肝癌患者肝移植术后肿瘤复发相关的血清蛋白质标记物筛选

Objective To appraise and compare protein expression profiles in sera of patients without or with recurrence following liver transplantation for hepatocellular carcinoma (HCC) using SELDI-TOF-MS technique,and establish the diagnostic and predictive model. Methods A total of 76 sera (41 from disease free survival patients and 35 from recurrence individuals) were collected pretransplantation and differentially expressed proteins were identified by SELDI-TOF-MS. The intensity values for each peak were analyzed by Biomarker Wizard Software to screen serum proteome biomarkers related to the recurrence post-transplantation. By using Biomarker Patterns Software, the classification trees were generate. from randomly selected samples (30 fingerprints obtained from each group). The sensitivity and specificity of best decision tree were then chosen for blind test with 16 samples (5 from recurrence individuals and 11 from recurrence-free survival patients). Results There were significant differences only in tumor size and the presence of vascular invasion between recurrence group and recurrence-free survival group (P＜0.05). According to serum protein fingerprints, a total of 368 protein peaks were identified at the mass-to-charge ratio (M/Z) value ranging from 2000 to 300 00. There were 22 significant differential proteins between two groups. Among them, 9 proteins were up-regulated and 13 proteins were down-regulated -espectively in recurrence group. The intensity values of differential proteins were input into BPS for classification tree analysis and the best performing tree could distinguish two groups successfully. As a result of blind assessment for this model,a sensitivity of 80.0 % (4/5) and specificity of 72.7 % (8/11) were obtained. Conclusion Some of differential proteins screened by SELDI-TOF-MS technique in the serum may be correlated with the prognoses of liver transplantation patients with HCC. The decision tree may be useful for the clinical application of formulating the indication for liver transplantation, detecting extrahepatic micrometastasis and setting up the diagnostic and treatment strategies.     

选择适合中国国情的肝癌肝移植适应证

我国是世界肝癌发病率最高的国家,肝癌治疗中手术切除仍是获得长期生存的最有效措施,但大部分肝癌病人就诊时已属晚期,多伴有严重的肝硬化,或呈多中心发生,能够胜任手术切除的不到10％。20世纪60年代肝移植的出现为肝癌治疗带来了新的思路。我国的国情与国外相比有很大不同,如何选择适合中国的肝癌肝移植适应证,长期以来一直存在着争论。本文回顾性分析了我院近5年来251例肝细胞癌（以下简称“肝癌”）肝移植病例,比较不同肝癌肝移植筛选标准对预后的影响,探讨了建立更适用于我国国情的肝癌肝移植新标准。     

原发性肝癌切除术后门静脉血栓形成的临床分析

目的：探讨原发性肝癌切除术后门静脉血栓形成的可能原因及防治方法。方法：回顾分析本中心2009年1月—2010年3月5例原发性肝癌切除术后门静脉血栓形成患者的临床资料,包括患者的人口统计学特征、手术方式、术后临床化验指标、相关的影像学检查结果、临床处理及预后。结果：原发性肝癌切除术后门静脉血栓形成的发生率为0.4%（5/1269）,均发生在术后1周内,以谷丙转氨酶、谷草转氨酶和乳酸脱氢酶短时间内急剧升高为初发表现。除1例门静脉右支部分血栓形成予抗凝治疗后存活;其余4例门静脉主干血栓者经抗凝治疗及肠系膜上动脉置管间接溶栓治疗无效,均于血栓形成2周内死亡。结论：门静脉血栓形成是原发性肝癌切除术后一种少见的,但却是致命的血管并发症,其确切的发病机制、有效的预防及治疗方法需重视和进一步研究。     

病毒载体在基因治疗中的应用

基因治疗是近年兴起的一种新的治疗模式,其关键之一在于使用有效的手段将目的基因准确地导入靶部位并有效、持久表达。在目前所用的基因转移技术中,病毒载体尤其引人注目。本文综述腺病毒载体、单纯疱疹病毒载体、腺相关病毒载体等病毒载体介导的基因转染的途径及其在遗传病、代谢病和肿瘤治疗中的应用。     

白细胞介素-1β促进人肝癌MHCC97-H细胞侵袭性的体外研究

肿瘤转移前存在微环境变化,炎症因子起着重要作用[1].白细胞介素-1(IL-1)在影响肿瘤微环境、促进残癌侵袭性中起重要作用[2].本研究对肝细胞癌(简称肝癌)能否分泌IL-1β以及IL-1β对肝癌侵袭性的影响及其可能机制进行了探讨.     

门静脉癌栓影像学诊断的比较

比较术前各影像学检查对门静脉癌栓诊断的敏感性和特异性。回顾性分析110例肝细胞肝癌(HCC)伴门静脉癌栓患者的术前影像学特征及诊断。以同期100例HCC不伴门静脉癌栓患者为阴性对照。US、CT和MRL／MRA诊断门静脉癌栓的敏感性分别为88%、、93％和94％,其特异性分别为95％、96％和98％。经x2检验,各影像学诊断门静脉癌栓敏感性和特异性的差异无统计学意义(P>0．05)。各影像学检查对门静脉癌栓诊断的敏感性和特异性相近。     

肝脏局灶性结节性增生60例临床分析

目的探讨肝脏局灶性结节性增生的诊断和治疗,提高对肝脏局灶性结节性增生(focalnodularhyperplasiaoftheliver,FNH)的认识。方法回顾性分析60例FNH的临床表现、影像学表现、病理学检查及外科治疗。结果我院1993—2003年共收治经病理证实的FNH60例,共72个病灶。男性41例,女性19例,平均年龄37岁。单发者55例,多发者5例。肿瘤直径小于5cm50例,5~10cm9例,大于10cm1例。术前确诊率55·0%(33/60),其中彩超确诊率33·3%(19/57),CT58·3%(28/48),MRI72·0%(18/25)。60例均获手术切除,术后恢复良好,无复发。结论CT和MRI是FNH的重要诊断方法,但部分典型FNH及所有的非典型FNH术前很难做出明确诊断。对有临床症状或诊断不明确的病例应行手术切除。