　两组心脏外科手术患者术后 4 8h内不同时间分别采集静脉血 ,测定心肌肌钙蛋白T(cTnT)、肌红蛋白 (Myo)、肌酸激酶MB同工酶 (CK MB)活性、CK MB蛋白量等心肌标志物浓度 ,评价他们在心脏手术后的应用价值。结果　微创冠脉搭桥手术组术后CK MB出现轻度增高 ,cTnT基本不出现增高 ;在心肌损伤较大的换瓣手术组术后CK MB、cTnT出现明显增高。两组术后Myo都出现明显增高。对照组 (胸外科手术 )中cTnT均未升高 ,而其他各标志物都有不同程度升高。结论　cTnT在判断心脏外科手术后心肌损伤程度上最具应用价值     

妊娠期糖尿病患者CRP、PAI-1与IR相关性的初步探讨

目的探讨C-反应蛋白（CRP）、纤溶酶原激活物抑制剂-1（PAI—1）与胰岛素抵抗（IR）的关系及在GDM发病机制中的作用。方法分别测定29例妊娠糖尿病患者（GDM）、31例糖耐量异常（IGT）孕妇和35例糖耐量正常（NGT）孕妇的CRP、PAI-1及葡萄糖耐量试验（OGTT）的4点血糖和对应的胰岛素水平,同时计算胰岛素抵抗指数（HOMA—IR）和胰岛β细胞功能指数（HOMA—HBCI）,分析比较各组的差异与关系。结果①NGT组HOMA—IR低于IGT和GDM组,均有统计学差异（P〈0．05）,NGT组的HOMA—HBCI高于IGT和GDM组,均有统计学差异（P〈0．05）②GDM组的CRP、PAI—1水平显著高于NGT和IGT组,差异有统计学意义（P〈0．05）。③相关性分析：血清CRP与空腹血糖（FPG）（r=0．331,P=0．01）、HOMA—IR（r=0．303,P=0．035）、孕前BMI（r=0．283,P=0．040）正相关;血浆PAI-1分别与HOMA—IR、空腹胰岛素（Flns）、孕前BMI正相关,相关系数分别为：r=0．525,P=0．001;r=0．550,P=0．001;r=0．625,P=0．000。结论GDM患者IR增加,但胰岛细胞分泌功能却下降,两者共同导致GDM的发生：炎症因子CRP、PAI—1都与IR有关．可能参与GDM的发生和发展。     

血清高尔基体蛋白73在肝硬化诊断及分级中的价值

目的:探讨血清高尔基体蛋白73(GP73)在慢性乙型肝炎(乙肝)、肝硬化中的表达及其与肝硬化分期间的关系。方法:采用酶联免疫吸附试验,定量检测198名正常对照组、171例慢性乙肝组患者、144例肝硬化患者和164例原发性肝细胞肝癌(HCC)患者血清中GP73水平,计算GP73检测受试者工作特征(ROC)曲线下面积及GP73检测对肝硬化诊断的灵敏度与特异度。检测慢性乙肝组和肝硬化组的乙肝病毒(HBV)-DNA载量和HBeAg水平,并对肝硬化组进行血清肝纤维化指标检测及Child-Pugh分级,分析以上指标与GP73水平间的相关性。结果:正常对照组、慢性乙肝组、肝硬化组和肝癌组的中位GP73水平分别为40.80 ng/mL、42.49 ng/mL、83.46 ng/mL和45.19 ng/mL,肝硬化组GP73水平明显高于正常对照组及慢性乙肝组(P<0.05)。结论:血清GP73水平在肝硬化患者代偿期即升高,而随着肝硬化的进展,其呈显著上升趋势,且与HBV活动相关。因此,GP73可作为肝硬化诊断及慢性肝病进展期病情监测的新指标。     

分次放疗中靶区和危及器官不确定性的研究

分次放疗过程中,靶区和周围危及器官的解剖结构及相对位置会产生不同程度的变化,这些不确定性因素的存在将会影响整个放疗计划的正常实施.在临床上通过影像验证系统可以观察到这些不确定性发生的程度,其不确定性产生的原因可能是在放疗过程中肿瘤出现容积变化,器官运动或形状改变、患者体重和体形发生变化以及存在摆位误差等.而图像引导放疗、剂量引导放疗和自适应性放疗技术的开发和临床应用为解决分次放疗期间靶区以及周围危及器官的不确定性创造了有利的条件.     

芪附龙葵汤对晚期直肠癌的临床疗效及相关蛋白表达的影响

正直肠癌为我国人群中最为常见的一种消化系统恶性肿瘤疾病。由于发病早期临床症状不明显,多数患者在发病中晚期时确诊,导致疾病的最佳治疗时机被延误,预后变差~([1])。晚期直肠癌患者手术治疗的风险性较高,术后疾病复发的可能性较大,故临床多对晚期直肠癌患者实施保守治疗~([2])。笔者采用芪附龙葵汤佐治晚期直肠癌36例,观察其疗效及对表皮生长因子受体(EGFR)、转移抑制基因23(nm23)蛋白、高迁移率族蛋白B1