李祥国治疗冠状动脉痉挛心绞痛的经验

李祥国教授对冠心病冠状动脉痉挛所致之心绞痛的治疗经验独到，强调从肝论治，辨其寒热、虚实，应用疏肝解郁、温阳舒脉及养阴清热、柔肝解痉之法，疗效显著。     

The relationship between dietary fat intake and risk of colorectal cancer: evidence from the combined analysis of 13 case-control studies

The objective of this study was to examine the effects of the intakeof dietary fat upon colorectal cancer risk in a combined analysis of datafrom 13 case-control studies previously conducted in populations withdiffering colorectal cancer rates and dietary practices. Original datarecords for 5,287 cases of colorectal cancer and 10,470 controls werecombined. Logistic regression analysis was used to estimate odds ratios (OR)for intakes of total energy, total fat and its components, and cholesterol.Positive associations with energy intake were observed for 11 of the 13studies. However, there was little, if any, evidence of anyenergy-independent effect of either total fat with ORs of 1.00, 0.95, 1.01,1.02, and 0.92 for quintiles of residuals of total fat intake (P trend =0.67) or for saturated fat with ORs of 1.00, 1.08, 1.06, 1.21, and 1.06 (Ptrend = 0.39). The analysis suggests that, among these case-control studies,there is no energy-independent association between dietary fat intake andrisk of colorectal cancer. It also suggests that simple substitution of fatby other sources of calories is unlikely to reduce meaningfully the risk ofcolorectal cancer.     

33例椎-基底动脉瘤的临床观察

目的：探讨椎－基底动脉瘤治疗方法与预后关系。材料与方法：报告３３例椎－基底动脉瘤。动脉瘤破裂致ＳＡＨ１８例，动脉瘤直径从５ｍｍ到４５ｍｍ。其中９例行保守治疗。直接手术治疗中，９例夹闭术，２例瘤壁加固术。１３例行血管内栓塞治疗。结果：９例保守治疗中３例因再次出血死亡。１１例直接手术均痊愈。１３例血管内栓塞治疗后１～３个月后复查造影，闭塞率＞８０％者１２例。结论：椎－基底动脉瘤积极手术治疗可降低死亡率，依动脉瘤部位与大小采用不同手术入路至关重要，血管内栓塞治疗适于直接手术难以达到者，疗效肯定。     

电视胸腔镜在胸部肿瘤中的应用

电视胸腔镜外科（ＶＡＴＳ）在胸部肿瘤的临床应用尚存争议。自１９９６年１０月～１９９７年８月，我科共行胸腔镜手术１６例：肺癌切除２例，纵隔肿瘤切除３例，恶性胸水行胸膜固定术２例，恶性心包积液行心包开窗术４例，常规开胸术前诊断性探查５例，初期结果较为满意。结论：ＶＡＴＳ创伤较小，安全有效。可选择性地用于胸部良恶性肿瘤的诊断和治疗。     

Sequential T Cell Response Involved in Tumor Rejection of Sarcoma, Meth A, in Syngeneic Mice

We investigated the type of T cell response involved in Meth A tumor rejection in primary immune and hyperimmune syngeneic mice. It was found that a CD4⁺ T cell-mediated delayed-type hypersensitivity (DTH) response activating non-specific killer cells such as macrophages, NK and LAK cells, without a specific CD8⁺ cytotoxic T lymphocyte (CTL) response, was the major immune response leading to Meth A tumor rejection in primary immune mice. In contrast, the specific CD8⁺ CTL response was the major response leading to the tumor rejection, in addition to CD4⁺ T cell-mediated DTH response, in hyperimmune mice. Analysis of CD4⁺ T cell clones established from primary immune and hyperimmune spleen cells indicated that a CD4⁺ T cell clone (C9) of primary immune mice (although only one clone was established) was of Th1 type, and induced cytotoxicity in accessory cells by classic DTH in vitro. Eight CD4⁺ T cell clones were established from hyperimmune spleen cells. Six out of the eight clones were of the Th2 type and two were Th0-like. However, no Th1-type CD4⁺ T cell clone was established from hyperimmune spleen cells. All of these CD4⁺ T cell clones, even the Th2-type clones, were capable of inducing cytotoxicity in vitro in T cell-depleted accessory cells, as in an in vitro DTH response. We postulate on the basis of these results that the T cell response leading to Meth A tumor rejection in vivo sequentially changed from a CD4⁺ T cell-mediated classic DTH response to a CD8⁺ CTL response, in addition to a cellular response mediated probably by Th2-type cells, during the process of repeated immunization.     

正常子宫内膜、子宫内膜增殖症及子宫内膜癌ras、HER-2/neu癌基因表达的研究

为研究ｒａｓ、ＨＥＲ－２／ｎｅｕ癌基因的表达与子宫内膜癌发生、发展的关系，本文用免疫组化ＡＢＣ法检测了２３例正常子宫内膜、４４例子宫内膜增殖症及１０３例子宫内膜癌组织中ｒａｓ、ＨＥＲ－２／ｎｅｕ癌基因的表达情况。结果表明：在子宫内膜非典型增生中即存在ｒａｓ基因的过度表达，过度表达率为２０％，子宫内膜癌ｒａｓ的过度表达率为１８．４％，且ｒａｓ的过度表达与子宫内膜癌的病理分级、分期及患者的生存率无关，说明ｒａｓ癌基因的异常表达可能与癌形成的早期有关。子宫内膜癌中ＨＥＲ－２／ｎｅｕ的过度表达率为２７．２％，ＨＥＲ－２／ｎｅｕ的过度表达与子宫内膜癌的分期无关，与分级及患者的预后有关，存在ＨＥＲ－２／ｎｅｕ过度表达者的生存率低于无过度表达者，前者的５年生存率为５４．８％，后者为７９．６％，结果提示ＨＥＲ－２／ｎｅｕ的过度表达是判断子宫内膜癌预后的生物学指标。     

