前列腺癌新辅助治疗临床分析（附32例报告）

目的 总结32例前列腺癌患者新辅助治疗（NHT）的作用。方法 32例前列腺癌患者中药物去势17例，手术去势15例，并联合抗雄激素治疗3个月，统计NHT前后前列腺癌体积、肿瘤大小、PSA、FSH、LH和睾酮水平变化。结果 2组NHT后前列腺体积明显变小、肿瘤变小、变软，甚至消失，PSA和睾酮明显下降，药物去势组睾酮水平在耻骨后前列腺癌根治术（RRP）术后2～3个月可恢复正常，而手术去势组RRP术后睾酮呈持续低水平。结论 NHT可明显缩小前列腺体积，降低PSA，有利于手术操作。药物去势对内分泌影响是可逆的，而手术去势内分泌改变不可逆。     

铜绿假单胞菌高活性β内酰胺酶检测及其耐药性分析

目的:研究临床分离铜绿假单胞菌(PA)持续高产AmpC酶和超广谱β内酰胺酶(ESBLs)的发生率及对耐药性的影响。方法:用改良三维试验法检验持续高产AmpC酶和ESBLs,用K—B法检测细菌耐药性。结果:我院2001年3月-2002年10月临床分离241株PA中,产生高活性β内酰胺酶共83株,检出率为34.4％,其中高产AmpC酶28株(11.6％),产ESBLs69株(28.6％),ESBLs与高产AmpC酶均阳性21株(8.7％),非AmpC酶、非ESBLs 7株(2.9％)。83株产酶PA主要分离自痰液(56株,67.5％)和烧伤创面分泌物(23株,27.7％)。易感人群以重症肺炎(34例,41.0%)、烧伤(23例,27.7 %)和肿瘤患者(10例,12.0%)为主。产酶株呈多重耐药性,对亚胺培南耐药率为10.8％,对受试的其他11种抗菌药物耐药率在49.4％～86.7％;除亚胺培南外,产酶株耐药率均明显高于非产酶株(X2≥16.1,P<0.005)。结论:我院PA临床株产ESBLs为主(约28.6％),其次是持续高产AmpC酶(约11.6％)。产酶株主要分离自重症肺炎、烧伤和肿瘤患者,其耐药率高,治疗用药应参考药敏试验结果。     

应用MRCP对63例肝移植术后胆道并发症的临床分析

目的评价MRCP在诊断原位肝移植术后胆道并发症中的临床应用价值。方法分析63例肝移植术后怀疑有胆道并发症患者的MRCP图像,并与手术、胆道造影、临床随访证实结果进行对照。所有病例均在高场强1.5T磁共振上进行。MRCP采用两种不同的成像方法:厚层块T2加权成像和薄层块多层T2加权成像。结果MRCP诊断移植术后胆道并发症的敏感性为95.3%(41/43),阳性预测值97.6(41/42),假阴性率为4.54%(2/44),假阳性率为2.27%(1/44)。总诊断准确率为95.2%(60/63)。MRCP作为唯一的诊断方法能为96.8%(61/63)的患者提供特异性诊断结果,仅2例患者需要ERCP和PTHC检查3.2%(2/63)。直接胆道造影作为一项治疗手段应用于22.2%(14/63)的患者中。结论MRCP是评价肝移植术后胆道并发症的有效影像学方法。     

PCR-ELISA检测弓形虫实验研究

目的建立快速、敏感、特异、稳定的PCR—ELISA方法，并用其检测感染动物体内的弓形虫。方法将生物素标记的PCR产物与地高辛标记的特异性探针杂交，再通过酶免显色反应测出OD值。以判断弓形虫感染情况。测定该方法的敏感性、特异性及稳定性。再分别以10^4、10^3弓形虫RH株速殖子腹腔接种小鼠。取全血、肝组织用PCR—ELISA检测小鼠感染情况。结果本实验中，PCR-ELISA方法的检测闻值为20fg弓形虫DNA，其灵敏度是电泳法的10倍，并且与人、小鼠、疟原虫、旋毛虫等DNA均无交叉反应。同一样本重复测试5次，结果经统计学检验，一致性良好（Alpha=0．72）。检测感染动物肝组织及全血标本，10^4、10^3组分别在感染后第二d、第三d即可测出阳性，两种标本的阳性检出效率无统计学差异（P〉0．05）。结论PCR—ELISA是一种快速、敏感、特异、稳定的检测方法，可试用于临床弓形虫病的诊断及流行病学调查。     

胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

血清瘦素在男生青春发育期的动态观察

目的 探讨血清瘦素在男生青春期发育中的作用。方法 健康男生170名，调查首次遗精时间，测定血清瘦素、睾酮、促卵泡成熟激素、黄体生成激素水平，采用多元Logistic回归模型分析男生青春期发育的影响因素；同时，连续两年观察，分析血清瘦素在青春期的动态变化。结果 末次研究已遗精组血清瘦素、睾酮、促卵泡成熟激素、黄体生成激素水平均明显高于未遗精组。多因素分析显示血清瘦素、睾酮、促卵泡成熟激素、体重为男生青春期发育的独立影响因素。初次资料分析，遗精前组血清瘦素、睾酮明显高于未遗精组。结论 血清瘦素、睾酮、促卵泡成熟激素、体重为男生青春期发育的独立影响因素，男生遗精前期血清瘦素、睾酮已有明显改变。     

