晚期食管鳞癌的化疗进展

鳞状细胞癌是我国食管癌最常见的病理类型。化学治疗对晚期食管癌有一定作用，尚无规范方案。采用单药或联合化疗，治疗不能手术或已发生广泛转移的患者，国内外已进行多方面研究。本文就晚期食管鳞癌的治疗加以综述。     

肿瘤规范化、标准化诊治 第9讲 软组织肉瘤的药物治疗策略

软组织肉瘤是一类起源于软组织及内脏器官的间质组织恶性肿瘤，可发生于人体的各个部位。据文献报道，软组织肉瘤的发病率约占所有恶性肿瘤的1％，在美国和欧洲其发病率分别为10000例／年和8000例／年。虽然我国尚无确切的最新发病统计，据估计其发病率与欧美相近。由于该病发病率较低以及受临床条件的限制，使得人们缺乏对此类肿瘤的认识。目前软组织肉瘤从临床角度可分为以下4类。     

miR-593通过调控PLK1基因的表达抑制结肠癌细胞的增殖

目的探讨miR-593在结肠癌细胞增殖中的作用及分子机制。方法利用生物信息学分析筛选miR-593可能结合的靶基 因为PLK1;利用双荧光素酶报告基因实验验证miR-593 和PLK1 基因的结合;通过qRT-PCR、Western blotting 验证PLK1 为 miR-593直接作用的靶基因;通过CCK-8实验证明miR-593通过调控PLK1基因的表达抑制结肠癌细胞的增殖。结果运用三 种生物信息学软件对PLK1可能结合的miRNA进行了预测与分析,发现miR-593可能结合PLK1基因;双荧光素酶报告基因实 验证明miR-593 与PLK1 基因发生了结合;Western blotting 结果表明,PLK1 在miR-593 mimic 转染组表达量显著下降,而在 miR-593 inhibitor 组明显升高,相对于对照组均具有统计学差异（P<0.05）;qRT-PCR结果表明,PLK1 RNA水平在各组中表 达水平差异无统计学意义（P>0.05）;细胞增殖实验表明,miR-593与PLK1对结肠癌细胞增殖的影响为相反关系,且共转染miR-593 mimic与PLK1过表达质粒组对细胞增殖的影响介于单独转染miR-593 mimic组与PLK1过表达质粒组之间。结论miR-593通 过调控PLK1基因的表达抑制了结肠癌细胞的增殖,并发挥抑癌miRNA的作用。     

潜降颗粒对高血压肝阳上亢证患者血压变异性的影响

【目的】观察平肝潜阳方药潜降颗粒对高血压肝阳上亢证患者血压变异性(blood pressure variability,BPV)的影响。【方法】将60例高血压肝阳上亢证患者随机分为治疗组32例与对照组28例。2组均给予苯磺酸氨氯地平口服,治疗组加用潜降颗粒,疗程4周。在治疗前后分别行动态血压监测,观察2组BPV的变化。【结果】(1)治疗后,2组BPV各项指标均明显下降(P0.05或P0.01),且治疗组对BPV各项指标的下降作用均明显优于对照组(P0.05)。(2)2组均能在降压的同时保持原有的昼夜节律,均能显著降低清晨高峰期(6∶00-12∶00)血压;治疗组经潜降颗粒治疗后获24 h全程平稳降压,但夜间降幅较白天略低,对夜间血压降低较对照组小,因而治疗后夜间的血压谷相对变浅。【结论】潜降颗粒不仅有助于降压达标,亦能有效减少血压变异性。     

