多重聚合酶链反应检测生殖支原体感染

目的建立一种敏感快速的多重聚合酶链反应（ＰＣＲ）用于检测生殖支原体（Ｍｇ）。方法性病门诊患者５１１例，正常对照５６人。分泌物（女性为宫颈、男性为尿道拭子）标本用ＮＰ－４０裂解液一步法制备模板ＤＮＡ。设计Ｍｇ种属特异性引物及功能性结蛋白基因引物，先进行标准株的特异性与敏感性试验，然后进行临床标本的ＰＣＲ扩增反应。结果两对引物有良好的特异性，对Ｍｇ标准株模板敏感性可达１０－６μｇ。临床标本检测，广东地区２６１例性病门诊患者的Ｍｇ－ＤＮＡ阳性率（５４／２６１，２０．７％）高于上海（９／８４，１０．７％）、常州（８／７０，１１．４％）及南京地区（１１／９６，１１．５％；χ２＝１６．１，Ｐ＜０．０１），后三者的感染率互相间比较，差异无显著性（χ２＝０．０５６，Ｐ＞０．０５）。性病门诊患者５１１例的Ｍｇ－ＤＮＡ总阳性率（８２／５１１，１６．１％）与５６例正常对照者（１／５６，１．８％）比较，差异有非常显著性（χ２＝７．８８２，Ｐ＜０．０１）。结论建立的ＰＣＲ技术检测Ｍｇ具有敏感、快速、特异的特点，是一种可靠的实验诊断手段。     

The role of technetium-99m-labeled octreotide acetate scintigraphy in suspected breast cancer and correlates with expression of SSTR

PURPOSE: To evaluate the value of (99m)Tc-octreotide acetate (hereafter, (99m)Tc-octreotide) somatostatin receptor (SSTR) scintigraphy in the detection of primary breast cancer and to correlate with expression of SSTRs. MATERIALS AND METHODS: Fifty-four female and 1 male patients (range, 17-77 years; mean age, 48 years) with palpable breast lesion were included in this study. (99m)Tc-octreotide and (99m)Tc-MIBI scintigraphy were undertaken in all patients, and the region of interest was drawn around each lesion. Tumor uptake was measured and expressed as the ratio of tumor to normal tissue activity (T/NT). Final clinical diagnosis was confirmed by histopathological analysis. Expression of SSTR1-5 mRNA was measured with RT-PCR in 15 patients with malignant neoplasm, and protein level of SSTR-2 and SSTR-5 was measured using immunohistochemical staining in 15 patients with malignant neoplasm and 18 patients with benign lesion. RESULTS: Thirty-five patients were confirmed to have infiltrative ductal breast carcinoma, 1 patient with cellular cancer, 1 patient with adenocarcinoma and 18 patients had benign lesions. The sensitivity, specificity, positive predictive value and negative predictive value of (99m)Tc-octreotide in detection of primary lesion were 91.8%, 22.2%, 71.8% and 57.1%, respectively. No significant correlation was observed between T/NT of (99m)Tc-octreotide and (99m)Tc-MIBI. SSTR mRNA subtypes were variably expressed. SSTR3 was the most highly expressed, followed by SSTR1, SSTR2 and SSTR5; SSTR4 was the least expressed in the level of mRNA of SSTR. Significant correlation was shown between T/NT and the expression of SSTR2 mRNA (r=0.73, P<.01). CONCLUSION: (99m)Tc-octreotide acetate scintigraphy was sensitive for the detection of primary lesion of breast cancer; however, nonspecific breast tissue uptake hampered the specificity and clinical value in the detection of lymph node metastasis. Five subtypes of SSTR mRNA and protein SSTR2 and SSTR5 were expressed variably in breast cancer due to tumor heterogeneity. (99m)Tc-octreotide imaging may hold promise in the evaluation of the level of SSTR2 in vivo.     

老年肺炎发病危险因素的研究进展

肺炎是老年人最常见的感染性疾病之一,严重影响老年人的生活质量和寿命,是老年COPD及肺癌死亡的主要诱因,是住院患者的主要并发症,而且病死率高。老年人基础疾病多,抵抗力差,肺炎的表现也不典型,可能没有明显的咳嗽、咳痰,甚至开始表现为消化、神经症状;脏器老化,对抗生素耐药,治疗时需特别注意监测肝肾功能。老年肺炎危害性大、治疗复杂。本文旨在对老年肺炎发病的危险因素进行综述,让大家更好地预防老年肺炎。     

冠心病患者血浆氧化修饰低密度脂蛋白、内皮素和α-颗粒膜蛋白水平变化的研究

通过对１０１ 例冠心病患者血浆氧化修饰低密度脂蛋白（ＯＸ－ ＬＤＬ） ,血浆内皮素（ＥＴ）和血小板α－ 颗粒膜蛋白（ＧＭＰ－ １４０） 水平变化的研究, 探讨动脉粥样硬化（ＡＳ） 形成的机制, 为冠心病的预防、早期诊断、治疗提供理论依据。采用抗ＯＸ－ ＬＤＬ单克隆抗体, 酶标多克隆抗体夹心和放射免疫分析的方法, 对血浆中ＯＸ－ ＬＤＬ、ＥＴ、ＧＭＰ－ １４０ 水平进行分析。结果显示除隐匿型外, 对照组与冠心病组之间的比较和冠心病组各型之间的比较, 血浆中ＯＸ－ ＬＤＬ、ＥＴ、ＧＭＰ－１４０ 水平均有显著差异（ Ｐ＜ ０ ．００１ 或Ｐ＜ ０ ．０１） ;测定三项指标其波动范围及ＯＸ－ ＬＤＬ／ＥＴ、ＧＭＰ－ １４０／ＥＴ的比值分析, 前者以隐匿型和心肌梗塞型最显著（２ ．２７ ,１ ．２３）,后者以心肌梗塞和心绞痛最明显（０ ．７１ ,０ ．７５） 。由此认为： ＯＸ－ ＬＤＬ、ＥＴ　ＧＭＰ－ １４０ 参与了ＡＳ的发生发展, 为冠心病的预防,早期诊断、治疗提供了理论依据。     