癌症合并糖尿病患者应用糖皮质激素安全性的前瞻性随机对照研究

目的从循证医学的角度探讨癌症合并糖尿病的患者使用糖皮质激素(glucorticoids,GC)是否安全。方法有糖尿病史或治疗前发现糖尿病者进入糖尿病组,无糖尿病史治疗前空腹血糖高于正常但未达到糖尿病诊断标准者进入空腹血糖损害(i m-paired fasting glucose,IFG)组,通过计算机随机筛选出最适合与实验组配对者作为对照组。GC及化疗根据需要按常规选择,定期测定全部患者的静脉血糖、糖尿病患者和IFG患者的毛细血管血糖,前瞻性评价GC治疗后的血糖变化、不良反应及其影响因素。结果糖尿病组患者29例,使用GC后恶心呕吐、腹部不适、头痛、失眠、肺炎、多汗、心慌及血压升高的比例高于对照组,但均无统计学意义。接受GC治疗期间,只有1例(3%)血糖正常,28例(97%)有1次以上血糖升高,显著高于对照组,t=6·309,P=0·000。但均在可以控制且不影响肿瘤治疗及GC治疗的范围内。对照组患者有5例(17%)血糖高于正常,其中1例血糖有4次血糖高于正常。入院前未接受降糖治疗的糖尿病患者,需要改变降糖措施的比例(2/11)高于入院前已接受降糖治疗的糖尿病患者(2/18)和IFG患者(2/24),但差异无统计学意义,F=0·73,P=0·694。IFG组24例,与糖尿病组有类似的结果。入院血糖正常的220例患者中,化疗后20例空腹血糖升高(9·09%)。未化疗仅使用GC者34例,4例空腹血糖升高(11·76%),无统计学意义。但在化疗患者中,不同的化疗方案影响血糖升高的发生率。NP方案治疗后发生空腹血糖升高的比例为34·61%,高于CAF(4·76%)、FLP(4·76%)、EP(3·70%)等治疗方案。结论癌症患者伴发糖尿病及IFG的比例远高于一般人群,但常规应用GC是安全的。血糖正常患者化疗同时使用GC,个别化疗药物、年龄、地塞米松日剂量和病期影响空腹血糖升高的发生率。     

卵巢上皮性癌BRCA1和p53基因表达的临床意义及相互关系研究

目的：探讨BRCA1、p53基因蛋白在卵巢上皮性癌中的表达情况及相互关系。方法：应用S-P免疫组织化学法检测50例卵巢上皮性癌组织中BRCA1和p53蛋白的表达。采用Kaplan—Meier法分析两种蛋白表达情况与患者预后的关系。结果：1)BRCA1蛋白在卵巢癌组织中的阳性表达率仅为30％，明显低于正常卵巢组织(100％)和良性肿瘤组织(90％)(P＜0．01)；BRCA1在低分化癌、有淋巴结转移的卵巢癌组织中表达减少甚至缺失。2)p53蛋白在卵巢癌组织中的表达率为64％，而在正常卵巢及良性肿瘤组织中无表达；其表达仅与病理学分级有关。3)两种基因蛋白表达比较呈显著负相关(P＜0．01)。4)患者生存随访表明，有BRCA1表达的患者平均生存期长于无表达者；而p53对生存时间无影响。结论：BRCA1基因在转录后水平的下调对卵巢上皮性癌的发生发展有重要的作用．同时BRCA1基因与p53基因协同促进肿瘤的演进恶化。     

岩沙海葵毒素人工抗原的合成及鉴定

目的制备岩沙海葵毒素(PTX)的人工抗原和抗血清,为建立PTX的酶联免疫检测方法提供技术基础。方法用小分子succinimidyl3-(2-pyridyldithio)propionate(SPDP)将PTX巯基化成半抗原PTX-PDP,用2-iminothiolane将大分子载体蛋白质匙眼血蓝蛋白(KLH)巯基化成KLH-SH,再将PTX-PDP和KLH-SH反应合成人工抗原PTX-PDP-KLH免疫雌性6~8周龄Balb/c小鼠,进行多抗的制备。用同样的方法制备酶联免疫反应之包被抗原PTX-PDP-BSA,用于检测血清抗体效价。结果根据紫外检测图谱,PTX的最大吸收波长在264nm处,KLH及BSA的最大吸收波长在278及279nm处,而合成的人工抗原PTX-PDP-KLH和PTX-PDP-BSA的最大吸收波长分别在267和273nm处。抗血清经间接酶联免疫吸附法检测,效价达到1∶3200,且与正常Balb/c小鼠、昆明种小鼠及兔血清间无交叉反应。结论合成的人工抗原纯度高,具有较好的免疫原性。     

CYP2E1基因多态性与肿瘤易感性研究进展

90％以上的肿瘤是由各种环境因素与职业因素引起，而大部分的外源性致癌物需经过Ⅰ相和Ⅱ相代谢酶的代谢活化才与体内生物大分子作用启动致癌过程。细胞色素P450 2E1(cytochrome P450s 2E1，CYP2E1)是人体内重要的Ⅰ相代谢酶类，参与N-亚硝胺类化合物等多种前致癌物的代谢活化过程，在体内各组织器官中有不同的表达。CYP2E1活性的表达受多种因素影响，存在多种限制性片段长度多态性，与人类肿瘤易感性间存在密切关系。