高血压病患者炎性因子、假性血管性血友病因子水平与代谢综合征

目的 比较伴代谢综合征(MS)的原发性高血压(EH)患者与单纯EH患者的炎性因子及假性血管性血友病因子(vWF)水平的差异,检验MS与炎症密切相关的假说.方法 连续住院的138例EH患者,根据2005年国际糖尿病联盟MS新定义分为EH MS组(A组)99例与单纯EH组(B组)39例.测定血生化、白细胞(WBC)计数、血清高敏C反应蛋白(hsCRP)及血浆vWF.应用统计学方法分析hsCRP、vWF及与MS的关系.结果 伴MS患者较不伴MS的病人腰围、体质量指数、三酰甘油(TG)及低密度脂蛋白胆固醇(LDL-C)明显升高(P＜0.05或＜0.01),WBC计数及血清hsCRP浓度升高,血浆vWF含量增加(P均＜0.05),高密度脂蛋白胆固醇(HDL-C)降低(P＜0.01).EH患者vWF与hsCRP之间显著相关(r=0.283,P＜0.01).多元回归分析显示,vWF仍与hsCRP显著相关,并与年龄、MS、舒张压(DBP)及吸烟显著相关(P均＜0.01).而hsCRP与vWF及白细胞计数显著相关(P均＜0.01).Logistic多元回归分析显示:HDL-C、TG、LDL-C及vWF可以预测EH患者MS的发生(P＜0.05或＜0.01).结论 代谢综合征患者体内炎性状态进一步活化,内皮损伤程度更重.vWF与hsCRP显著相关,并与EH患者MS相关.     

柴胡龙牡方联合穴位贴敷治疗冠心病冠脉介入治疗术后焦虑患者的临床观察

[目的]观察柴胡龙牡方联合穴位贴敷治疗冠心病冠脉介入治疗(PCI)术后焦虑患者的临床疗效.[方法]将78例冠心病PCI术后合并焦虑的患者随机分为治疗组和对照组,每组各39例.对照组给予常规冠心病药物治疗,治疗组在对照组的基础上,给予柴胡龙牡方联合穴位贴敷治疗,连续治疗6周.治疗6周后,评价2组患者的临床疗效,观察2组患...     

抗中性粒细胞胞质抗体相关性血管炎的中枢神经系统受累

抗中性粒细胞胞质抗体相关性血管炎（AAV）是一类主要累及毛细血管、小动静脉的寡或无免疫复合物沉积的坏死性血管炎。中枢神经系统损害是其临床表现之一,甚至部分患者以此为首发表现。其发病机制为颅内血管炎和来源于颅内或邻近组织的炎性肉芽组织压迫。中枢神经系统受累表现形式多样,常见症状为头痛,可累及脑血管、脑膜、垂体、下丘脑、脊...     

126例新型冠状病毒肺炎患者的心肌损伤标志物及心电图分析

目的 分析新型冠状病毒肺炎（COVID-19）患者的心肌损伤标志物及心电图特点，探讨新型冠状病毒感染对心脏的影响。方法 收集2020年1月10日至3月3日，武汉大学中南医院收治的126例新型冠状病毒肺炎患者临床资料，根据疾病严重程度将其分为轻型组、普通型组、重型组及危重型组，分析各组心肌损伤标志物及心电图方面的特点。结果 总共有126例确诊为新型冠状病毒肺炎的患者纳入此研究，平均年龄为（57.2±15.2）岁，47.6%为男性，其中重型及危重型组年龄较轻型和普通型组大［（62.3±17.0）岁比（55.0±14.0）岁］（P<0.05）。重型及危重型组的患者合并更多高血压、冠心病、慢性阻塞性肺疾病等慢性基础疾病（P<0.05）。与轻型及普通型患者相比，重型及危重型患者的肌钙蛋白I （cTNI）、肌酸激酶同工酶（CK-MB）、脑钠肽（BNP）均显著增高（P<0.05）。在心电图异常率分析中，重型及危重型患者比轻型和普通型组更容易出现各种心律失常（P<0.05）。患者的异常心电图中出现频率较高的为ST段压低（17.5%）、T波异常（14.3%）及窦性心动过速（11.1%）。不同组别的异常心电图比较，在ST段压低、窦性心动过速及心房颤动方面差异有统计学意义（P<0.05）。结论 COVID-19患者合并心血管基础疾病可能会加速肺炎病情的发展，重型和危重型患者更容易出现心肌损伤、心律失常及心衰。     