X线衰减校正对SPECT断层图像质量的影响

目的:评价X线衰减校正对SPECT断层图像质量的影响.材料和方法:Jaszczak模型行常规断层显像,肺癌患者1例行99mTc-octreotide SPECT显像,对衰减校正图像(AC)和非衰减校正图像(NAC)进行对比分析.结果:AC图像较NAC图像计数明显增加,尤以中心部分显著,图像更加趋于均匀;分辨率方面,NAC图像分辨率为9.5mm,AC图像分辨率为7.9mm,对比度方面两者无显著性差异(P>0.05).结论:X线衰减校正可改善图像质量.     

脑梗死患者血清中ACA、hs-CRP和Hcy含量变化的相关性探讨

目的：通过对脑梗死患者血清中抗心磷脂抗体（ACA）、高敏C-反应蛋白（hs-CRP）、同型半胱氨酸（Hcy）含量检测,探讨脑梗死的发生机制及与其相互关系。方法：分别采用酶联免疫吸附试验（ELISA）、放射免疫分析（RIA）、时间偏振荧光化学发光分析对210例脑梗死患者和30例正常对照者血清中的ACA、hs-CRP、Hcy含量进行检测,比较脑梗死组与正常对照组间各指标的差异性,并对脑梗死患者三项指标之间（ACA、hs-CRP、Hcy）进行相关性检验。结果：脑梗死患者组血清中ACA、hs-CRP、Hcy含量与正常对照组比较有显著性差异（P〈0.001）;脑梗死患者组血清hs-CRP与Hcy水平比较呈正相关（r1=0.714）;ACA与hs-CRP和Hcy比较呈正相关（r2=0.893、r3=0.597）。结论：脑梗死患者血清ACA、hs-CRP、Hcy含量变化与其发生、发展密切相关,是发生脑梗死独立的危险因素,三项联检更有利于脑梗死的早期诊断、治疗和预后判断。     

电视胸腹腔镜下与传统开胸手术治疗食管癌的疗效对比分析

目的电视胸腹腔镜下与传统开胸手术治疗食管癌的疗效观察。方法将我院收治并确诊的116例食管癌患者随机分为两组。对照组58例采用传统开胸手术治疗,试验组58例采用电视胸腔镜手术治疗。比较两组患者手术住院等相关情况及术后并发症发生率、总生存率的差异。结果试验组患者手术时间显著大于对照组(P<0.05),但其术后引流时间、平均住院天数及手术失血量均明显低于对照组(P均<0.05);术后并发症主要为肺部感染、吻合口瘘、喉返神经损伤等,试验组患者术后并发症发生率为6.9%显著低于对照组(6.9%对20.7%,P<0.05);试验组复发或转移3例,死亡1例,总生存率为98.28%(57/58);对照组复发或转移9例,死亡2例,总生存率为96.55%(56/58);两组总生存率接近(P>0.05)。结论电视胸腹腔镜下较传统开胸手术治疗食管癌的疗效更显著。电视胸腹腔镜下手术治疗食管癌住院时间短,恢复时间快,失血量少,患者术后并发症发生率低,可促进患者术后恢复,改善生活质量。     

microSPECT/CT显像定量评价肿瘤99mTc－3P4－RGD2摄取及整合素αVβ3表达水平的实验研究

目的:探讨99mTc－HYNIC－PEG4－E[PEG4－c(RGDfk)]2(简称99mTc－3P4－RGD2)microSPECT/CT显像定量肿瘤放射性摄取及整合素αvβ3表达水平的可行性研究?方法:对不同99mTc样品进行microSPECT/CT显像,评价样品体积?活度对放射性计数的影响;对荷脑胶质瘤裸鼠行99mTc－3P4－RGD2 microSPECT/CT显像,对比基于CT?SPECT及融合图像测定的肿瘤体积与肿瘤实际体积一致性,并评价肿瘤整合素αvβ3表达水平,由病理证实?结果:99mTc样品microSPECT/CT显像放射性计数与其放射性活度呈直线相关(R2 = 0.999 7),Bland－Altman一致性分析显示,基于microSPECT/CT测定的肿瘤体积与肿瘤实际体积差异(%)为-2.48 ± 8.17,显著低于microCT(15.04 ± 79.53,t = 5.60,P = 0.005)和microSPECT(17.04 ± 36.27,t = 7.17,P = 0.002);microSPECT/CT显像肿瘤99mTc－3P－RGD2摄取与整合素αvβ3表达呈正相关?结论:microSPECT/CT显像可定量99mTc放射性活度和成活肿瘤组织体积,有效评估整合素αvβ3受体表达,为肿瘤整合素受体靶向治疗患者筛选及药物剂量个体化提供影像学数据?