某社区老年人支气管哮喘流行病学调查

目的　了解社区老年人支气管哮喘的患病情况 ,为哮喘防治奠定基础。　方法　采用整群抽样 ,对南海市桂城社区 2 481名 60岁以上老年人进行哮喘的流行病学调查。　结果　确诊老年人哮喘 98例 ,患病率为 3 .95 % (男4.91%、女 2 .92 % ) ,男性高于女性 (P <0 .0 5 ) ;工业区老年人哮喘的患病率高于文化区 (患病率分别为 5 .12 %、3 .2 6% ,P<0 .0 5 ) ;有遗传家族史者 45例 ,占 45 .92 % ;78%的患者发病年龄 >14岁 ;诱发因素前 3位分别是上呼吸道感染、气候变化和刺激性气体 ;合并COPD2 5例 ,占 2 5 .5 1%。　结论　老年人哮喘是不容忽视的疾病 ,需加强对社区哮喘的管理和教育。     

NK／LAK细胞对人口腔癌耐细胞药株杀伤活性的观察

OBJECTIVE: To understand the relation between cytotoxic activity of immunologic effector cells and multidrug resistance of the tumor cells. METHODS: Continuous observation of the morphological changes and MTT colorimetry were employed to evaluate the cytotoxic activity of lymphokine-activated killer (LAK) cells and natural killer (NK) cells against multidrug-resistant (MDR) human oral carcinoma cell line-KBV200 (before and after reversal of MDR) and parental drug-sensitive cell line KB. The morphologic changes of LAK cells and the 3 target cell lines were observed continuously under inverted microscope 3 h after co-culture of LAK cells with one of three target cell lines respectively. The lysis rates of three tumor cell lines in response to co-culture with LAK or NK cells were determined using MTT colorimetry. RESULTS: In comparison with the parental drug-sensitive cell line KB, both KBV200 and its reserved cell line by verapamil (KBVV) showed earlier adherence and greater number of cells lysed by LAK. In MTT colorimetry assay, the cytotoxicity of both LAK and NK cells against the 3 cell lines was associated with the effector-to-target (E/T) cell ratio; the lysis rates of KBV200 and reversed KBV200 cells by verapamil in response to LAK and NK cells were higher than that of KB cells (P<0.05), but KBV200 and KBVV did not significantly differ (P>0.05). At the same E/T ratio, LAK cells possessed stronger cytotoxicity than NK cells against all the tumor cell lines (P<0.05). CONCLUSIONS: Immunologic effector cells possess strong cytotoxic activity against multidrug-resistant cell line KBV200. Modulation of MDR does not decrease the cytotoxic activity of the immunologic effector cells. The results of this study suggest that adoptive cell immunotherapy with immunologic effector cells may be of value in controlling the progress of MDR tumors.     

江门市区实施乙型肝炎免疫策略16年的效果评价

目的：对江门市区1986年1月1日起全面实施的乙型肝炎(乙肝)免疫策略进行效果评价。方法：运用血清流行病学调查和疫情资料对比分析，比较实施“免疫策略”前后江门市区0～15岁人群乙肝发病率和感染率变化情况和乙肝表面抗体(抗-HBs)增长情况。结果：实施“免疫策略”后16年，0～15人群的乙肝发病率由1985年的367．39／10万，降至2001年的21．10／10万，下降94．26％；HBsAg阳性率由1985年的9．17％降至2002年的0．6％，下降93．46％；乙肝病毒总感染率由1985年的35．82％降至2002年的1．20％，下降96．65％；抗-HBs阳性率由1985年的24．64％上升到2002年的93．00％，上升2．77倍。结论：江门市区现行乙肝免疫策略效果显，能有效预防和控制地区性大面积的乙肝流行与传播。经过一代人的努力，能彻底改变人口乙肝高发病率和HBV高感染率及高携带率的状况。     

腮腺血管瘤的超声诊断

腮腺血管瘤系先天性良性肿瘤或血管畸形,本文通过对12例经手术病理证实的腮腺血管瘤作一回顾性分析,探讨腮腺血管瘤的超声诊断价值。1材料与方法本组12例腮腺血管瘤,均在我院口腔科做腮腺血管瘤切除并经病理证实,年龄1~15岁,平均6岁。其中男5例,女7例。血管瘤均位于一侧腮腺区,左侧8例,右侧4例。临床表现为病人颜面不对称,局部隆起,皮肤颜色可正常或透出青紫色,肿瘤边界不清,扪之柔软,可被压缩,部分产生疼痛、面瘫等症状。术前超声均诊断为腮腺血管瘤可能性大。仪器采用西门子G50,HDI-4000彩超诊断仪,探头频率10MHz,超声检查时患者仰卧,…