糖耐量减低者的冠状动脉病变特点及相关因素分析

目的 研究糖耐量减低(IGT)者的冠状动脉病变特点.方法 根据糖耐量(OGTT)结果 将疑似缺血性胸痛的住院患者490例分为IGT组(161例)、2型糖尿病(T2DM)组(159例)、糖耐量正常(NGT)组(170例),检测3组血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和高敏C反应蛋白(hs-CRP)含量,计算BMI,记录一般临床资料(包括性别、年龄、吸烟史、高血压病史),分析3组的冠状动脉造影(CAG)结果 和冠状动脉Gensini评分情况.结果 (1)T2DM组、IGT组血清TG[(2.41±1.70)mmol/L和(2.26±1.20)mmol/L]均明显高于NGT组[(1.95±1.14)mmol/L],差异有统计学意义(t=0.4610,0.3124,P<0.01,<0.05),但IGT组和T2DM组间TG水平比较差异无统计学意义(P>0.05);3组间TC、HDL-C、LDL-C差异无统计学意义(P均>0.05).(2)T2DM组和IGT组血清hs-CRP[(2.38±1.76)ms/L和(2.33±2.03)ms/L]均明显高于NGT组[(1.54±1.32)mg/L,t=0.8391,0.7815,P均<0.01],而T2DM组与IGT组比较差异无统计学意义(P>O.05).(3)IGT组和T2DM组的BMI[(25.50±3.04)kg/m2和(26.09±2.86)kg/m2]均明显高于NGT组[(24.70±3.27)kg/m2],差异均有统计学意义(t=0.8063,1.3947,P<0.05,<0.01),但T2DM组与IGT组比较差异无统计学意义(P>0.05).(4)单支冠状动脉病变发生率NGT组为44.7%,明显高于IGT组(23.6%)和T2DM组(18.9%)(x2=16.310,25.116,P均<0.05),但IGT组和T2DM组间差异无统计学意义(P>0.05);T2DM组、IGT组2支血管病变发生率分别为37.1%和39.8%,均明显高于NGT组(23.5%)(x2=7.200,10.099,P均<0.05),而IGT组和T2DM组间差异无统计学意义(P>0.05);3支冠状动脉病变发生率IGT组和T2DM组分别为33.5%和40.9%,均明显高于NGT组(20.O%)(x2=7.767,17.028,P均<0.05),IGT组和T2DM组间差异无统计学意义(P>0.05).(5)次全或完全闭塞发生率T2DM组和IGT组分别为22.6%和18.0%,均高于NGT组(7.6%)(x2=14.573,8.019,P均<0.05),而IGT组和T2DM组间差异无统计学意义(P>0.05);IGT组和T2DM组血管弥漫性病变发生率分别为24.8%和30.8%,均高于NGT组(12.4%)(x2=8.583,16.724,P均<0.05),但IGT组和T2DM组间差异无统计学意义(P>0.05).(6)Gensini评分IGT组和T2DM组分别为(55.05±22.99)和(56.15±24.87),较NGT组(38.03±17.38)明显升高,其差异有统计学意义(t=17.0142,18.1186,P均<0.01),IGT组与T2DM组间比较差异无统计学意义(P>0.05).结论 IGT患者2支及3支冠状动脉病变发生率明显升高,次全或完全闭塞及弥漫性病变发生率也明显高于NGT者,与糖尿病患者冠状动脉病变特点相似,提示IGT与冠状动脉病变严重程度密切相关,临床工作中应高度重视此类患者.

Abstract：

Objective To investigate the characteristics of coronary's pathological changes in patients with impaired glucose tolerance. Methods Four-hundred and ninety patients who were suspected with ischemic chest pain were divided into three groups according to their OGTT results: (1) IGT group: n = 161,(2) 12DM group:n = 159, (3) NGT group: n = 170. Serum levels of triglyceride (TG) , total cholesterol (TC) , highdensity lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) and high sensitive Creactive protein (hs-CRP) were detected, their body mass indexes (BMI) were calculated. General clinical information (including gender, age, history of smoking, history of hypertension) were collected. All the CAG results were analyzed and Gensini scores were assessed as well. Results The TG levels in the T2DM group and IGT group ([2. 41 ± 1.70] mmol/L and [2. 26 ± 1. 20] mmol/L) were significantly higher than that of the NGT group (1.95 ± 1.14) mmol/L, the differences were significant (t=0.4610,0.3124, P<0. 01 and 0.05,respectively),whereas there was no significant difference between the IGT group and T2DM group (P >0.05);No significant difference was found among the three groups about TC, HDL-C, LDL-C levels (either P > 0.05). The levels of hs-CRP in T2DM group ([2. 38 ± 1. 76] mg/L and IGT group [2. 33 ± 2. 03] mg/L) were higher compared with the NGT group ([1. 54 ± 1. 32] mg/L), the differences were significant (t = 0. 8391,0. 7815, Ps < 0. 01), whereas there was no significant difference between the IGT group and T2 DM group (P >0.05). BMIs of the IGT group ([25.50 ± 3.04]kg/m2) and T2DM group ([26.09 ± 2.86]kg/m2) were higher than that of the NGT group ([24. 70 ± 3. 27] kg/m2), the differences were significant (t = 0. 8063,1. 3947, P<0. 05 and <0.01, respectively),whereas no significant difference was found between the T2DM group and IGT group (P > 0. 05). The incidence of single coronary pathological changes was 44.7% in the NGT group,it was higher than that of the IGT group (23. 6%) and T2DM group (18. 9%) (x2 = 16. 310,25. 116,Ps < 0. 05), whereas there was no significant difference between the IGT group' and T2DM group (P > 0. 05);The incidences of 2 branches pathological changes in the T2DM group (37. 1%) and IGT group (39. 8%) were higher compared with NGT group (23. 5%) ,the differences were significant (x2 =1. 200,10. 099,Ps <0. 05),whereas there was no significant difference between the IGT group and T2DM group (P >0. 05) ;The incidences of 3 vessels pathological changes in the T2DM group (40.9%) and IGT group (33. 5%) were higher than that of the NGT group (20. 0%) , the differences were significant (x2 = 7. 767,17. 028, Ps < 0.05), there was no significant difference between the IGT group and T2DM group (P > 0. 05). The incidence of subtotal or total occlusion of the T2DM group and IGT group were 22. 6% and 18.0% respectively,both were higher than that of the NGT group(7. 6%) (x2 = 14. 573,8. 019 ,Pa < 0.05) , whereas no significant difference was found between the T2DM group and IGT group (P > 0. 05). The incidences of vascular diffusing pathological change in the IGT group (24. 8%) and T2DM group (30. 8%) were higher compared with the NGT group (12.4%) (x2 =8.583,16.724, Ps < 0.05), whereas there was no significant difference between the IGT group and T2DM group (P >0.05). The Gensini scores in the IGT group (55. 05 ± 22. 99) and T2DM group(56. 15 ± 24. 87) were significnatly higher than that of the NGT group (38. 03 ± 17. 38), the differences were significant ((t =17.0142,18. 1186,Ps <0.01),whereas there was no significant difference between the IGT group and T2DM group (P>0.05). Conclusion The incidences of 2 and 3 vessels pathological changes increase significantly in patients with IGT. Moreover, the incidences of occlusion and diffuse stenosis increase significantly. This is similar to the coronary artery pathological charactersitics in patients with diabetes, which indicates that IGT is closely related to the pathological severity of coronary artery. We should pay much attention to those patients with IGT in the clinical work.     

原发性肺淋巴瘤临床特点分析

回顾性分析1999年1月至2009年12月经病理学证实的13例原发性肺淋巴瘤患者的临床资料.其中8例为黏膜相关性淋巴组织来源的边缘带淋巴瘤,2例为弥漫大B细胞型非霍奇金淋巴瘤,1例为NK/T细胞型非霍奇金淋巴瘤,1例为结节硬化型霍奇金淋巴瘤,1例为淋巴细胞为主型霍奇金淋巴瘤.临床症状多表现为咳嗽、发热、盗汗或体重减轻,2例无症状.CT检查多表现为肺内肿块,实变影中常见支气管充气征.5年总生存率9/13,其中黏膜相关性淋巴组织来源的边缘带淋巴瘤型的5年生存率7/8.